UNDERSTANDING DEPRESSION

January 6, 2012

Depression is an extremely complex disease. It occurs for a variety of reasons. Some people experience depression during a serious medical illness. Others may have depression with life changes such as a move or the death of a loved one. Still others have a family history of depression. Those who do may experience depression and feel overwhelmed with sadness and loneliness for no known reason

What Are the Main Causes of Depression?

There are a number of factors that may increase the chance of depression, including the following:

• Abuse
  Past physical, sexual, or emotional abuse can cause depression later in life.


• Certain Medications
  For example, some drugs used to treat high blood pressure, such as beta-blockers or reserpine, can increase your risk of depression.


• Conflict
  Depression may result from personal conflicts or disputes with family members or friends.


• Death or a Loss
  Sadness or grief from the death or loss of a loved one, though natural, can also increase the risk of depression.


• Genetics
  A family history of depression may increase the risk. It's thought that depression is passed genetically from one generation to the next. The exact way this happens, though, is not known.


• Major Events
  Even good events such as starting a new job, graduating, or getting married can lead to depression. So can moving, losing a job or income, getting divorced, or retiring.


• Other Personal Problems
  Problems such as social isolation due to other mental illnesses or being cast out of a family or social group can lead to depression.


• Serious Illnesses
  Sometimes depression co-exists with a major illness or is a reaction to the illness.


• Substance Abuse
  Nearly 30% of people with substance abuse problems also have major or clinical depression.

Fibromyalgia and Depression

Many studies link fibromyalgia and depression. In fact, about three out of every 10 people with fibromyalgia also have major depression at the time of their diagnosis.

Some researchers feel that depression leads to changes in brain chemistry. Others look at abnormalities of the sympathetic nervous system -- the part of the nervous system that determines how you handle stress and emergencies. These abnormalities, they contend, may lead to the release of substances that cause more sensitivity to pain. The result is fibromyalgia with its chronic pain and feelings of depression.

Learning more about the connection between fibromyalgia and depression can help you seek appropriate medical treatment from your doctor. That includes asking your doctor about antidepressants.

By following an appropriate fibromyalgia treatment plan and getting the support of family and friends, you can take control of your fibromyalgia. You can also get control over your symptoms of depression and improve your quality of life.

What Is the Link Between Fibromyalgia and Depression?

The stress from fibromyalgia's pain and fatigue can cause anxiety and social isolation. The chronic deep muscle and tender point pain can result in less activity. That causes you to become more withdrawn and can also lead to depression. It is also possible that anxiety and depression are part of fibromyalgia, just like the pain.

Depression and fibromyalgia can greatly interfere with the way you manage your activities at home or at work. So it is important to openly discuss any symptoms of depression you have with your doctors.

Does Stress Increase Depression With Fibromyalgia?

The stress of living with chronic pain and relentless fatigue can put a person into "overload." That can result in overwhelming feelings of nervousness and anxiety. What isn't clear is whether a stressful life brings about the fibromyalgia or if having fibromyalgia leads to stress.

No matter which comes first, stress adds to problems of anger, distractibility, and irritability. It can even lead to further physical changes, such as high blood pressure or heart problems. Most patients feel worsening of pain and fatigue when they have more stress. Sometimes, severe stress occurs just before the disease starts.

Is Depression Common With Chronic Pain Conditions?

Feelings of depression are common with all types of chronic pain, including headache, back and neck pain, hip pain, shoulder pain, and the pain of fibromyalgia. For example, the prevalence of major depression in people with chronic low back pain is three to four times greater than in the general population.

By the same token, having a depressive disorder also increases the risk of developing chronic pain. Patients who are depressed have greater pain. They describe greater hindrance from pain and display more pain behaviors than pain patients who are not depressed.

People with chronic pain such as fibromyalgia often become depressed and isolated. As a result, they spend more time away from other people, even people they love, such as family and friends. Instead of focusing on their personal lives or the lives of their loved ones, they become increasingly focused on their pain and suffering, which is very real. Adding to the frustration are the repeated appointments with health care providers to try to find relief and the resulting costs.

Linking Fibromyalgia to Depression and Anxiety

Chronic, widespread muscular pain and tenderness, sleep problems and fatigue, morning stiffness and headaches, concentration and digestive irregularities: All these symptoms can make daily functioning very difficult for those with fibromyalgia. But equally challenging are the depression and anxiety that often accompany the disorder.

Depression and anxiety each occurs in approximately 8 percent of those with fibromyalgia, according to Jacob Teitelbaum, M.D., medical director of The Fibromyalgia & Fatigue Centers, a nationwide group of treatment centers. In people with fibromyalgia, he says, anxiety often manifests itself as rapid shallow breathing (hyperventilation), and depression as a decrease in normal interests.

