By Lana Barhum, Columnist
There are nearly 40 million American adults living with severe or significant chronic pain, according to the National Institutes of Health. Chronic pain affects more people than cancer, diabetes and heart disease combined.
Chronic pain is devastating and can be a challenge to treat. Pain also causes depression and depression leads to decreased function, poor treatment outcomes and further healthcare costs. About half of people with chronic pain are also depressed, according to a recent study in the Journal of Affective Disorders.
"The dual burden of chronic physical conditions and mood and anxiety disorders is a significant and growing problem," wrote senior author Silvia Martins, MD, associate professor of Epidemiology at the Mailman School of Public Health.
Pain experiences are different for each person and your response to chronic pain depends on how you feel pain, and thoughts and behaviors related to your underlying pain conditions.
When pain invades every aspect of your life and leaves you uncertain of the future, anxiety, sadness, anger and grief are imminent. For many, the burden is so difficult, it leads to major depressive disorder, also known as clinical depression.
Research shows the highest rates of clinical depression are in people with fibromyalgia. According to a study in Pain Research and Treatment, people with fibromyalgia have a 90% chance for depressed symptoms and up to 86% risk for major depressive disorder.
What is Clinical Depression?
Clinical depression is more complicated than dealing with sadness and grief. This type of depression leaves you unable to focus on work, get good quality sleep, eat well, or enjoy time with friends and loved ones. Some people experience clinical depression once, but many have experienced it several times during their life.
Some symptoms of clinical depression are:
- Fatigue and loss of energy
- Feelings of guilt and worthlessness
- Struggles with concentration and decision making
- Sleep problems, including insomnia or excessive sleeping
- Disinterest in almost all activities
- Constant thoughts of dying and suicide
- Significant weight loss or gain
My Experience with Clinical Depression
Depression has been a frequent visitor to my chronically painful life, but the first time I was formally diagnosed with clinical depression was 2011. It had been 3 years since I was diagnosed with rheumatoid arthritis and fibromyalgia, two painful and life-altering conditions. Not only was pain dominating my life, there was so much more happening because of pain, that I couldn’t handle it all.
I knew I was struggling, but I didn’t know the extent. I was crying for no reason, not sleeping, and my mind was constantly racing. And I thought about death – not contemplating suicide but that death had to be better than living with real physical and emotional pain.
It was my rheumatologist who recognized the extent of my depression, prescribed an anti-depressant and referred me to a therapist. Talk therapy helped me better handle my feelings about living with pain and other obstacles, and the medication managed the chemical part of depression. Eventually and with time, I found some clarity.
There have been other times in more than nine years of living with illness and pain that depression has gotten its clutches on me. But it was not until last summer that I had another episode of clinical depression. I unexpectedly lost my mother in late August and that loss shook me to my very core and brought back my old friend depression with it.
Preventing Recurrent Depression
Anyone who has suffered from at least one episode of depression is at risk for another, and the risk is higher in people who have been diagnosed with clinical depression. According to a 2104 report from the University Medical Center Groningen in The Netherlands, recurrent depression is more common in people who live with pain.
The best way to treat and prevent recurrent depression, according to a discussion in the Primary Care Companion to The Journal of Clinical Psychiatry, is through maintenance therapy that includes talk therapy and medication, and where medication is decreased as the depression lessens.
Depression does not have to last forever and it doesn’t have to consume your life. But when you are dealing with the sadness, anger, grief and pain, relief seems unimaginable. My experience with clinical recurrent depression and pain has taught me that there is always hope. It won’t be easy, but it’s not impossible.
If you want to manage your depression and prevent it from coming back, it is important to take a proactive approach. Here’s how:
Early Recognition. If you have been clinically depressed before, you know that depression comes and goes. If you find you are feeling exhausted, hopeless, distressed and struggling to be productive daily, reach out to your doctor or therapist to find ways to keep symptoms from worsening.
Learn Your Triggers. For most of us, pain is a stressor and increases the chance being depressed. But depressed feelings and anxiety also worsen pain. Therefore, it’s important to focus on minimizing things that exacerbate pain.
Communication. Many people with chronic pain do not reach out to their doctors because they don’t think there is anything that can be done or they feel that if their pain levels are managed, then their depression will go away. But depression doesn’t just go away and it only worsens your pain levels. Getting treatment is the only way to a full recovery and to prevent depression from returning.
Please know you are not alone. There are millions of people with chronic pain and clinical recurrent depression. Reach out and seek support, whether it is online, in a local community support group or from others – a pastor, a mental health professional, a friend or loved one. Your mental health is just as important as your physical and it is important to treat it as such.
Lana Barhum lives in northeast Ohio. She is a freelance medical writer, patient advocate, legal assistant, and mother. Having lived with rheumatoid arthritis and fibromyalgia since 2008, Lana uses her experiences to share expert advice on living successfully with chronic illness. She has written for several online health communities, including Alliance Health, Upwell, Mango Health, and The Mighty.
To learn more about Lana, visit her website.
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.