Chronic Pain and Depression

chronic-pain-and-depression

People who have been diagnosed with a medical condition and experience chronic pain because of it are quite likely to develop depression.  Chronic pain is debilitating and can impact everyday life by rendering suffering individuals dependent, powerless, and feeling very sick.  Suffering because of pain is already enough to make someone depressed but the added negative psychological effects pain brings can help deepen feelings of sadness, fear, and hopelessness.

Understanding Chronic Pain

Chronic pain is the condition in which pain from an injury or illness lasts longer than what is considered normal.  Chronic pain causes the body to react negatively, thus contributing to problems in other areas even if these are not related to the original pain source.  A body in prolonged pain can exhibit mood disorders, muscle pain, fatigue, and impaired cognitive and physical functions. Sometimes, chronic pain causes neurochemical changes which increase the body’s sensitivity to the pain.  The afflicted may actually start feeling pain in other areas of his body.

The Pain and Depression Tandem

Chronic pain is difficult to cope with so that many sufferers go into a depression.  Unfortunately, depression can amplify pain; so that the cycle continues…more pain leads to deeper depression and so on.  Depression’s symptoms such as insomnia, lack of energy, loss of appetite, and decreased physical activity are factors that worsen pain.

Depression’s viability as a partner of pain may rest on the fact that both share the same two neurotransmitters: 5-HT and NA.  Neurotransmitters are chemicals in the brain that relay signals to help nerve cells communicate.  These chemicals send the messages for the heart to beat, the stomach to digest, and the lungs to take in air and expel it, among other signals.

Pain and depression often go hand in hand; but, they are not inseparable.  Depression may be treated separately with cognitive behavioural therapy and medication.  Relief from depression can decrease pain as well.

Physical and Emotional Issues Chronic Pain Induces:

A person experiencing chronic pain is often anxious and irritable.  He may also feel:

  • Angry
  • Constantly anxious or panicky
  • Mood swings
  • Low self-confidence
  • Confused
  • Decreased sexual appetite
  • Weight loss; weight gain
  • Physical weakening
  • Sleep disturbances
  • Fear of injury
  • Fatigue

All these symptoms also point to depression which needs to be treated in order to ease a patient’s pain and allow him to live capably with it.

Treatment

As mentioned, chronic pain and depression touch on the same neurotransmitters and nerve system.  As such, antidepressants can help relieve pain by making the brain change its perception of the pain’s degree while reducing the symptoms of depression as well.  New antidepressants such as Duloxetine HCL and Venlafaxine HCL do not have as much side effects as the older tricyclic antidepressants.

Depression can be further treated separately with talking therapies such as Cognitive Behavioural Therapy.  When depressive symptoms are reduced, the degree of chronic pain also usually decreases.

Physical exercise may also be recommended as part of the treatment plan.  Although it may be the last thing anyone in chronic pain would want to do, exercise is a necessary part of helping the body cope with the pain.  Consistent physical movement helps keep the body fit and less prone to more injuries and worsening pain.  Moreover, exercise helps dampen depression by increasing the very brain chemicals antidepressant drugs are designed to release.  A physician may help formulate a safe and effective exercise regimen for the patient.

chronic-pain-cycle

Cognitive Strategies for Dealing with Chronic Pain

There are no easy answers for dealing with chronic pain.  The person involved must make a lot of effort to take control of his condition and live successfully with it.  Some of the things a person in chronic pain can do are:

  • Learn as much as he can about type of chronic pain he is afflicted with.  Knowledge can lessen the fear that pain is causing more damage than what it is.
  • Know good sleep hygiene or habits that contribute to better rest and sleep.  Pain can be exacerbated by fatigue and a body that sees little rest.
  • Sidetrack pain or remove the focus from pain by engaging in things you like doing.  Being preoccupied with something of real interest could relegate pain into the background.
  • Knowing what thoughts are unhelpful and switching these for more positive ones in order to improve outlook and mood
  • Indulge in meditation and relaxation therapies in order to decrease overall muscle tension caused by pain.  Muscle tension actually exacerbates pain so a reduction of the tension could also spell pain reduction.

