Depression Chapter 11

Depression and Pain


When Depression Hurts

Pain and depression walk hand in hand. People with depression tend to experience more severe and longer-lasting pain than people without depression. In fact, having untreated clinical depression increases by 50% the likelihood that you’ll develop a chronic pain condition. Pain disorders suffered by people with depression can include nerve pain, irritable bowel syndrome, low back pain, fibromyalgia, and headaches (particularly migraines). READ MORE

Two of the most common pain disorders in people with depression are fibromyalgia and migraine headaches.

  • Fibromyalgia. Fibromyalgia is a chronic pain condition in which individuals experience multiple tender points in muscles, joints, and bones throughout the body. More than 50% of people with fibromyalgia have major depressive disorder. Typically, they also suffer from chronic insomnia and fatigue. Usually the onset on depression precedes the onset of fibromyalgia.

  • Migraine headache. Migraine is a severe and recurrent vascular headache that often lasts for 24 hours or longer and is associated with photophobia (hypersensitivity to light), phonophobia (hypersensitivity to sound), and nausea. About 10% of Americans get migraine headaches. Major depressive disorder is common in patients with migraine: about 40% of all people who suffer from migraines experience major depressive disorder at some point. Clinical depression may start before or after the onset of migraine headaches.



A Two-Way Street

The relationship between clinical depression and pain is a two-way street: depression can cause pain, and pain can lead to depression. Not only are people with depression more likely to develop chronic pain disorders, but people with chronic pain are two to four times more likely to become clinically depressed.


How Are Depression and Pain Related?

It was once thought pain and depression were associated for mainly psychological reasons: it is depressing to always be in pain, and being in psychological pain may manifest in painful physical symptoms as well. Now, however, researchers investigating how the nervous system interacts with other parts of the body have made some surprising discoveries. READ MORE

The sensing of pain is a complex process and goes both ways, from the brain to the body and the body to the brain. Pain involves neurotransmitters and other molecules acting in both peripheral and central pain signaling pathways. Many different neurotransmitters are involved in depression, too. Serotonin and norepinephrine are neurotransmitters that are involved in both pain and depression. LESS


The Neurotransmitter Connection

It’s known that in people with depression, there are changes or reductions in serotonin and norepinephrine and their receptors. Concentrations and output of the two neurotransmitters become erratic, leading to a dysregulated signaling system. The pathways of serotonin and norepinephrine in the brain begin in the brain stem and project to various brain regions, including the frontal cortex, hypothalamus, and limbic regions. Symptoms of depression are associated with the frontal cortex and limbic regions. The hypothalamus is associated with loss of appetite, weight loss or gain, and loss of pleasure. READ MORE

Serotonin and norepinephrine pathways also extend downward from the brain stem into the spinal cord. These descending pathways have many functions, including suppressing the body's input from minor pain, like aching muscles and joints. It’s important that these minor pain signals be cut off—otherwise we would be so distracted that we would be unable to function normally.

A dysfunctional serotonin and norepinephrine system that promotes depressive symptoms is likely to also have dysfunctional descending serotonin and norepinephrine pathways. This would have the effect of intensifying pain signals and may explain why depressed patients often suffer from chronic pain, including headaches, lower back and neck pain, joint pain, as well as fatigue and tiredness. And, just like chronic depression, chronic pain can itself alter the functioning of the nervous system and perpetuate itself. LESS

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