By: Jessica Franke
It is estimated that 30-40 percent of the fibromyalgia community suffers from depression. For the afflicted individual, it is almost impossible to understand how anyone could have FM and not be depressed, but clinical depression is a separate condition with its own causes and treatment options. However, the fact that the two conditions exist together so often suggests a relationship, be it biological or situational.
“It is widely accepted that depression is a biochemical imbalance of certain neurotransmitters in the brain, specifically serotonin, norepinephrine and/or dopamine,” says Rebecca Ross, a psychiatric mental health nurse practitioner and graduate student researching FM. “Different causes can contribute to this imbalance: physical stress, emotional stress, and the psychosocial stress of living with FM… Current research also suggests depression and FM share a common neuroendocrine (brain hormones) dysregulation.”
Dr. Renee Taylor, PhD, who studies and develops methods chronically ill people can use to improve their lives, says that the reasons FM patients develop depression are complex and depend on the individual. “Some explanations include, but are not limited to, demoralization resulting from the pain and functional limitations imposed by FM; an extended period of grieving the onset of a chronic illness and the many resource losses that may accompany it; decreased social contact and changes in key relationships; changes in family, social, and occupational roles; usage of certain prescribed medications, which may be centrally acting and may lead to or exacerbate the depression; and biological predispositions in some individuals.”
All FM patients experience many of these life changes to a certain degree as a result of the disease. Also, many typical symptoms of clinical depression, such as decreased energy and changes in sleeping patterns, are also symptoms of fibromyalgia. How will an individual know when he or she has crossed the line from a normal response to clinical depression?
“Individuals should seek help when natural feelings of grieving and loss associated with the onset of a chronic illness have a prolonged duration, when an individual feels hopeless about the future and about the chances for improvement, and when an individual notices that feelings of depression are leading to a worsening of symptoms,” Taylor says.
“If the symptoms of depression are significant enough to interfere with daily functioning, then they should seek professional help,” says Ross.
Patients should also watch for the many standard signs of clinical depression, including feelings of worthlessness or decreased interest in activities that used to be enjoyable. Patients should seek immediate help if having thoughts of suicide or death.
People with FM, clinically depressed or not, can benefit from many kinds of psychotherapy, some of which teach coping mechanisms and stress management to facilitate adapting to life with a chronic illness.
“Research in this area is limited, but some studies suggest that cognitive behavioral therapy can be effective in alleviating depression for certain individuals with FM,” says Taylor.
Cognitive behavior therapy (CBT) is based on the idea that the way we think and act affects how we feel, so to change our emotions we need to alter our negative behavior and thought patterns. The active nature of this therapy and its focus on general coping skills can help return a sense of mastery and control when a patient feels overwhelmed or helpless.
Principles of CBT are often combined with other types of therapy to provide an individualized course of treatment that addresses the specific needs of the patient.
“I have found a combination of CBT, supportive therapy (empathic listening and problem solving), and Systems Therapy (family/social structures therapy) to be helpful. EMDR can be very helpful to some people, especially those with past traumas and/or severe anxiety/panic disorders,” says Ross. In EMDR, a trained professional guides the patient through a traumatic memory while delivering bilateral physical stimulation in order to remove the emotional reaction to that memory.
It is important that the patient feel comfortable with his or her therapist, as private information will be shared. Part of feeling comfortable and being able to progress in therapy involves feeling validated, which mandates that the therapist has an understanding of fibromyalgia and how it can affect the patient’s life.
“Because FM is a unique syndrome and few mental health practitioners fully understand it, asking for a referral from a medical specialist that treats many patients with FM is the best place to start,” says Taylor.
FM patients can identify potential therapists through an insurance provider list, local fibromyalgia support groups, friend or family recommendations, the American Psychological Association (http://www.apa.org/), or by just checking out the phone book.
Ross offers this advice: “The best way to find out if someone is knowledgeable about FM is to ask—this is not only appropriate, it is necessary to find the support you will need!”
Above all, it is essential that the patient be comfortable with his or her therapist. With the help of psychotherapy (and potentially medication), depression is one aspect of fibromyalgia that can be effectively treated.
Dr. Renee Taylor is an Associate Professor within the Department of Occupational Therapy at the University of Illinois, Chicago.
Rebecca Ross is a Psychiatric Mental Health Nurse Practitioner and is currently a fourth year PhD student of Nursing Research at the Oregon Health Sciences University.