Chronic pain can change one’s life.  It can affect a person’s ability to work and live the way he was used to.  As such, it is important to factor in coping strategies into everyday life so that chronic pain and the depression it drags with it are not given the opportunity to radically lower one’s quality of life.

Obesity and Its Impact on Mental Health

obesity scale

While the world’s population has been going on a rising trajectory, it has also been growing heavier by the year.  Obesity is now a global health issue.  According to the World Health Organization (WHO), the epidemic is spawned by the pervasive issues of unhealthy diets and low physical activity.  Obesity is expected to be one of the biggest killers by the year 2020.

High body mass indices (BMIs) of 30 or more plague an estimated 300 million people globally at every social class and age group, particularly in the U.S., U.K., Middle East,  Australia, China, and the Pacific Islands.  Much more disturbing is the phenomenon of rising child obesity which has almost tripled within the last three decades.

Notwithstanding the fatal repercussions morbidly excessive weight can have on physical health, obesity takes its toll on mental health as well.

The Relationship between Obesity and Mental Health

Research backs evidence of an intrinsic link between obesity and common mental disorders. Obesity can cause depression, anxiety, and other unhealthy mental conditions just as these mental illnesses can lead to obesity.  According to the March 2011 National Obesity Observatory paper on Obesity and Mental Health, studies point to a two-way correlation between depression and obesity.  “Obese persons had a 55% increased risk of developing depression over time, whereas depressed persons had a 58% increased risk of becoming obese.  Another recent systematic review and meta-analysis found a weak but positive association between obesity and anxiety disorders.”

Generally, an obese person is not a very happy person.  Obesity can trigger many unhealthy psychological conditions:obesity stigma

Depression

A higher incidence rate of depression occurs among morbidly obese individuals, especially those with BMIs of 35 and over.  Studies also reveal that obese children often rate their quality of life lower than children suffering from cancer.  The Swedish Obese Subjects (SOS) study disclosed that very obese individuals often had as much as or higher depression scores than patients who were afflicted with chronic pain.

Western culture places a stigma on weight and as a result, excessively overweight individuals tend to develop self-imposed social isolation, poor self-image, and low self-worth, all major contributory factors to depression.  This has not been without just cause, though.  Society has not been very kind to the excessively overweight.  Fat people have often been ridiculed, ostracised, and stereotyped; hence leading most overweight individuals to adopt even more self destructive behaviours such as binge eating and substance abuse.

There is a silver lining though.  When obese patients begin to take off significant weight, their mental state also begins to improve.

Anxiety and Mood Disorders

A study that involved NESARC data found that obese persons were one and a half times more likely to report a mood disorder or panic attacks that have been plaguing them for the past year or as long as they can remember.  Extremely obese individuals were twice as likely to report the same.  The anxiety phenomenon is stronger in women than in men.

Because of Western culture’s aversion to fat people, obese individuals can develop social anxiety disorder (SAD) just from the sole reason of being extremely overweight.  Such a disorder has served to impair their functioning in their social milieu.

On the obverse, anxiety can breed obesity as well.  Anxiety can trigger compulsive and excessive eating patterns and depress the will to engage in physical activity, two factors which generally lead to obesity over time.

What Can Be Done?

For people with mental health disorders due to obesity, there is good news.  Mental health conditions significantly improve as one reduces his weight.  However, making radical changes to lifestyle eating and movements may backfire if one does not make such changes with a support group or team.

Consider approaching the obesity problem with the help of qualified professionals.  Your GP can draw up a safe, balanced eating plan and exercise regimen while a psychiatrist or psychologist can help you discover the core issue behind overeating and your subsequent weight gain.  These professionals can also help you deal with negativity and low self-esteem.

Depending on the level of obesity, medications for obesity or surgical procedures such as gastric bypass, bariatric surgery, and the like may be prescribed.  However, lifelong lifestyle changes will always be obligatory to complement and maintain obesity treatment.

Mental Health During Pregnancy and Postpartum

pregnant-depressed-women1

Pregnancy is a life changing condition.  Physically and mentally, there are many changes that happen with new life growing within.  These changes during the perinatal and postnatal periods often put new mothers and mothers-to-be at high risk for developing anxiety and depression.  Less common but worse conditions may include bipolar disorder and postpartum psychosis.

