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Many people with fibromyalgia, chronic pain, and chronic fatigue syndrome become depressed. How can you recognize the symptoms, and what can be done to help you?

Did you know?

  • An estimated 20 percent of fibromyalgia sufferers are depressed
  • As many as a third of people with chronic fatigue syndrome suffer from depression
  • More than 60 percent of chronic pain patients may have major depressive disorder
While chronic pain can be caused by numerous different things, this triad is unfortunate in that it is not uncommon for someone to have both fibromyalgia and chronic fatigue syndrome, and though it's not talked about much, fibromyalgia can absolutely result in chronic pain. All three of these entities can co-exist in the same person, then. 

Though research hasn't "officially identified" the exact reason for which chronic pain and depression are linked, it's not that hard to understand — chronic pain overshadows every aspect of life, interfering in daily functioning and robbing patients of the ability to do the things they need and want to do. Depression can itself lead to even more physical symptoms than you were already dealing with, and studies have shown that it has a negative impact on the odds that the treatments you're prescribed for your chronic pain will be effective for you. 

This leads to two practical questions — if you're depressed, how can you recognize the symptoms so you're able to get the treatment you need, and how is depression treated if there is an underlying or contributing physical illness?

Fibromyalgia, chronic fatigue syndrome, and chronic pain: How can you tell if you're depressed?

Depression can set in without an obvious cause, but can also absolutely be triggered by objective circumstances and still be considered major depressive disorder. The diagnostic criteria are the same. Look at the symptoms included in the diagnostic criteria laid out in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and ponder:

  • If you recognize a minimum of five of these symptoms
  • If yes, whether they've applied to you for at least two weeks, on most days or for most of the day
  • Your symptoms include the first or second diagnostic criterium, or both

The diagnostic criteria for major depressive disorder are:

  1. A depressed mood — this can more concretely be described as feeling sad, tearful, low, empty, pessimistic, and hopeless. In some cases, it also (partially) manifests are anger. 
  2. You've lost interest in daily activities or activities that used to mean something to you, or at least have diminished interest. This can show up as not feeling like socializing or doing things that used to really excite you, but also as not being able to find the motivation to do daily tasks like tidying up or going to work.
  3. Weight and appetite changes — some depressed people lose their appetite and consequently lose weight, while others overeat and gain weight. 
  4. Changes in sleep that can include sleeping a lot (hypersomnia) or being unable to get to sleep or stay that way (insomnia). 
  5. Slowed physical movement, or, on the other hand, being physically restless.
  6. Fatigue or loss of energy.
  7. Feelings of guilt or being worthless.
  8. Difficulty concentrating and feeling indecisive.
  9. Thoughts about death or suicide, beyond worrying about dying. 

These symptoms will represent a change in your normal state of being, and can't be solely attributed to another disorder. 

How is depression treated in this case?

Major depressive disorder is typically treated with talk therapy if it's mild, and a combination of talk therapy and antidepressants if it is moderate or severe. This is true for people who suffer from chronic fatigue syndrome, fibromyalgia, and chronic pain as well. If you are prescribed antidepressants, your doctor will need to make sure that they do not interact with any medications you are already taking. 

Other medications may also play a role in alleviating your depression, however:

  • Anti-seizure drugs, especially pregabalin (Lyrica) — which is FDA-approved for the treatment of fibromyalgia — and gabapentin (Neurotontin) can be extremely helpful to fibromyalgia patients and those with chronic pain disorders.
  • Benzodiazepines, such as Valium, can be prescribed in the short-term to alleviate depression and anxiety as well as to relax muscles and induce sleep. They are addictive, however, so caution is advised. 
  • Nonbenzodiazepine hypnotics like zopiclone and zolpidem also help with sleep and may make you more energetic. They can, like benzodiazepines, be habit-forming.
  • Muscle relaxants such as Flexeril and Cycloflex can help you sleep.
  • If pain contributes or directly causes depression, it is no surprise that alleviating pain can help fight depression. Effective pain killers, usually prescription-only ones, can play a powerful role in your treatment. 

Lifestyle steps and alternative remedies such as exercise, acupressure, meditation, and yoga can also be beneficial. 

The bottom line

If you suffer from chronic fatigue syndrome, fibromyalgia, chronic pain, or all three, your risk of developing major depressive disorder is significantly higher than it is in the general population — where depression is already pretty prevalent. The fact that there is an obvious contributing factor, in the form of a diagnosis that limits your abilities to live your life the way you want to, doesn't mean that there is nothing that can be done for you, however! 

As a patient, you can get the help you need by familiarizing yourself with the diagnostic criteria for depression and letting your doctor know if you believe you are depressed. If you are diagnosed with depression, your treating healthcare provider and you can then work out the individual treatment plan that best meets your needs. 

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