Depression is an extremely complex disease. It occurs for a variety of reasons. Some
people experience depression during a serious medical illness. Others may have depression
with life changes such as a move or the death of a loved one. Still others have a family
history of depression. Those who do may experience depression and feel overwhelmed with
sadness and loneliness for no known reason
What Are the Main Causes of Depression?
There are a number of factors that may increase the chance of depression, including the
Past physical, sexual, or emotional abuse can cause depression later in life.
- Certain Medications
For example, some drugs used to treat high blood pressure, such as beta-blockers or
reserpine, can increase your risk of depression.
Depression may result from personal conflicts or disputes with family members or
- Death or a Loss
Sadness or grief from the death or loss of a loved one, though natural, can also increase
the risk of depression.
A family history of depression may increase the risk. It's thought that depression is
passed genetically from one generation to the next. The exact way this happens, though, is
- Major Events
Even good events such as starting a new job, graduating, or getting married can lead to
depression. So can moving, losing a job or income, getting divorced, or retiring.
- Other Personal Problems
Problems such as social isolation due to other mental illnesses or being cast out of a
family or social group can lead to depression.
- Serious Illnesses
Sometimes depression co-exists with a major illness or is a reaction to the illness.
- Substance Abuse
Nearly 30% of people with substance abuse problems also have major or clinical depression.
Fibromyalgia and Depression
Many studies link fibromyalgia and depression. In fact, about three out of every 10 people
with fibromyalgia also have major depression at the time of their diagnosis.
Some researchers feel that depression leads to changes in brain chemistry. Others look at
abnormalities of the sympathetic nervous system -- the part of the nervous system that
determines how you handle stress and emergencies. These abnormalities, they contend, may
lead to the release of substances that cause more sensitivity to pain. The result is
fibromyalgia with its chronic pain and feelings of depression.
Learning more about the connection between fibromyalgia and depression can help you seek
appropriate medical treatment from your doctor. That includes asking your doctor about
By following an appropriate fibromyalgia treatment plan and getting the support of family
and friends, you can take control of your fibromyalgia. You can also get control over your
symptoms of depression and improve your quality of life.
What Is the Link Between Fibromyalgia and Depression?
The stress from fibromyalgia's pain and fatigue can cause anxiety and social isolation.
The chronic deep muscle and tender point pain can result in less activity. That causes
you to become more withdrawn and can also lead to depression. It is also possible that
anxiety and depression are part of fibromyalgia, just like the pain.
Depression and fibromyalgia can greatly interfere with the way you manage your activities
at home or at work. So it is important to openly discuss any symptoms of depression you
have with your doctors.
Does Stress Increase Depression With Fibromyalgia?
The stress of living with chronic pain and relentless fatigue can put a person into
"overload." That can result in overwhelming feelings of nervousness and anxiety. What
isn't clear is whether a stressful life brings about the fibromyalgia or if having
fibromyalgia leads to stress.
No matter which comes first, stress adds to problems of anger, distractibility, and
irritability. It can even lead to further physical changes, such as high blood pressure or
heart problems. Most patients feel worsening of pain and fatigue when they have more
stress. Sometimes, severe stress occurs just before the disease starts.
Is Depression Common With Chronic Pain Conditions?
Feelings of depression are common with all types of chronic pain, including headache, back
and neck pain, hip pain, shoulder pain, and the pain of fibromyalgia. For example, the
prevalence of major depression in people with chronic low back pain is three to four times
greater than in the general population.
By the same token, having a depressive disorder also increases the risk of developing
chronic pain. Patients who are depressed have greater pain. They describe greater
hindrance from pain and display more pain behaviors than pain patients who are not
People with chronic pain such as fibromyalgia often become depressed and isolated. As a
result, they spend more time away from other people, even people they love, such as family
and friends. Instead of focusing on their personal lives or the lives of their loved ones,
they become increasingly focused on their pain and suffering, which is very real. Adding
to the frustration are the repeated appointments with health care providers to try to
find relief and the resulting costs.
Linking Fibromyalgia to Depression and Anxiety
Chronic, widespread muscular pain and tenderness, sleep problems and fatigue, morning
stiffness and headaches, concentration and digestive irregularities: All these symptoms
can make daily functioning very difficult for those with fibromyalgia. But equally
challenging are the depression and anxiety that often accompany the disorder.
Depression and anxiety each occurs in approximately 8 percent of those with fibromyalgia,
according to Jacob Teitelbaum, M.D., medical director of The Fibromyalgia & Fatigue
Centers, a nationwide group of treatment centers. In people with fibromyalgia, he says,
anxiety often manifests itself as rapid shallow breathing (hyperventilation), and
depression as a decrease in normal interests.