Women may develop a mental health problem during pregnancy or may have a recurrence of such a problem if she had such issue before pregnancy.  Women on medication for some mental disorder may have to stop taking their prescriptions when they get pregnant.  Unfortunately, they form a high risk group for recurring symptoms.  Seven out of ten women who stop their antidepressant medication for instance fall back into depression or anxiety during their pregnancy.

In the U.K., about 10-15 out of 100 pregnant women become clinically depressed or anxious.  The cause is not singular but it is usually a mix of factors and it can happen to anyone.  These factors may depend on:

  • Degree of recent or ongoing stress in one’s life such as a death of a loved one, divorce or separation, etc.
  • Attitude toward pregnancy.  The thought of raising a child, for instance, may put undue worry on a person especially one with a difficult childhood.  Changes in weight and shape may take an emotional toll especially if the mother has an eating disorder.
  • Whether one is on treatment or medication.  Stopping treatment could make one fall ill again.
  • Type of mental illness one has experienced

Postpartum Depression and Anxiety

As pregnancy and post pregnancy are times of great changes, depression symptoms may not be so easy to identify.  Depression signals may come when there are big changes in everyday routines or habits such as short sleeping hours, increase in appetite, etc.

If you are experiencing some of these symptoms for more than two weeks, get some help:

  • Feelings of hopelessness, worthlessness, emptiness, sadness, and other feelings of inadequacy
  • Very low moods; extreme sadness
  • Feeling numb
  • Easily irritated, angry, or resentful
  • Unfounded fears for the baby or of motherhood
  • Loss of interest in things that were normally enjoyable
  • Withdrawal from social contact
  • Not taking care of self
  • Insomnia
  • Poor concentration and decision making
  • Harbouring thoughts of harming the baby or one’s self; thoughts of suicide
  • Decreased energy; extreme lethargy

Anxiety is a common partner of depression.  When experiencing these symptoms, you need to see your GP or health professional who may test your degree of depression and anxiety using the Edinburgh Postnatal Depression Scale (EPDS).  The EPDS is a questionnaire which assesses your feelings if these fall outside the normal range and into the depression/anxiety scope.  This test may be conducted twice during pregnancy and once after childbirth.

Seeking Help

A pregnant woman, who has had prior history of mental illness such as schizophrenia, bipolar disorder, anorexia, or severe depression, must make a wise decision to talk to her GP.  Consultation with a specialist, even if she feels very good about herself and her pregnancy at the moment, is important because there is a high enough risk for her mental illness to recur during pregnancy or after childbirth.  One needs a care plan drawn up by a GP in order to head off or at least lessen the effects of the illness.

Medication During Pregnancy

Since many pregnancies are usually unplanned, some women may be under medication at the time of conception.  If you are under medication but suspect a pregnancy, do not stop medication suddenly but go see your doctor immediately.  He will assess whether to change or gradually take you off your medicines.  Stopping medications suddenly can quickly cause a relapse of your symptoms or cause undesirable side-effects.  If the doctor sees no harm to the foetus with the drugs you were prescribed with, he may insist that you continue with your medicated treatment.

While many medications are unsafe for pregnancy, selected antidepressants such as a few serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are considered safe for pregnant women.  These few have not been associated with birth defects and pass at very low levels through breast milk.

The decision of your doctor on whether to continue or not to continue medication may rest on the ff. factors:

  • the likelihood that you may not be able to take care of yourself when off medication
  • your tendency to turn to drugs or alcohol because you feel unwell without medication.  This tendency is harmful for both you and the developing foetus.
  • your tendency to develop postpartum depression which will affect your nurture and care for your baby
  • you are at a high risk for a relapse.  A relapse may require more medication, usually a higher dose or a supplementary drug, both situations that can be very harmful to the baby.
  • if talking therapies are not enough to mitigate your mental health issues.  Mental health problems like depression must be addressed because these can cause a host of problems from low birth weight to infant development.

Talking Therapies

Talking therapies or psychological treatments may be imperative treatments for pregnant women afflicted with depression or anxiety.  Cognitive behavioural therapy (CBT) for one can help you cope with your feelings by changing the way you think and behave.  Talking therapies help people identify the problem and ways to change their thinking and behavioural patterns so that the effects of the triggers are significantly lessened.  Some people may do away with medication and get by very well with talking therapy alone.