While it is not unexpected to have an emotional or psychological response to a chronic illness, there may be other physiological reasons that explain why anxiety and depression occur in fibromyalgia patients consistently enough that they are listed as symptoms of the condition. "Biochemically, depression is very different in [people with] fibromyalgia than otherwise," says Dr. Teitelbaum. "In fibromyalgia, it is often associated with an underactive adrenal function [a low cortisol level], whereas depression [in a non-fibromyalgia population] is associated with a high cortisol level."

Physical Factors That Can Affect Emotional Health

According to some doctors who routinely treat fibromyalgia, there are a number of factors that appear to increase the likelihood of developing anxiety and/or depression if you have this condition.

• Hypothyroidism
  Antiaging medicine specialist Pamela W. Smith, MD, MPH, director of The Center For Healthy Living and Longevity in Michigan, says, "Ninety-five percent of people with fibro have low thyroid function (hypothyroidism) and 100 percent of them have low adrenal function - and both conditions can cause depression and anxiety." The thyroid gland produces hormones that help regulate metabolism. Fortunately, hypothyroidism (when the level of certain thyroid hormones produced is below normal) is easy to diagnose. A complete blood test for thyroid levels, including TSH (thyroid stimulating hormone) and other thyroid hormones, can identify if a problem exists, says Dr. Smith. Once treated with appropriate medication, thyroid function should return to normal, and depression or anxiety should ease as well.


• Low Cortisol Levels
  Cortisol is a hormone produced by the adrenal glands in response to stress. When the adrenals produce an insufficient supply of cortisol, however, it can result in what's sometimes called "adrenal fatigue;" symptoms include muscle aches and pains, extreme fatigue, anxiety, and elevated levels of cholesterol, blood sugar, and blood pressure. According to Dr. Smith, adrenal fatigue can occur when the body is under stress for extended periods of time. "When you are first stressed, cortisol elevates," she explains. "But if you stay stressed for a long time, the body can't keep up by making extra cortisol, so it makes just enough to keep you alive."

  Dr. Smith says that low cortisol levels related to stress often do not show up on standard blood tests, and she believes they are best measured by saliva testing. "Many physicians only measure cortisol levels as related to Addison's disease or Cushing's disease. They do not look at what happens when the body makes only enough cortisol to stay alive but not to function well (adrenal fatigue)," she explains.

  Cortisol levels can be normalized by reducing stress, says Dr. Smith. Techniques Dr. Smith recommends include "prayer, meditation, tai chi, yoga, breathing techniques and massage, [although] herbal therapies, adrenal extracts, and medications may all be necessary to bring cortisol levels back to normal." she says, adding, "it may take one to two years to fully normalize the body's stress system." As cortisol levels are restored, fibromyalgia-related anxiety and depression generally lessen, she notes.

  
  
• Poor Mitochondrial Functioning
  Mitochondria are the energy-producing parts of the cell that assist in vital body processes like metabolism. When their function is impaired, they can also play a role in the development of depression and anxiety in people with fibromyalgia, says Dr. Smith. She reports that in her patients, supplements such as coenzyme Q10 (CoQ10), the amino acid-like compound L-carnitine, NADH (nicotinamide adenine dinucleotide, which is related to niacin, a B vitamin), D-ribose, and the antioxidant alpha-lipoic acid all help to refuel mitochondria. And in some patients, taking these supplements has been helpful in reducing symptoms of depression and anxiety related to fibromyalgia.


• Vitamin D Deficiency
  Fibromyalgia has been linked to low levels of vitamin D, which has also been found to occur more frequently in patients with anxiety and depression. Vitamin D deficiency can be offset by supplementation and eating foods enriched with this nutrient, such as fortified orange juice or margarine.


• Poor Sleep
  Insufficient restorative sleep can lead to or aggravate existing anxiety and depression in people with fibromyalgia, and they do not go into the stage of sleep known as REM sleep, says Dr. Smith. This problem may be further compounded by taking antidepressant medication, which can suppress REM sleep in certain people. Other causes of non-restorative sleep in patients with fibromyalgia can include muscular aches and pains and, according to one study, decreased levels of the hormone melatonin.

  "There really are metabolic reasons why people with fibromyalgia have the symptoms that they have," says Dr. Smith. She recommends that people with fibromyalgia undergo testing to determine if an underlying deficiency or a related health condition could be complicating their situation and bringing depression and anxiety to the surface.