Severe Depression & Chronic Pain

Major depression is a mental health condition. It is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with daily life for weeks or longer. This info comes from WebMD.  Mental health conditions can lead to future health concerns if you don’t get those thoughts in check.  Law of Attraction:  if you bring negative thoughts into your life they will inevitably happen. So silence those thoughts… in redemption to get on with your life? Is so much easier to find love with loving thoughts!!

Causes

Doctors do not know the exact causes of depression. It is believed that chemical changes in the brain are responsible. This may be due to a problem with your genes. Or it may be triggered by certain stressful events. More likely, it is a combination of both.

Some types of depression run in families. Other types occur, even if you have no family history of the illness. Anyone can develop depression, even children and teens.

Depression may be brought on by:

  • Alcohol or drug abuse
  • Certain medical conditions, including underactive thyroid, cancer, or long-term pain
  • Certain medicines, such as steroids
  • Sleeping problems
  • Stressful life events, such as death or illness of someone close to you, divorce, childhood abuse or neglect, loneliness (common in the elderly), relationship breakup

Symptoms

Depression can change or distort the way you see yourself, your life, and those around you.

With depression, you often see everything in a negative way. It is hard for you to imagine that a problem or situation can be solved in a positive way.

Symptoms of depression can include:

  • Agitation, restlessness, and irritability, anger
  • Becoming withdrawn or isolated
  • Fatigue and lack of energy
  • Feeling hopeless and helpless, worthless, guilty, self-hate
  • Loss of interest or pleasure in activities that were once enjoyed
  • Sudden change in appetite, often with weight gain or loss
  • Thoughts of death or suicide
  • Trouble concentrating
  • Trouble sleeping or sleeping too much

Depression in teens may be harder to recognize. Problems with school, behavior, or alcohol or drug use can all be signs.

If depression is very severe, you may have hallucinations and delusions (false beliefs). This condition is called depression with psychotic features.

Exams and Tests

Your health care provider will ask about your medical history and symptoms. Your answers can help your doctor diagnose depression and determine how severe it may be.

Blood and urine tests may be done to rule out other medical conditions that have symptoms similar to depression.

Treatment

Depression can be treated. Treatment includes medicines, talk therapy, or both.

If you are thinking about suicide or are very depressed and cannot function, you may need to be treated in a hospital.

After you have been on treatment, if you feel your symptoms are getting worse, talk with your doctor. Your treatment plan may need to be changed.

MEDICINES

Antidepressants are medicines used to treat depression. They work by bringing back the chemicals in your brain to the right levels. This helps relieve your symptoms.

If you have delusions or hallucinations, your health care provider may prescribe additional medicines.

Tell your provider about any other medicines you take. Some medicines can change the way antidepressants work in your body.

Allow your medicine time to work. It may take a few weeks before you feel better. Keep taking your medicine as instructed. Do not stop taking it or change the amount (dosage) you are taking without talking to your provider. Ask your doctor about possible side effects, and what to do if you have any.

If you feel your medicine is not working, tell your provider. The medicine or its dosage may need to be changed. Do not stop taking medicines on your own.

WARNING: Children, teens, and young adults should be watched closely for suicidal behavior. This is especially true during the first few months after starting medicines for depression.

Women being treated for depression who are pregnant or thinking about becoming pregnant should not stop taking antidepressants without first talking to their provider.

Beware of natural remedies such as St. John’s wort. This is an herb sold without a prescription. It may help some people with mild depression. But it can change the way other medicines work in your body, including antidepressants. Talk to your health care provider before trying this herb.

TALK THERAPY

Talk therapy is counseling to talk about your feelings and thoughts, and help you learn how to deal with them.

Types of talk therapy include:

  • Cognitive behavioral therapy teaches you how to fight off negative thoughts. You learn how to become more aware of your symptoms and how to spot things that make your depression worse. You are also taught problem-solving skills.
  • Psychotherapy can help you understand the issues that may be behind your thoughts and feelings.
  • At group therapy, you share with others who have problems like yours. Your therapist or doctor can tell you more about group therapy.

OTHER TREATMENTS FOR DEPRESSION

  • Electroconvulsive therapy (ECT) may improve mood in people with severe depression or suicidal thoughts who do not get better with other treatments. ECT is generally safe.
  • Light therapy may relieve depression symptoms in the winter time. This type of depression is called seasonal affective disorder.

