Episode 20: Exploring the Relationship between Fibromyalgia and Depression
Typical of me when I am depressed
I am having a hard time getting started writing this post about depression. I thought this would be a short quick-write that I would have completed in about two days, but this subject has sent me down so many rabbit holes including: affective spectrum disorder, functional pain syndrome, central sensitization syndrome, CCD, IBS, TMD, CCCP and etc.; the list is endless. I have actually been writing this one post for over 4 plus weeks. The struggle initially was to pinpoint whether my depression started before fibromyalgia, or if I had fibromyalgia, and then depression reared its ugly head. I honestly think that it is a chicken or the egg thing. Which begs the question, does it even matter?
Let's look at it. Fibromyalgia and depression are two separate disorders that often converge and share a complex relationship. Understanding the link between them is essential for appropriate treatment. In this blog post, I explore the connection between fibromyalgia and depression, their shared symptoms and the importance of a understanding both disorders in order to help ensure the right treatment and a better quality of life.
Separate disorders same shared symptoms
Fibromyalgia is characterized by all over body pain, fatigue, brain fog, depression and anxiety. In my case, I experience all over body pain as pain from my hair follicles to my toe nails. Other pain shifts from my right metatarsals to my left shoulder, to my right elbow, to my right eye, to a dull roaring headache, to knee cap pain, to my left ankle and then starts all over again. The pain shifts from place to place all the while maintaining a bone deep low level ache that moves though my body like waves on an ocean - undulating and rolling from top to bottom and side to side.
Isn't it interesting that people living with fibromyalgia are up to three times more likely to also be diagnosed with depression. Depression is characterized by feelings of sadness, fatigue and lack of energy, feelings of worthlessness, anxiety and agitation, slowed thinking or brain fog, unexplained aches and pains and feeling miserable and unhappy without knowing why. My depression sits me on the couch and has an ongoing conversation with me about how I could have done better, that I am worthless and that I should just stay put and not move. My anxiety shoots through the roof, yet, I have no energy and it is hard for me to think. My body hurts and I am unhappy and often agitated by the smallest things.
Affective Spectrum Disorder
So does my body hurt because I am depressed? Or am I depressed because my body hurts? It seems we have shared symptoms between separate disorders... or are they. A 2012 study suggests that "Fibromyalgia and depression might represent two manifestations of affective spectrum disorder". If you are like me, we just let out another collective sigh with the addition of yet another "disorder" on the books. With that deep and arduous sigh, let's dig into it.
What is Affective Spectrum Disorder?
This disorder is news to me. Because of that, I will only describe affective spectrum disorder in the briefest and most accurate way to the best of my ability right now. And to the best of my understanding affective spectrum disorder is an umbrella term for psychiatric and physiologic conditions such as but not limited to: generalized anxiety disorder, major depressive disorder, irritable bowel syndrome, and migraine. Fibromyalgia may slide in under this umbrella and be linked to depression because it, "share[s] similar pathophysiology and [is] largely targeted by the same drugs with dual action on serotoninergic and noradrenergic systems". Fibromyalgia and depression may be two symptoms from one underlying condition. What that is, I don't know. But it makes sense to me that all-over body pain and depression go hand in hand.
Functional Pain Syndrome
If it is true, depression doesn't cause fibromyalgia, and fibromyalgia doesn't cause depression. There may be one underlying cause of both. But fibromyalgia, by itself, is also considered a "Function Pain Disorder" grouped with irritable bowel syndrome (IBS), TMD (temporomandibular dysfunction) and chronic cardiac chest pain (CCCP). This is another umbrella term for pain that has "no obvious organic origin" affecting about 10% of the world population.
This has just initiated in me a serious "AHHHHHHHH!" episode.
