With the high incidence of depression in those of us with fibromyalgia (FMS) and chronic fatigue syndrome (CFS or ME/CFS), it's a topic that comes up a lot. Because a lot of us are told that we're "just depressed," it's understandable that the very word sets some people's nerves on edge. Personally, I've never been diagnosed with depression and don't feel that I've ever needed treatment for it, so please don't interpret anything I say as meaning that depression causes FMS or ME/CFS -- nothing could be further from the truth.
However, I do see a lot of misconceptions about depression and its connection to these conditions. Two recent comments here caught my attention. One reader said this, while talking about her therapist:
"While I do disagree with her that depression is a chemical thing… I think that’s just not the whole story."
Another reader, in response, said this:
"I too disagree with depression being due to a chemically imbalance-there’s no proof at all to prove this so far."
While it's true that brain chemistry isn't the sole contributor to depression, we actually do have overwhelming evidence that depression involves neurotransmitter dysregulation. (For specifics, check out the long references list on About.com Depression Guide Nancy Schimelpfening's article, The Chemistry of Depression.)
Some quick facts:
- Anyone with a chronic illness, especially a debilitating one, is at risk for depression.
- Numerous studies show people with FMS or ME/CFS (Fukuda definition) have substantially higher rates of depression than those with similarly debilitating conditions, such as rheumatoid arthritis, or even terminal cancer.
So why are we, as a group, more prone to depression? Several reasons:
- We have a chronic illness that can dramatically change our lives and lower our quality of life.
- We've got a lot of really unpleasant symptoms and too few effective treatments.
- Our illnesses are poorly understood and too often misunderstood, even by our doctors.
Certainly, that's plenty of reason right there. You might be asking, "What does any of that have to do with brain chemistry?" The answer is, plenty!
When it comes to the brain, it's nearly impossible to separate the physical from the emotional. Every time you experience an emotion, it's associated with a chemical response in your brain, and physical things (such as pain or lack of quality sleep) cause chemical changes in your brain that impact your emotions. Prolonged sadness, in anyone, can cause changes in brain chemistry that can lead to depression. So can prolonged pain, prolonged sleep disturbance, even viral infection. When you combine emotional and physical factors, it's easy to see why our depression rates are so high.
From a physical perspective, we're more prone to depression because all three conditions -- FMS, ME/CFS and depression -- are linked to dysregulation of 3 neurotransmitters: serotonin, norepinephrine and dopamine.
Each of those neurotransmitters (chemical messengers in the brain) has physical and emotional effects, depending on the area of the brain and the type of receptors it interacts with. For example, dopamine dysregulation is part of both Parkinson's disease (physical) and schizophrenia (psychological). Low serotonin can cause physical symptoms (fatigue, headaches, bowel problems) and emotional symptoms (irritability, emotional outbursts, odd behavior.)
The common physiological factors are the reason antidepressants work for some people with FMS and ME/CFS. They also cause the symptom overlap that makes it so hard for some doctors to recognize when it's not depression.
The bottom line is that depression is chemical, whether its causes are emotional, physical, or both. We need to understand that depression isn't a weakness or character flaw, but a normal consequence of the emotional and physical impact of our illness. And we need to seek out doctors and therapists who understand each of our conditions and how to treat them appropriately.
Suggested Reading:
- Fibromyalgia, Depression & Anxiety
- Neurotransmitter Abnormalities: Symptoms & Treatments
- What is Depression?
Photo © David De Lossy/Getty Images
One thing not often considered is the fact that when your body is placed under the stress of nerve and/or muscular pain for large amounts of time,your body in response is producing unusually large amounts of stress hormones which of course can leave you with very low feelings-it doesn’t make you weak in any way to admit that you feel depressed…in fact,searching for help and trying to improve your situation only means that you are still “fighting the good fight” and not giving in!
I find these articles here at about.com a bit naive concerning CFS and Fibro. Please go to the experts like Cheney and Teitelbaum and Lapp and Roger Burns’s forums, and do some research, and report. Your reports are watered down versions of the decades of knowledge these guys have, and tend to lead some patients down the wrong lane.
This one is a bit better than usual, but still misses some of the most important distinctions that we know today.
Go listen to NPR’s coverage from Teitelbaum on May 24, 2009, around 6 or 7 pm. It’s on the net.
J,
The articles and blogs here are compiled from the full body of credible research that is available. Many of the distinctions made by particular doctors and researchers are not yet proven, or may apply only to a narrow subset of patients. Many people are led down the wrong path by doctors with experimental protocols that may work well for some, but can be useless or damaging to others. Dr. Cheney just came out with new information on portions of his and others’ protocols he now believes are harmful and should be abandoned.
My personal opinion is that it’s wise to gather information from a wide variety of sources rather than rely on a small group of researchers/practitioners. So far, no one is able to see the whole picture when it comes to these illnesses, so we need to piece it together from everywhere.
You say:
“From a physical perspective, we’re more prone to depression because all three conditions — FMS, ME/CFS and depression — are linked to dysregulation of 3 neurotransmitters: serotonin, norepinephrine and dopamine.“
Being linked to something simply means somebody, somewhere thinks there is a connection and perhaps published a paper. It does not mean that the premise of connection is proven, that the paper is properly researched, that the experiment, if there was one, was well designed, or anything of the sort. As for serotonin, your link above leads to a page which says the following:
“A growing pool of research suggests that people with fibromyalgia (FMS) may have low levels of serotonin. Experts are split, however, as to whether serotonin levels are high or low in people with chronic fatigue syndrome (CFS or ME/CFS).”