Talking therapy may be done as a one-on-one consultation or as a group event.  This type of therapy may also be conducted online as e-therapy through e-mail or video sessions.

postpartum blues

Seasonal Affective Disorder (SAD)

winter blues

Seasonal Affective Disorder, properly appellated with an acronym SAD, is a type of depression that occurs at the same season each year.  Winter is the most common time for SAD and that is why this emotional phenomenon is also known as winter depression or the winter blues.

The symptoms of depression usually begin sometime during late autumn when days become shorter and continue toward winter.  This low mood takes an upturn when  spring and summer come along.  Unfortunately, SAD may return the next autumn or winter season to begin its cycle.

Causes of SAD

Scientists are not sure what causes Seasonal Affective Disorder but the theory is that the lack of sunlight during autumn and winter’s shortened periods may have some effect on the brain’s hypothalamus which in turn has something to do with:

  • upsetting one’s circadian rhythm which throws your sleep-wake pattern off-kilter
  • lowering the levels of serotonin in the brain.  Serotonin is a hormone that affects one’s mood, sleep, and appetite
  • increasing the production of the hormone, melatonin, which makes one more drowsy than usual

Symptoms of SAD

SAD is a subtype of major depression, the only difference is that it comes and goes with the trigger season.  The symptoms can range from mild to severe, in which case the symptoms may hamper the person’s day-to-day activities.  Symptoms of SAD include:

  • chronic low mood or sadness
  • irritability
  • feelings of hopelessness, despair, guilt
  • plunging self-esteem
  • anxiety
  • lethargy and drowsiness during daytime
  • disinterest in day-to-day activities or even hobbies.  A person with SAD may suddenly take no pleasure from his usual interests
  • sleeping longer hours and still feeling exhausted upon waking
  • insomnia
  • carbohydrate cravings
  • weight gain
  • weakened immune system

Who are Most at Risk?

There seems to be more women patients of SAD than there are men.  People who live far from the equatorial region which have shorter daylight hours are prone to the condition.  It is however interesting to know that Iceland has a very low incidence of seasonal affective disorder.  The theory is that Icelanders eat a voluminous of fish, about 90 kg.  per year, compared to Canadians who average only 24 kg. per year and have a high incidence level of SAD.

SAD is also hereditary so people with the genes may develop the condition.

Additionally, age is a factor for susceptibility as well.  People between the ages of 15-55 are at higher risk of developing SAD than other age groups.

Treatment for SAD

Different treatment strategies are available for Seasonal Affective Disorder.  These are:light therapy

  • Light therapy – a light box is employed for the patient’s needed exposure to light.  This special lamp is made of fluorescent lights that are brighter than indoor bulbs but not as bright as
    natural sunlight.  UV lights, tanning lights, and heat lamps cannot be used to substitute for light boxes.
  • Cognitive Behavioural Therapy (CBT) or other talking therapies.  Counselling can help one understand SAD, manage its symptoms, and help prevent future recurrences.
  • Lifestyle modifications – implementing an exercise regimen, changes in diet, adjustment in sleeping schedules, and the like to maximise exposure to sunlight and manage stress
  • Antidepressant Medication – these include SSRIs such as Paxil and Zoloft or bupropion (Wellbutrin) and venlafaxine (Effexor).
  • Vitamin D supplementation – Another theory of cause for SAD is that the sufferer may not have enough Vitamin D because of insufficient absorption of Ultraviolet-B by the skin.  In this case, Vitamin D supplements may then be included as part of the therapy.
  • Negative air ionization — Releasing a sufficient density of negatively charged particles into the air while a patient is asleep has led to almost a 50% improvement in the condition.

The Exercise and Mental Health Connection

exercise lifts moods

The mind-body connection is so intertwined that one’s well-being hinges on the health of both of these major areas of the human organism.  An ailing body poses a psychological impact on the otherwise healthy mind.  Likewise, an unhealthy mind also impacts a person’s physical health.  For an individual to be considered in top form, both mind and body must be in good shape.

