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Depression and Chronic Pain


Updated September 24, 2009

It is no secret that there is a link between chronic pain and depression, something that can be frustrating during the diagnosis stage. In fact, depression is often one of the first conditions that doctors try to rule out when diagnosing chronic pain.

Though it is possible to be in pain without ever becoming depressed, it is very likely that if you suffer from chronic pain, you will also battle depression at some point in your life.

Depression and Chronic Pain Are Closely Related

As many as 50% of people who suffer from chronic pain also have recurrent clinical depression. Clinical depression is more than a feeling of sadness or low mood: it is a psychological state that causes fatigue, lack of motivation, appetite changes, slowed response time and feelings of helplessness. Depression has physical symptoms as well, including aches, pains and difficulty sleeping. Sound familiar?

Depression is more than a side effect of chronic pain: the two diagnoses are often so interwoven so that they can be difficult to separate. People who are depressed and people with chronic pain tend to be less active than those who are healthy, because their minds and bodies cause them to slow down. When the two combine, it can be hard to tell where one ends and the other begins. It can be even harder to figure out which one to treat first.

Stress Can Lead To Depression

Pain activates the areas of the brain that respond to stress. This is one of the body’s coping strategies for dealing with acute pain. When the brain gets the signal, the brain reacts by sending the body into overdrive, to prepare for fight or flight. When the pain goes away the signals are supposed to stop.

With chronic pain, the fight or flight signals don’t turn off, and the nervous system stays in a constant state of high alert. The body does not get a break from the brain’s stress chemicals. Too much stress without time off eventually wears the body down, which can leave you vulnerable to depression.

Constant pain can also affect your mood. Being in pain is difficult, and often keeps you from doing many of the things in life that you enjoy such as playing with your children or working in the garden. Not feeling happy with your quality of life is often an emotional drain. With few outlets available for stress relief, it is easy to fall into a downward spiral that leads to depression.

Using Antidepressants To Treat Chronic Pain

Even if you are not feeling low in mood, your doctor may prescribe a low-dose antidepressant to treat your chronic pain symptoms. While this may seem strange, the use of antidepressants for pain control is scientifically based and has been going on since the 1960’s. Even at low doses, these medications cause chemical changes in the brain that alter the way pain is perceived.

Another reason antidepressants are commonly used to treat chronic pain is that they can stop the cycle that leads to depression before it begins, or at least provide a running start. Depression can intensify feelings of pain, leading to a lower activity level and quality of life, which in turn intensifies the feelings of depression. It is easy for this cycle to begin, and even easier for it to spin out of control.

Catching depression before it begins or in its early stages can help you get part of your life back. Early treatment of chronic pain with the right antidepressant can help fight this downward spiral.

Antidepressants commonly used to treat chronic pain:

  • Tricyclic antidepressants, or TCAs, increase the body’s production of serotonin and norepinepherine. Because of this, they have both an analgesic and sedative effect. In plain English, tricyclic antidepressants reduce the number of pain sensations that reach the brain, and encourage a more relaxed state in the mind and the body. Amitriptyline, generic for Elavil, is one of the most commonly used trycyclic antidepressants for chronic pain.
  • Monoamine Oxidase Inhibitors, or MAOIs, increase the amount of norepinepherine and serotonin in the brain, like TCAs. They also increase the amount of dopamine present, a chemical which is associated with pleasure sensations. Phenelzine, generic for Nardil, is a commonly prescribed MAOI.
  • Selective Serotonin Reuptake Inhibitors, or SSRIs, work primarily on serotonin as their name suggest. Because they do not have the same sedative effect as the other classes, they are thought to be less effective in pain control. However, they tend to have fewer side effects, making them more tolerable for some people. A common SSRI is Paxil, which is the name brand for the generic paroxetine.
  • Serotonin and Norepinepherine Reuptake Inhibitors, or SNRIs, work much like TCAs though on a more selective scale. So far, there is not enough evidence to determine whether SNRIs are more effective than TCAs in pain control, but they certainly have fewer side effects. Venlafaxine, or Effexor, is a commonly used SNRI.
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