Depression, Emotion, and Physical Pain

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According to Harvard Health, “Pain, especially chronic pain, is an emotional condition as well as a physical sensation. It is a complex experience that affects thought, mood, and behavior and can lead to isolation, immobility, and drug dependence.”  Pain and depression are often connected.  Pain can cause depressive symptoms and depressive symptoms can cause or intensify pain.  It had been found that people with chronic pain have three times the average risk of developing psychiatric symptoms connected with mood or anxiety disorders.  Likewise, it has been found that depressed patients have three times the average risk of developing chronic pain. 

Medications that Help With Depressive Physical Pain

Many of the medications used in psychiatry can alleviate problems associated with mental health issues, but they can reduce physical pain.  Psychiatric medication, which includes SSRI antidepressants, mood stabilizers, and anticonvulsants can work to relieve anxiety symptoms, depressive symptoms, and physical pain.

There are two major types of antidepressants, tricyclics and selective serotonin reuptake inhibitors (SSRIs).  The antidepressant Amitriptyline (Elavil), a tricyclic, is often recommended as an analgesic,  because its sedative properties can also help with complaints of pain. SSRIs such as fluoxetine (Prozac) and sertraline (Zoloft) have less side effects, but not as successful in treating pain complaints.  Some physicians prescribe an SSRI during the day and amitriptyline at bedtime for pain patients.

According to Harvard Health, “Both drug classes act in brain pathways that regulate mood and the perception of pain. Tricyclics heighten the activity of the neurotransmitters norepinephrine and serotonin; SSRIs act more selectively on serotonin. Some researchers and clinicians believe that a newer antidepressant which acts strongly on both neurotransmitters, the so-called dual action drug venlafaxine (Effexor), is superior to both tricyclics and SSRIs for treating pain. So far, the evidence is inconclusive.”

Depression and Migraine Headaches

There is also an association of depression with migraine headaches.  Migraines are often a complaint with those suffering with depression and anxiety.  The article quotes, “Depression affect more than 10% of Americans… One study found that over a two-year period, a person with a history of major depression was three times more likely than average to have a first migraine attack, and a person with a history of migraine was five times more likely than average to have a first episode of depression.”

Because depression can disrupt the nervous system, pain is a logical complaint.  Harvard Health goes on to explain this connection: “The convergence of depression and pain is reflected in the circuitry of the nervous system. In the experience of pain, communication between body and brain goes both ways. Normally, the brain diverts signals of physical discomfort so that we can concentrate on the external world. When this shutoff mechanism is impaired, physical sensations, including pain, are more likely to become the center of attention. Brain pathways that handle the reception of pain signals, including the seat of emotions in the limbic region, use some of the same neurotransmitters involved in the regulation of mood, especially serotonin and norepinephrine. When regulation fails, pain is intensified along with sadness, hopelessness, and anxiety. And chronic pain, like chronic depression, can alter the functioning of the nervous system and perpetuate itself.”

People with the diagnosis of depression often have complaints of chronic pain and those with chronic pain also complain of depressive symptoms.  The connection between depression and pain is a new field of study that is beginning to find more support by medical evidence in studies that show changes in the brain and nervous system.  Since the rate of depression diagnosis is increasing as well as complaints of pain, it is important that medical research continues to explore this mind body connection and discovers the best way to treat both symptoms.  Since psychiatric medications can help with management of pain, continued education to practitioners such as psychiatrists and pain management specialists is needed to help treat both medical and psychological issues. 

- Kim B.

Insightful Comments

I have suffered with chronic pain for over a decade, and at times it became quite apparent to me that the severity of my physical pain was often in direct correlation to my emotional state.  I have never been formally or professionally diagnosed with depression. However, as a professional counselor, I would confess that I often possess the characteristics of a person with depression. I understand the difference between sadness and depression.

I am sure that sadness could lead to depression. Perhaps even depression could lead to sadness. However, I was uncertain for a very long time as to whether depression could affect my physical pain.  I believe now, after informally using my experiences and myself as a scientific experiment (I am my own Guiana pig), that our physical, emotional, and mental states are in direct connection with one another.

I have performed physical activities that were to me very enjoyable, dare I say, even fun over the course of the decade that I have suffered from chronic pain. When I was able to participate and enjoy the times of physical activity, my mind was not focused on the pain and despair that I so often carried with me.

For example, I am a happily married man and enjoy having sexual intimacy with my wife. When I was in my most severe physical pain, my desire to be sexually intimate with my wife did not wane. I still desired to be her husband and lover, and it was almost miraculous to me that whenever we focused our attentions on one another and our intimate needs that my pain levels were minimal if existent at all.

We can discuss endorphins and hormones and all the scientific reasons for the missing pain, but I believe most if not much of it was between my ears (the brain). At least my ability to tolerate the pain was in my mind. If I could readjust my focus on my wife and not on my pain, I often found that I was not suffering from the pain.

I am not implying that my pain was or is not real. I am simply stating that by shifting my focus away from myself onto someone or something else I was often able to suffer less from my pain. 

In contrast, on the days that I was feeling ‘blue’ or down, and on the days that I decided to wallow in my self-pity because of my pain, life seemed very difficult to bear. I was in pain for certain, but not only was I suffering physically, I exacerbated it by putting all of my thoughts and focus on my pain.

I am not a follower of the ‘Power of Positive Thinking’, but I I like the idea. What can it hurt? Be positive and perhaps you will positively feel better!

- Bergen

New Releases. (n.d.). Retrieved December 17, 2014, from http://www.health.harvard.edu/newsweek/Depression_and_pain.htm

“Hurting bodies and suffering minds often require the same treatment” in the Harvard Mental health Letter, addresses the connection between depression and pain (This article was first printed in the September 2004 issue of the Harvard Mental Health Letter. For more information or to order, please go to http://www.health.harvard.edu/mental.)