Outlook (Prognosis)

You may start feeling better a few weeks after starting treatment. If you take medicine, you will need to stay on the medicine for several months to feel good and prevent depression from returning. If your depression keeps coming back, you may need to stay on your medicine for a long period.

Chronic depression may make it harder for you to manage other illnesses such as diabetes or heart disease. Ask your doctor for help in managing these health problems.

Alcohol or drug use can make depression worse. Talk to your doctor about getting help.

When to Contact a Medical Professional

If you have thoughts of suicide or harming yourself or others, call your local emergency number (such as 911) right away. Or go to the hospital emergency room.

You can also call a suicide hotline 24 hours a day: 1-800-SUICIDE or 1-800-999-9999.

Call your doctor right away if:

  • You hear voices not coming from people around you.
  • You have frequent crying spells with little or no reason.
  • Your depression is disrupting work, school, or family life.
  • You think that your current medicine is not working or is causing side effects. Do not stop or change your medicine without talking to your doctor.

Prevention

Do not drink alcohol or use illegal drugs. These substances make depression worse and may lead to thoughts of suicide.

Take your medicine exactly as your doctor instructed. Learn to recognize the early signs that your depression is getting worse.

Keep going to your talk therapy sessions. Counseling is just as effective as taking medicine.

The following tips may help you feel better:

  • Get more exercise.
  • Maintain good sleep habits.
  • Do activities that bring you pleasure.
  • Volunteer or get involved in group activities.
  • Talk to someone you trust about how you are feeling.
  • Try to be around people who are caring and positive.

Depression and Chronic Pain

 Living with chronic or long-term pain is a tremendous burden. But when you have chronic pain and depression, the burden gets even heavier.

Depression magnifies pain. It makes it more difficult to cope with everyday living. The good news is that chronic pain and depression are not inseparable. Effective medications and psychotherapy can help relieve the depression and make chronic pain more tolerable.

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 What Is Chronic Pain?

Chronic pain is pain that lasts much longer than would be expected from the original problem or injury. When pain becomes chronic, your body may react in several ways. Chronic pain may be characterized by abnormalities in brain hormone, low energy, mood disorders, muscle pain, and impaired mental and physical performance. Chronic pain worsens as neurochemical changes in your body increase your sensitivity to pain. Then you begin to have pain in other parts of your body that do not normally hurt.

Chronic pain can prevent sleep and cause you to awaken frequently at night. This lack of sleep results in daytime fatigue and low productivity. The ongoing pain will cause additional irritation and make it difficult to deal with others. If you have to care for children or work full time, chronic pain may make your life seem too challenging. The overwhelming feelings can lead to irritability, depression, and even suicide for those who feel no hope for relief is in sight.

What Happens With Chronic Pain and Depression?

If you have chronic pain and depression, you’ve got plenty of company. Depression is one of the most common psychological issues facing people who suffer from chronic pain, and it often complicates the patient’s conditions and treatment. Consider these statistics:

  • According to the American Pain Foundation, about 32 million people in the U.S. report have had pain lasting longer than one year.
  • From one-quarter to more than half of the population that complains of pain to their doctors are depressed.
  • On average, 65% of depressed people also complain of pain.
  • People whose pain limits their independence are especially likely to get depressed.

Because depression in patients with chronic pain frequently goes undiagnosed, it often goes untreated. Pain symptoms and complaints take center stage on most doctor visits. The result is depression — along with sleep disturbances, loss of appetite, lack of energy, and decreased physical activity, which may make pain much worse.

Is There a Cycle of Depression and Pain?

Pain provokes an emotional response in everyone. If you have pain, you may also have high anxiety, irritability, and agitation. These are very normal feelings when you’re hurting. Normally, as pain subsides, so does the stressful response.

But with chronic pain, you may feel constantly tense and stressed. Over time, the constant stress can result in different emotional problems associated with depression. Some of the problems individuals with both chronic pain and depression have include:

  • Altered mood
  • Anger
  • Chronic anxiety
  • Confused thinking
  • Decreased self-esteem
  • Family stress
  • Fatigue
  • Fear of injury
  • Financial concerns
  • Irritability
  • Legal issues
  • Physical deconditioning
  • Reduced sexual activities
  • Sleep disturbances
  • Social isolation
  • Weight gain or loss
  • Work issues

Why Is There an Overlap Between Depression and Chronic Pain?

