Fibromyalgia and Depression
For many years the medical community tried to link fibromyalgia and depression. And despite evidence to the contrary, some in the psychological arena still insist on believing that fibromyalgia is caused by - or at least strongly linked to - depression.
The fact is, depression is no more prevalant with fibromyalgia than it is with any other chronic illness. The Cleveland Clinic describes depression as a “complication” of chronic illness and estimates that “up to one-third of individuals with a serious medical condition experience symptoms of depression.” They list the following depression rates for various illnesses:
- Heart attack: 40%-65%
- Parkinson’s disease: 40%
- Multiple sclerosis: 40%
- Stroke: 10%-27%
- Cancer: 25%
- Diabetes: 25%
I've seen various estimates as to the rate of depression for people with fibromyalgia, but they tend to range between 20 – 30%, about the same as for cancer, diabetes and rheumatoid arthritis.
I have to admit, it still frustrates me when I see articles that list depression as a symptom of fibromyalgia. It is not a symptom, but rather a comorbid condition – a condition that sometimes occurs simultaneously with another illness – just as irritable bowel syndrome and migraines are comorbid conditions of FM.
It's actually not surprising that any chronic illness, including fibromyalgia, would sometimes be accompanied by depression. Chronic illness often causes major lifestyle changes. It can severely impact an individual's ability to work, function in the household, and socialize. It may add significant stress to a marriage and other close relationships. All of these things could contribute to feelings of depression. People with fibromyalgia also tend to have low levels of the neurotransmitters serotonin and norepinephrine, which are thought to be connected with depression.
Although I think some people over-emphasize the connection between fibromyalgia and depression, I don't want to minimize the importance of identifying and treating depression if it exists. While treating the depression doesn't make the fibromyalgia go away, it can make it much easier to cope with.
Some common symptoms of depression include:
- Loss of interest or pleasure in daily activities
- Significant weight gain or weight loss
- Sleeping too much or not able to sleep
- Problems with concentration
- Apathy (lack of feeling or emotion)
- Feelings of worthlessness or guilt
- Fatigue or loss of energy
- Recurrent thoughts of death or suicide
If you have several of the symptoms above, be sure to tell your doctor. Note: some of the symptoms of depression are also symptoms of fibromyalgia – sleep disturbances, fatigue and difficulty concentrating. This can sometimes make it more difficult to distinguish between the two, so the other symptoms are very important in identifying depression.
Depression is usually treated with a combination of antidepressant medication and therapy. I think both are important components in dealing with and recovering from depression.
Medication – If you have a chemical imbalance, the medication will help bring those chemicals back to normal levels. Two of the three medications approved for the treatment of fibromyalgia – Cymbalta and Savella – are classified as antidepressants, but are prescribed in lower doses for FM than for depression. In addition to their effects on serotonin and norepinephrine, antidepressants can also help block pain and improve sleep. If you are suffering from depression as well as FM, you might need to take a higher dosage of the antidepressant.
Therapy – Sometimes people are uncomfortable with the idea of talking with a counseler or psychologist, but it really can be very helpful. Actually, working with a therapist can be helpful even if you don't have depression. They can be very good at helping you learn to recognize how you respond to pain and teaching you techniques that can aid you in coping with your FM symptoms and the changes it has brought about in your life.
The bottom line is, don't let depression go untreated. Getting appropriate treatment for depression will not only help you feel better overall, but it may also help ease the severity of some of the physical FM symptoms.
Chronic Illness and Depression. The Cleveland Clinic Foundation. Retrieved 5/5/10.