Central Sensitization Syndrome
I will insist that for many people, depression and fibromyalgia go hand in hand regardless of whether it is under one umbrella or the other. Well, let's throw another syndrome in the mix that may actually may feel more helpful for some of us. In 1983, many of the disorders grouped under both affective spectrum disorder and functional pain syndrome were now referred to as central sensitization syndrome, or CSS. Cental sensitization syndrome differs from affective spectrum disorder and functional pain disorder in that: CSS was discovered and studied after the others seemed to be inadequate in describing the experiences of the sufferers. This seems to be the umbrella under which we can place most disorders associated with fibromyalgia, including depression.Though the cause for these two disorders is not yet fully understood, as a layman, I am go out on a limb and say that in the case of fibromyalgia, the relationship between depression and fibromyalgia is bidirectional. In other words one disorder feeds the other and vice versa.
This doesn't contradict what I said earlier in this post that depression doesn't cause fibromyalgia, and fibromyalgia doesn't cause depression. By "bidirectional" I am saying that fibromyalgia and depression feed off of one another. A review of literature by the National Institute of Health showed that: "In fact, the most prevalent condition in patients previously diagnosed with FM is depression. The proven bidirectional relation between FM and depression represents important clinical implications, given that the presence of one of the diseases mentioned above increases the risk and worsens the outcome of the other."
Fibromyalgia and the pain it inflicts can lead to feelings of helplessness and hopelessness, adding to the occurrence or worsening of depressive symptoms. And on the flip side, depression can lead to a more persistent bodily expression of pain. Because of this, it is important to talk to your doctor(s) to help manage both disorders.
Fibromyalgia and depression are multifaceted bidirectional disorders that share many of the same symptoms. Often, they can be grouped together under the older umbrellas of affective spectrum disorder, functional pain syndrome, or the more current umbrella, central sensitization syndrome. Generally, they can be treated with many of the same medications. Knowing this, whether the fibromyalgia came before the depression, or the depression showed up before the fibromyalgia is a question of whether the chicken or the egg came first. To a layperson, does that question even matter? It is important for you and your doctor to recognize and treat both the physiological and psychological aspects of these complex conditions. As you address the physical and emotional aspects of fibromyalgia and depression, you and your healthcare provider can work towards improving your quality of life.
If you enjoyed this post, share it with your friends and colleagues, and consider becoming a subscriber. If you have any tips or suggestions about how to better cope with chronic pain, leave a comment. I would love to hear from you!
Karen Palmen, EdD is a veteran educator in Saint Paul, Mn. She teaches Dance and English at Saint Paul Central High School. She has an active TikTok page that features humorous, political, mental health, and educational content (kickin it with karen). And a a dormant YOUTUBE channel with the same name, featuring fermented foods and other cooking oddities.
DISCLAIMER: THIS BLOG DOES NOT PROVIDE MEDICAL ADVICE
The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this blog.
Citations:
Adams, Leah M, and Dennis C Turk. “Psychosocial Factors and Central Sensitivity
Syndromes.” Current Rheumatology Reviews, 26 Jan. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4728142/#:~:text=Central%20sensitivity%20syndromes%20(CSSs)%20represent,being%20the%20most%20prominent%20feature.
Crabtree, David, and Praveen Ganty. “Common Functional Pay Syndromes.”
Academic.Oup.Com, 20 May 2016, academic.oup.com/bjaed/article/16/10/334/2288619.
“Depression (Major Depressive Disorder).” Mayo Clinic, 14 Oct. 2022,
www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007#:~:text=Feelings%20of%20sadness%2C%20tearfulness%2C%20emptiness,insomnia%20or%20sleeping%20too%20much.
Fuller, Kristen. “Differentiating Fibromyalgia, Depression, and CFS.” Psychology Today, 23
Dec. 2021, www.psychologytoday.com/us/blog/happiness-is-state-mind/202112/differentiating-fibromyalgia-depression-and-cfs.
Gracely, Richard H, et al. “Fibromyalgia and Depression.” Pain Research and Treatment, 19
Nov. 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3236322/.
Yepez, Daniela, et al. “Fibromyalgia and Depression: A Literature Review of Their Shared
Aspects.” Cureus, 11 May 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9187156/.