Pain and Mood: Depression Hurts
September 20, 2004
By James Bakalar

Newsweek, Sept. 27 issue - Every child knows that a scraped knee can bring tears as well as blood. Physical pain always has emotional overtones, and we now know that emotional distress can be physically painful. Depressed people suffer three times their share of chronic pain, according to recent studies, and people in pain are at high risk of depression. Some studies suggest that if physicians tested all pain patients for mood problems, they might discover 60 percent of all undiagnosed depression. If you're struggling with either problem, there's a good chance you're suffering from both of them.

The link between sensory pain and emotional pain is rooted in the nervous system. Both are governed by the same neurotransmitters (chemicals such as serotonin, norepinephrine and substance P), and both are processed in the same parts of the brain. When the circuitry is working properly, pain and anguish are self-limiting: we recoil from unpleasant experiences, the feelings fade and life goes on. But if a problem persists, or the circuitry malfunctions, the brain's distress signals stay switched on, with devastating consequences. One study found that over a two-year period, a person with a history of migraine was five times more likely than average to have a first episode of depression. In a related condition known as fibromyalgia, the brain's overactive pain centers cause pain and tenderness in muscles all over the body. Not surprisingly, at least 30 percent of fibromyalgia sufferers go on experience depression as well.

The bright side of this story is that treating chronic pain can often help alleviate depression, and vice versa. The older antidepressants, known as tricyclics, have well-known analgesic effects—even at lower doses than depressed patients receive. Newer antidepressants such as Prozac, Zoloft and Paxil (the selective serotonin reuptake inhibitors) may not be quite as effective, but they're safer and may be easier to tolerate. Almost any drug that relieves an underlying psychological condition can help control pain. In pain rehabilitation centers, specialists often combine these medicines with common analgesics such as aspirin, ibuprofen and acetaminophen.

Drugs aside, mind-body techniques such as meditation, hypnosis and progressive muscle relaxation can help modulate emotional responses to pain. And psychotherapy can teach us to recognize thoughts and behaviors that amplify our feelings of distress. No one escapes having those feelings from time to time. Fortunately, they don't have to dominate our lives.

Adapted from the Harvard Mental Health Letter. For more information go to http://health.harvard.edu/NEWSWEEK.