- Hi I'm Dr. Tracey Marks
and I make mental health education videos.
What's the relationship between pain and depression?
Today's video is based on a viewer question from John
and he asks, "Dr. Marks,
how much does chronic pain play into depression?"
Thanks John for your question.
Well it turns out there's a very close relationship
between pain and depression.
You can think of it as bi-directional meaning
that each entity influences the other.
Pain worsens or can even cause depression
and depression worsens your pain tolerance.
This worsening of your pain is not just your perception
because you feel down,
depression increases your sensitivity to pain.
So it's as though you feel pain more intensely
when you're depressed,
than you would if you weren't depressed.
This is related to what we call the somatization
of depression or the tendency to feel depression
in your body.
Depression can affect you physically,
even if you don't have a pain problem,
when you get depressed, you can be more sensitive
to body sensations and experience them in a negative way.
Some people can have complain of joint pain,
headaches, or dizziness.
You may feel bloated or constipated.
It's not because depression makes you constipated,
but when you're depressed you can neglect your fluid intake
and then have slower moving bowels.
Then your mental state magnifies the intensity
of that experience.
So that's the person with depression who has somatic
or body manifestations of their depression.
But let's say you have a back injury,
or some other source of pain like arthritis.
Depression can actually make you more sensitive
to the pain such that you experienced pain longer
and may not respond as well to your regular doses
of pain medicine.
The second relationship between pain
and depression is chronic pain that goes unresolved
for months can cause depression.
Usually chronic pain is pain that lasts more
than three months.
And here's why chronic pain can cause depression,
even if you never had depression before.
Pain sensations are expressed
through a special sensory nerve pathway called nociceptors.
When you experience something painful
which is called noxious stimulation
these special nerves send a signal that travel
through your spinal cord and up to your brain.
The brain detects this as noxious,
and generates an emotional
or behavioral response like crying or flinching,
grabbing the area,
or shifting your weight to lessen the pain.
So you have the sensation of pain that comes from somewhere
on your body, that gets interpreted in the brain,
and then the brain produces an emotional response.
The place in the brain where this decoding
of pain information takes place is close to the areas
of the brain for mood regulation.
Imagine the injury pathways
and mood regulation pathways existing
in a modern day workspace with an open floor plan.
It's easy for what's going on in the injury area,
to spill over to the mood area and vice versa.
So what kind of information will crossover
between the two areas
that wouldn't make one affect the other?
Good question.
A proposed process for this involves neuroplasticity.
Neuroplasticity is defined as the ability of the brain
to form and reorganize synaptic connections,
especially in response to learning,
experience or following an injury.
In general tighter connections
between the individual nerve cells,
promotes better communication between the cells,
so they can process important signals faster
and more precisely.
You can think of pain and depression as injury states.
Injury states are associated with looser connections
and poor communications between the cells.
Since some of the pain nerves sit adjacent
to the nerves involved in depression,
if pain triggers a reorganization of the cells
and loosens those connections,
the depression nerves connections are affected as well.
If you go back to the open office analogy,
if an earthquake hits the pain office,
the whole floor is wrecked and everyone suffers.
So that's two ways depression and pain are related.
One, depression can lower your pain sensitivity,
making you experience the pain more intensely
and not respond as well to pain management.
Two, chronic pain can cause depression by we think anyway
by altering the connections between the nerves
that regulate your mood.
This is a very simplified explanation,
for more juicy details you can read the references
in the description.
Also keep in mind not everyone
with chronic pain develops major depressive illness.
It can make you feel low and discouraged
but depression is more than feeling low.
So what can you do about this?
When you have a combination of pain and depression you have
to use different approaches to treat both.
As for non-medication options
there's cognitive behavior therapy
that's targeted at pain and depression.
The focus is usually
on helping you reframe your thoughts around your pain,
and develop better coping skills to manage the pain.
Then there's relaxation training using things like,
progressive muscle relaxation, mindfulness and yoga.
Hypnotherapy is a specialized therapy
where a therapist gets you into a trance-like state,
and then speaks positive suggestions
about your pain that you internalize and act on.
Think of it as like drinking alcohol to loosen you up
to give you the nerve to do something
that you wouldn't do if you weren't the influence.
Well hypnotic suggestion lets you internalize things
that you couldn't when you weren't under the influence.
Hypnosis is something that you can learn to do yourself.
Ask for medications there are three types of medications
that have been studied to treat both depression
and anxiety and pain.
And these are the serotonin-norepinephrine
reuptake inhibitors like,
duloxetine and venlafaxine,
the tricyclic antidepressants like amitriptyline,
and some anticonvulsant mood stabilizers like lamotrigine.
Pain management doctors may use the tricyclic medications
at lower doses for pain management.
But psychiatrists don't use them much anymore
to treat depression, because they have a lot
of side effects at the higher doses.
So be careful if you're already on an antidepressant,
and you get prescribed to tricyclic on top of that for pain.
The doctor prescribing your main antidepressant,
may need to decrease the dose
or discontinue it to reduce your risk of serotonin syndrome.
I talk about serotonin syndrome and how I recognize it,
in this video.
That's it, thanks for watching,
see you next time.