Some of the overlap between depression and chronic pain can be explained by biology. Depression and chronic pain share some of the same neurotransmitters — brain chemicals that act as messengers traveling between nerves. Depression and chronic pain also share some of the same nerve pathways.

The impact of chronic pain on a person’s life also contributes to depression. Chronic pain can force you to struggle with tremendous losses, such as the loss of exercise, sleep, social network, relationships, sexual relationships, even a job and income. These losses can make you feel depressed.

Depression then magnifies the pain and reduces your coping skills. While you used to exercise and be active when you felt stressed, with chronic pain you can no longer deal with stress in this manner.

Research has compared people with chronic pain and depression to those who only suffer chronic pain. Those who suffer with both depression and chronic pain report:

  • More intense pain
  • Less control of their lives
  • More unhealthy coping strategies

Because chronic pain and depression are so intertwined, they are often treated together. In fact, some medications can improve both chronic pain and depression.

Is There a “Whole-Life” Approach to Treating Pain and Depression?

Chronic pain and depression can affect a person’s entire life. Consequently, an ideal treatment approach addresses all the areas of your life that are affected by chronic pain and depression.

Because of the connection between chronic pain and depression, it makes sense that treatments for these conditions overlap.

How Do Antidepressants Help Both Chronic Pain and Depression?

Because chronic pain and depression involve the same nerves and neurotransmitters, antidepressants are used to treat both chronic pain and depression. Antidepressants work on the brain to reduce the perception of pain.

There is abundant evidence of the effectiveness of tricyclic antidepressants such as Elavil and doxepin. However, because of side effects, their use is often limited. Newer antidepressants known as serotonin and norepinephrine reuptake inhibitors (Cymbalta, Effexor), on the other hand, seem to work well with fewer side effects.

How Can Physical Activity Help Both Chronic Pain and Depression?

Many people with chronic pain avoid exercise. But, if you don’t exercise, you get out of shape and have an increased risk of injury and worsened pain. Consult with a physician to design an exercise plan that’s safe and effective for you.

Exercise also helps ease depression by releasing the same kind of brain chemicals that antidepressant medications release.

Why Is Taking Control Important for Healing?

Chronic pain affects your ability to live, work, and play the way you’re used to. This can change how you see yourself — sometimes for the worse as you feel victimized by the pain and depression.

Getting busy and taking control of your life is important. Working with a health care provider who refuses to see you as a helpless victim but sees you as a healthy person with pain is important.

How Does Talk Therapy Help Chronic Pain and Depression?

Research clearly shows that, for many people, certain kinds of mental training can help improve chronic pain.

Cognitive therapy is one approach. In cognitive therapy, a person learns to notice the negative “automatic thoughts” that surround the experience of chronic pain. These thoughts are often distortions of reality. Cognitive therapy can teach a person how to change these thought patterns and improve the experience of pain.

Cognitive therapy is also a proven treatment for depression and can reduce symptoms of anxiety in those with chronic pain.

What’s the Best Way to Manage Chronic Pain and Depression? continued…

Tell your doctor that you want to gain control over your chronic pain and depression. As you develop a plan, keep in mind that the ideal pain management plan will be multidisciplinary, which means it will address all areas of your life that are affected by the pain.

Empower yourself by tapping into available resources such as the American Chronic Pain Association, the American Pain Foundation, and the Academy of Cognitive Therapy. Stay committed to the treatment plan until you feel in control of your pain and depression and can fully live your life, doing the activities you enjoy.

Find a cognitive therapist near you with experience in the treatment of chronic pain. You can locate one by contacting the national pain organizations or cognitive therapists’ professional groups mentioned above.

What’s the Best Way to Manage Chronic Pain and Depression?

The best way to approach managing chronic pain is to team up with a pain specialist or even your family doctor to create a treatment plan. When chronic pain and depression are combined, the need to work with a doctor  is even greater.

Jaime Tartar tells us about how the brain interprets what is stressful, how it determines our behavioral and physiological response to stressors, and how it can also do damage by stress. She will discuss how the body’s reaction to acute stress has protective and adaptive effects in the short run while chronic stress can lead to poor health consequences such as decreased memory performance and depression.  Jaime Tartar is  Associate Professor of Psychology at Nova Southeastern University.


Dr. Jon Kabat-Zinn speaking at Dartmouth College on the healing power of mindfulness
Dr.Kabat-Zinn’s presentation starts at the 4:05 mark in the following video:

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