A person who wishes to achieve a balanced state of well-being in both mind and body should have a good level of physical activity as part of his lifestyle priorities.  People with jobs that demand some cardiovascular and muscle toning movements daily, such as fire fighting; construction work; and farming, are lucky to have some measure of fitness incorporated into their lifestyle.  Exercise does not just mean sports-related activities such as running, cycling, or weight lifting.  It also encompasses everyday movements that get tasks done like walking to the store, scrubbing floors, and lifting grocery bags.  The lowly house chores demand daily muscle movement and cardiovascular toning if one just does some manual cleaning.  For instance, floor scrubbing by hand can work your core area and back muscles.  Taking out heavy garbage bags and moving furniture also works on your gluts, thighs, arm, core, and back muscles.  You just have to know the proper form of deadlifting heavy weights so that you avoid any injury.

What Physical Activity Can Do For Your Mind

Many people underestimate the power of physical activity.  There is more to exercise than just muscle strengthening and cardiovascular endurance.  The human body is hard-wired to move frequently and the brain responds to these movements.  The amount of physical activity we do daily does have an impact on our brains.  Daily high levels of physical movements equate to more psychological positivity while an almost daily sedentary lifestyle may play an indirect or direct role in accelerating the degree of mental health issues over time.

Exercise Maintains Our Cardiovascular Health through the Sympathetic Nervous System

Research at the Wayne State University School of Medicine in Michigan discovered physical changes in brains of rats which were kept sedentary for three months.  These rats’ neurons acquired extra branches that connected to the sympathetic nervous system, part of the brain that controls our involuntary functions like breathing, heart pumping, constriction of blood vessels, and digestion.  Too many neuron branches apparently overstimulate the nervous system.  Because this system regulates the heart and blood vessels, an overactive sympathetic nervous system can spell hypertension and other cardiovascular illnesses.  It can also cause depression, anxiety, and disturbed sleep, among other things.  This just goes to show how dangerous long periods of physical inactivity can become.

Regular Exercise Improves Mental Healthbenefits-of-exercises1

Those who suffer from depression or anxiety disorder stand to gain a lot from a regular exercise regimen.  There is much scientific evidence that physically active people have significantly lower incidences of anxiety and depression than sedentary people.  Regular exercise helps minds cope with stress and maintain good moods.  A ten-minute brisk walk may even help alleviate a low mood, albeit temporary, much like a quick fix for a headache does.

According to a study, people who regularly do vigorous exercise may be 25% less likely to develop depression or anxiety disorder in the next five years.  Exercise can actually form part of a therapy for some people who respond quite positively to it.  For mild depression, exercise may even take the place of antidepressants as a treatment alternative.

Physical activity stimulates the brain towards the production of endorphins, those feel-good hormones that give one, the “runner’s high.”  Endorphins are natural sedatives and analgesics which reduce one’s perception of pain, tamp down stress, boost self-esteem, and improve sleep.  Regular exercise then improves mood and maintains it with the constant flow of “euphoric” endorphins.

Regular Physical Activity Promotes Good Sleep

One of the most telling symptoms of depression and anxiety is sleep deprivation.  A stressed person usually has a difficult time keeping to a healthy sleeping pattern.  Sleep deprivation contributes to fatigue, a form of stress, which exacerbates very low moods, worry, nervousness, and irritability.  It also impairs memory, perception, and other cognitive functions.

Regular exercise however has proven to be beneficial to insomniacs in the long term.  A study revealed that people with sleep problems reported improved sleep and rest after participating in a four-month long regular exercise program.  The key word here is regular because one just cannot expect better sleep patterns after one or two bouts of physical activity.  Steady sessions of exercise however builds up the body’s propensity toward better sleeping patterns.  This is why many physically active people tend to have better sleep quality than sedentary ones.  Better sleep quality translates to better mood states and reduced degrees of anxiety and depression.

Getting the Habit to Move

One has to incorporate some extra physical activity into his daily routine.  Instead of riding a car to work, have you thought of walking or biking to it?  How about getting that usual cup of coffee from a cafe a little further down your usual route?  Once you make a habit out of some extra activities, it would not be that hard to get moving more everyday.

 

Depression: When Sadness Becomes More Than Itself

depression

Clinical depression is a growing concern in the Western World.  It has become a common debilitating mental disease with one in five persons in the U.K. having had depression at some point in their lives.  It hits all age groups, income levels, and communities.  Its growth is accelerating to the point that it could become one of the most incapacitating conditions in the developed world by 2020, second only to heart disease.

