Depression often referred to clinically as major depressive disorder (MDD), is a common and disruptive disorder. The diagnosis is often missed or inadequately treated. The latter is important because the prognosis is worse if 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 a desire to end life. People often do not, or feel unable to, take steps that would help treat this condition, such as increased activity, exercise, obtaining a psychiatric or psychology consultation, starting medication, eating properly and sleeping properly. The described symptoms often cause the afflicted person not to 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 believed it was useless.
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There is a strong link between pain disorders and depression. Some studies show that certain nerve chemicals, such as brain-derived neurotrophic factor, respond similarly to chronic pain and depression, leading to a lesser resilience over time of systems that regulate many bodily functions. It leaves the body feeling like it is in a perpetual state of attack. This causes an increased risk of 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 less, 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 with chronic pain disorders. Conversely, there is a higher rate of pain problems and pain issues are more likely to be experienced in those with depression.
Learning to live life despite pain reduces the quantity of the pain while helping to improve the quality of life. This can also reduce the risk of depression developing. Try to remember what you enjoyed in the past or what you might enjoy given your physical limitations and make these a part of your life. If depression is there, it is not anyone's fault, but something that requires assistance to get better. If left untreated, there is a greater likelihood that both the physical and emotional pain will become more problematic and prevent one from trying to get better. Don’t let this vicious cycle be you.
Jose Veliz MD is the medical director of Palomar Spine & Pain, in Escondido, CA (North San Diego County).