Dispersing the Black Clouds
“So, Kathryn, how long were you experiencing these feelings of depression before the pain arose?” The doctor eyed me thoughtfully.
“I wasn't depressed before the pain started,” I explained. “It has simply come on gradually because I feel so helpless trying to deal with this pain.”
“Yes, I see, but what happened to upset you before the pain started?” he persisted.
“Nothing happened!” I said, surprised. “I was quite happy taking a year out between college and university, and looking forward to going traveling in the summer.”
“Yes, but something must have triggered your depression to bring on the pain you are now experiencing,” he explained.
“But I told you, I wasn’t depressed before the pain started,” I reiterated, beginning to feel annoyed.
“Depression is a common cause of pain,” he continued, as though I hadn't spoken, “and as there does not seem to be another satisfactory explanation for the pain you are experiencing at the moment, Kathryn, I think your depression is the most likely cause.”
“Well, I don't see how, when the pain started at least one month before I started having any feelings of depression.” My voice rose in irritation. This conversation was my first encounter with the proposed link between chronic pain and depression, and it left me feeling quite defensive.
Sound familiar? This conversation happened about 13 years ago, and, fortunately, I have since discovered that there is very little evidence linking depression as a causative factor of fibromyalgia.
I remember feeling very relieved and vindicated on hearing a lecture by a clinical psychologist, Dr. Amanda Williams, a senior lecturer at Guys & St Thomas's Medical School in London, England in 2002. She stated that “there is no basis for the model that unresolved emotional problems cause pain, and no evidence that depression produces pain.” However, this does not mean that people with fibromyalgia do not experience depression.
Who would not at times feel depressed when having to cope day by day with chronic pain? Loss of health can lead to all kinds of emotions: frustration, anger, resentment, and mourning the life you have lost. These feelings are perfectly natural and can lead to reactive depression, meaning that they are a direct reaction to the situation a person is dealing with. Clinical depression, on the other hand, can arise for no particular reason and is what people experience when nothing specific has happened.
But if this is the case, then why are we prescribed antidepressants? The answer is that antidepressants in very low doses (that would have a very limited effect on clinical depression) can work to suppress pain signals and restore sleep patterns by helping to rebalance levels of serotonin and noradrenaline. Just because your doctor prescribes antidepressants, that does not mean that he thinks the cause of your fibromyalgia is depression.
Despite reactive depression not being the cause of fibromyalgia, it is still important to deal with the symptoms, especially if they become overwhelming. Working through anger and resentment, along with tackling thought processes and beliefs, can radically alter our ability to cope with and manage the pain and fatigue. Understanding the pain and how to handle it can mean the difference between feeling depressed, powerless and isolated, to being in control, having a positive outlook, and getting satisfaction out of life again.
You may feel wary about mentioning your feelings of depression to your doctor, just as I was after the conversation above; however, since then I have attended pain management programs on the advice of my new doctor and have learned how to tackle my thoughts and belief systems through cognitive behavioral therapy (where the patient and therapist work together to recognize unhelpful habits and behavior and to develop positive coping strategies) and to recognize when I would benefit from counseling to deal with any build-up of anger and frustration. Now I feel that I have some weapons at my disposal to attempt to disperse any descending black clouds.