While it is not unexpected to have an emotional or psychological response to a chronic
illness, there may be other physiological reasons that explain why anxiety and depression
occur in fibromyalgia patients consistently enough that they are listed as symptoms of the
condition. "Biochemically, depression is very different in [people with] fibromyalgia than
otherwise," says Dr. Teitelbaum. "In fibromyalgia, it is often associated with an
underactive adrenal function [a low cortisol level], whereas depression [in a
non-fibromyalgia population] is associated with a high cortisol level."
Physical Factors That Can Affect Emotional Health
According to some doctors who routinely treat fibromyalgia, there are a number of factors
that appear to increase the likelihood of developing anxiety and/or depression if you have
Antiaging medicine specialist Pamela W. Smith, MD, MPH, director of The Center For Healthy
Living and Longevity in Michigan, says, "Ninety-five percent of people with fibro have low
thyroid function (hypothyroidism) and 100 percent of them have low adrenal function - and
both conditions can cause depression and anxiety." The thyroid gland produces hormones
that help regulate metabolism. Fortunately, hypothyroidism (when the level of certain
thyroid hormones produced is below normal) is easy to diagnose. A complete blood test for
thyroid levels, including TSH (thyroid stimulating hormone) and other thyroid hormones,
can identify if a problem exists, says Dr. Smith. Once treated with appropriate
medication, thyroid function should return to normal, and depression or anxiety should
ease as well.
- Low Cortisol Levels
Cortisol is a hormone produced by the adrenal glands in response to stress. When the
adrenals produce an insufficient supply of cortisol, however, it can result in what's
sometimes called "adrenal fatigue;" symptoms include muscle aches and pains, extreme
fatigue, anxiety, and elevated levels of cholesterol, blood sugar, and blood pressure.
According to Dr. Smith, adrenal fatigue can occur when the body is under stress for
extended periods of time. "When you are first stressed, cortisol elevates," she explains.
"But if you stay stressed for a long time, the body can't keep up by making extra
cortisol, so it makes just enough to keep you alive."
Dr. Smith says that low cortisol levels related to stress often do not show up on standard
blood tests, and she believes they are best measured by saliva testing. "Many physicians
only measure cortisol levels as related to Addison's disease or Cushing's disease. They do
not look at what happens when the body makes only enough cortisol to stay alive but not to
function well (adrenal fatigue)," she explains.
Cortisol levels can be normalized by reducing stress, says Dr. Smith. Techniques Dr. Smith
recommends include "prayer, meditation, tai chi, yoga, breathing techniques and massage,
[although] herbal therapies, adrenal extracts, and medications may all be necessary to
bring cortisol levels back to normal." she says, adding, "it may take one to two years to
fully normalize the body's stress system." As cortisol levels are restored,
fibromyalgia-related anxiety and depression generally lessen, she notes.
- Poor Mitochondrial Functioning
Mitochondria are the energy-producing parts of the cell that assist in vital body
processes like metabolism. When their function is impaired, they can also play a role in
the development of depression and anxiety in people with fibromyalgia, says Dr. Smith. She
reports that in her patients, supplements such as coenzyme Q10 (CoQ10), the amino
acid-like compound L-carnitine, NADH (nicotinamide adenine dinucleotide, which is related
to niacin, a B vitamin), D-ribose, and the antioxidant alpha-lipoic acid all help to
refuel mitochondria. And in some patients, taking these supplements has been helpful in
reducing symptoms of depression and anxiety related to fibromyalgia.
- Vitamin D Deficiency
Fibromyalgia has been linked to low levels of vitamin D, which has also been found to
occur more frequently in patients with anxiety and depression. Vitamin D deficiency can
be offset by supplementation and eating foods enriched with this nutrient, such as
fortified orange juice or margarine.
- Poor Sleep
Insufficient restorative sleep can lead to or aggravate existing anxiety and depression
in people with fibromyalgia, and they do not go into the stage of sleep known as REM
sleep, says Dr. Smith. This problem may be further compounded by taking antidepressant
medication, which can suppress REM sleep in certain people. Other causes of
non-restorative sleep in patients with fibromyalgia can include muscular aches and pains
and, according to one study, decreased levels of the hormone melatonin.
"There really are metabolic reasons why people with fibromyalgia have the symptoms that
they have," says Dr. Smith. She recommends that people with fibromyalgia undergo testing
to determine if an underlying deficiency or a related health condition could be
complicating their situation and bringing depression and anxiety to the surface.