Understanding the Effects of Pain and Depression
When you have a great deal of pain, depression is often not far away. Conversely, the very presence of depression can cause you to have aches and pains that may have no other known cause. To make matters worse, medications taken for pain, such as opiates, can relieve symptoms of depression due to the manipulation of neurotransmitters in the brain. Although this doesn’t sound like a bad thing necessarily, it can lead to dependence as the patient uses the drug, not for pain but to treat the depression.
That’s why it is vitally important to diagnose cases of depression before medicating pain properly. If medications, such as SSRIs, control the depression, a patient will be less likely to use opiates to self-medicate. Knowing what depression is, how it interfaces with pain, and breaking the cycle can help eliminate dependence on pain medications due to mood problems.
Defining Depression
Constant pain causes an emotional state of constant stress. You worry that your pain won’t go away, that the medications won’t work, or that you won’t be able to function with the pain that is driving your need for medications. Symptoms of uncomplicated depression without pain can include hopelessness, feelings of guilt, and suicidal ideation. However, with the added pressure of pain, the signs are subtler to diagnose.
Pain patients with depression may exhibit an altered mood, such as chronic sadness, helplessness, hopelessness, and thoughts of hurting themselves, but they are not always present. Constant anxiety is often seen in this type of depression, and anger, justified or unjustified, is another mood that may present. The patient may feel a lack of self-esteem, fatigue, irritability, and isolation. Financial, legal, and family issues are often present with depression, and loss of muscle tone, sleep disturbances, and lack of interest in sex are other common manifestations.
How Depression Causes Pain
Pain and depression are often seen together because they share some of the same biologies. For instance, depression and pain are regulated by some of the same neurotransmitters in the brain. This is why SSRI medications that affect the neurotransmitter serotonin are now showing some evidence for treating chronic pain. Besides, pain and depression use some of the same neural pathways, and one can actually activate another.
Depression can magnify the pain, making it seem worse than it really is. It also keeps you from pursuing coping skills that would help with both conditions. Meditation is a standard alternative treatment for both conditions, but untreated depression can lead you to abandon these activities as useless. This will make the pain worse because you aren’t using a treatment to lessen your pain. Research has shown that those who have depression and pain experience more pain, have more deficient coping skills, and feel less in control of their lives.
Available Treatments for Pain and Depression
Treating pain often decreases depression, and treating depression usually reduces pain. For this reason, it is important to get a definitive diagnosis of your depressive symptoms. It is easier for some people to admit they are in pain than that they are depressed. If you feel sad, hopeless, and isolated, these feelings will only make your pain worse. What’s more, depression is treatable through a host of non-opiate medications that can make you feel better.
The first type of drug for depression is the SSRIs, such as Prozac and Lexapro. These are the drugs that most people are familiar with for dealing with depression. They have shown some promise for treating chronic pain, but not as promising as SNRIs. These medications, such as Cymbalta, help increase the brain’s neurotransmitter norepinephrine. They are the first antidepressant medications that the FDA approved for chronic pain. Older drugs, such as tricyclic antidepressants, are also being studied for their chronic pain use. The newer medications are often used, though, due to this class of drugs’ side effects.
If you have chronic pain and also suffer from depression, it is important to get a professional to diagnose, since one can easily be mistaken for another, and you may seek to self-medicate with opiates to treat both conditions. This can lead to dependence and is not recommended. Only by treating the depression with the proper medications and therapy can you gain control of your life again.
