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Jose G. Veliz, M.D. M.S.A.
Medical Director
Palomar Pain Management Center
Pomerado Pain Management Center
Posted July 21, 2008 11:05 AM
Pain and Depression
Marshall Teitelbaum, M.D.
Depression, often referred to clinically as MDD (major depressive disorder), is a common and disruptive disorder. The diagnosis is often missed or inadequately treated. The latter is important because the prognosis is worse if the MDD is only improved and allowed to become chronic. Commonly seen symptoms may include a lack of pleasure, sadness, irritability, sleep and/or appetite changes, reduced energy and motivation, hopelessness, and at times a desire to end life. A problem is that people often do not, or feel unable to, take steps that would help treat this condition, such as increased activity, exercise, going to psychotherapy, obtaining a psychiatric consultation and starting medication, as well as eating and sleeping properly. The previously described symptoms often cause the afflicted person to no feel as though it will matter and to not have the motivation to get started. Imagine trying to go through 3-6 months of physical therapy after knee or back surgery if you did not believe it would matter at the end of that time.
There is a strong link between pain disorders and depression. There are studies that show certain nerve chemicals, such as brain-derived neurotrophic factor, respond similarly to chronic pain or depression, leading to a lesser resilience over time of systems that regulate many bodily functions. In other words, it leaves the body feeling like it is under a perpetual state of attack. This causes an increased risk for high cholesterol, obesity, diabetes and even sudden death.
Unfortunately, chronic pain can also cause people to be less active, less hopeful about the future, sleep les, to eat improperly and otherwise not pay as much attention to the general care of their bodies. Whether cause or effect, there is a higher rate of depression developing with chronic pain disorders. Conversely, there is a higher rate of more pain problems or how the pain issues are experienced in folks with depression.
Although it is important to obtain the best care possible to identify the cause of the pain disorder and treat it to its fullest, it is also imperative that those afflicted not mix the core of who they are with the medical problem with which they are dealing with. No person is a case of a bad back but rather a person having to live with 'a bad back.' Try to remember what you enjoyed in the past or what you might enjoy given your physical limitations and find a way to make these a part of your life.
To summarize, learning to live life in spite of pain reduces the quantity of the pain while helping to improve the quality of life. This can reduce the risk of depression developing, too. If depression is there, it is not anyone's fault, but something that requires assistance to get better. Don't left untreated, there is a greater likelihood that both the physical and emotional pain will gradually become more problematic and prevent one from taking the appropriate steps to get better. Dont let this vicious cycle be you!
About the author:
Marshall Teitelbaum, M.D. is board certified in general psychiatry and child and adolescent psychiatry. He completed his training at the University of Miami School of Medicine, the Cleveland Clinic Foundation psychiatry residency program and the Univ. of South Florida child and adolescent psychiatry fellowship program. He now practices in Jupiter, FL and is president of Atlantic Psychiatric Care, located at:
641 University Blvd, Su. 206
Jupiter, FL 33458
(561) 630-8530
Facsimile (561) 630-8531
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