Normal bouts of sadness are natural occurrences.  Death of a loved one, for instance, may cause one, grief.  In a mentally healthy individual, the intensity may last for a short time and taper off eventually to a steady acceptance.  Grief that spirals into clinical depression however will stay with the individual for the long haul and could disrupt his daily functions.

Depression Is a Real Illness

A person with a depressive disorder is truly sick.  Much like a physical illness in which an organ or its system is weakened, so it is with depression of which its compromised organ is the brain.  Diabetes, for instance, is a physical disease that involves the impaired function of the metabolic system to handle the hormone, insulin.  Likewise, the condition of depression involves an impairment of the nervous system manifesting with the imbalance of certain brain chemicals; low production of neurons and nerve cell connections; and impaired nerve cell growth and nerve circuit functions.

Many factors can trigger depression.  Life events can traumatize people into a depression.  Our biological makeup such as genetics and brain chemistry are major factors as well.  Serious medical illnesses such as cancer and Parkinson’s disease can also lead a person into a depressive state.  Some medications used to treat physical illnesses may have depression as its side effect.

The State of Depression Varies for Each Person

The degree, frequency, and length of depressive symptoms are as individualized as the person afflicted by it.  Symptoms vary from person to person with the variety dependent on age, gender, culture, and other factors.  Some people feel only a few symptoms while others are burdened by many.  In addition, there are people, especially children and adolescents, who do not even recognize the symptoms of depression.  Men feel it differently than women and have different coping strategies as well.

Symptoms of Depression

The tell-tale signs of depression include but are not limited to the following:

  • Sad or anxious mood that does not go away for a long time
  • Chronic empty feeling
  • Thoughts of suicide; attempts at suicide
  • Increased pessimism; hopelessness
  • Restlessness
  • Irritability
  • Insomnia or oversleeping
  • Decreased cognitive functions.  Depressed person has trouble remembering or making sound judgements or decisions.
  • Physical aches, pains, and other symptoms, such as headaches, palpitations, and stomach aches which do not test positive for any physical illness
  • Feelings of very low self-worth, inferiority, and guilt
  • Chronic reduced energy levels; exhaustion; fatigue
  • Fast weight changes and appetite changes
  • Loss of interest in things previously enjoyed; loss of interest in anything and anyone
  • Markedly reduced libido

Some people may not be aware of their depressed state because symptoms can come gradually to them.  They may have kept themselves busy to avoid feeling sad or hurt.  Eventually the strain does catch up to them and they start to exhibit some of the above symptoms.  Physical pains however without any physical cause may also signal that a person has a psychological issue.

Treatment for Depression

The good news is that depression, even severe cases, can be treated; however, diagnosis and treatment is best at the early stages where recovery is faster.  When you suspect yourself of being depressed, seek professional help as soon as possible.  Expect treatment to include talking therapies with your psychiatrist.  Antidepressant medication may also be prescribed if your situation warrants it.

What You Can Do to Help Yourself

Aside from seeking professional help, there are a number of ways by which you can help yourself feel better.  First thing you can do is take charge of your physical health.  As the mind and body are tied together, whatever affects the body affects the mind and vice-versa.  You can start by:

  • Eating a well balanced diet everyday
  • Beginning and sticking seriously to an exercise program
  • Avoid alcohol, caffeine, smoking, and illicit drugs.  These substances just worsen depression.
  • Fixing your sleeping patterns.  Getting a good night’s rest everyday is crucial to your recovery.

Your emotional state needs nurturing as well:

  • Find a trusted friend or family member you can talk to about your issues and emotional condition.
  • Approach depression with a plan.  Write down what you think is causing the problem and the positive ways you can fight your negative state.
  • Join a support group of people with the same problem.
  • Avoid making any major life decisions until you can handle big changes.
  • Avoid piling up more work to perpetually take your mind away from your issue.  You need to set aside time to go over the problem so you can eventually come to terms with it.

stronger than depression

Learn all you can about depression in order to understand the condition better.  The road to recovery may be a shorter path if you simply work positively toward achieving that healing goal.