That certainly doesn’t sound like a connection has been proven at all. FMS MAY be connected to low levels of serotonin, and for CFS nobody can make up their minds whether it’s high levels or low levels.
I’ve had both diseases (or maybe it’s only one disease?) for the past 20 years. I spent the first 10 years following the research closely. What I found was 2 things. First, there are many doctors out there, and they all need to publish. CFS and FMS offer a wonderful playground. Nobody knows anything about them, therefore the field is wide open. So lots of papers are published. Many are not well researched, many are based on logically flawed experiment design, and some are completely fraudulent. The worst seem to be based on the premise that similar symptoms are all caused by similar things. That is like saying some frogs are green and trees are green, therefore all green frogs are really trees. It doesn’t take an expert in logic to realize that the this statement is false, but when you publish it in a medical journal, substitute FMS/CFS and depression for frogs and trees, and dysregulation of neurotransmitters for green, surround it all with fancy words and statistics, many people who should know better are fooled. Research papers like that prove nothing except the author’s ignorance, but they confuse both the medical and pharmaceutical professions. That means we patients are peddled expensive medications which do not work for our primary condition. They may help with the low feeling that comes with having a disease that changes out lives so dramatically, but they do not work on the disease itself.
Second, the pharmaceutical industry has jumped on this supposed connection between depression and FMS/CFS and gone hog wild! A new use for the old medication! A new reason to develop new, non-generic anti-depressants! More money to be made! I have no real knowledge of anti-depressants except that when they gave them to me, I felt worse and stopped taking them, whereupon I felt better. I do know that my niece suffers from depression and has probably taken every anti-depressant made. She is still depressed 20 years later. When one such medication wasn’t working, the doctor kept doubling her dose. Her pharmacist alerted her to the fact that she probably had toxic blood levels, but by the time her blood test came back (positive) she was in the hospital with heart damage due to the toxic levels of anti-depressant in her system! I see ads on the TV that tout new drugs to be used ‘if you are still depressed while taking your anti-depressant.’ And I know from talking with friends that a woman with just about any problem that doesn’t exhibit spurting blood is usually told to ‘take an anti-depressant and call me in the morning.’
I think that any attempt to connect FMS/CFS to depression, except reactive depression due to a dramatically changed life, is dangerous. They’ve been trying for 20 years to find some way to say that CFS/FMS and depression are the same thing and they haven’t done it. The track record of anti-depressants used for depression appears to be spotty at best. It’s bad enough to have a disease with no cure or treatment. I don’t want to have a treatment that doesn’t work because if that happens, the real research will slack off and nothing will ever be done about finding a real cause and a real cure.
I agree with Adrienne. Nobody, even so-called experts, can see the whole picture. I have read more technical information at times, but I am quite happy with the distilled and easy to read information in this blog. (Perhaps you are lucky enough not to suffer the brain fog that I do!)
I suffered from depression before I suffered from the fibromyalgia. My depression started when I was pregnant with my second child. A child that my husband and I planned for, I was happy at the time, my life was good. Why I was so miserable was a mystery for me. I also could not pull myself out of the depression. I have suffered with the depression for the last 18 years. I have gotten control of it, and can tell the difference between my emotional/stress depression (which everyone experiences from time to time) and my chemical imbalance depression. I know for sure at least some depression episodes are chemically caused. I don’t need scientists to prove it. Scientists can’t even agree if fibromyalgia is a real illness or not. They can not prove that exists either. That doesn’t mean they don’t exist and aren’t real, and millions of people’s lives are forever changed by both illnesses.
Treating the drpression does not get rid of the CFS, fibro symptoms.
I agree with Fran, treating the depression I suffered never touched the FM/Cf. In the end I quit taking antidepressants. This doesn’t mean that they can’t be helpful. I believe they did help in the beginning but as I Educated myself more about my condition, the less I needed them. keeping up to date with research based information, gathered from a variety of reliable sources, has helped me most over the years, enjoying my life when I am symptom free, or the symptoms are low key, listening to my body, knowing my limits. When I am in a bad flare i bring out my arsenal of remedies, – meds. soothing music, soft sheets, a good mattress, lotions, foot massages, warm epson salt baths, and many other ‘feel’ good potions I have discovered over the years. I try not to beat myself up over the things I can’t do.
I enjoy Adrienne’s posts. It is food for though and gives me something to go on. Of course, I have read all of the technical stuff. But I am a person and I like to read how someone with CFS like Adrienne relates and she relays info in a way without whoping you over the head with it. I also do not have time nor energy to spend pouring over the technical articles that she reads (thank you!).
I am very curious what Dr. Cheney said about which protocols should be abandoned. Could you email me the links?
Thanks!
As far as depression. I agree with what Adrienne has said about it. Dealing with chronic disease is enough to bring it on, etc. I do not know if this helps, but I take for my thyroid a compounded T3 TRIIODO-L-THYRONINE (bioidentical T3) I believe Cytomel is a synthetic version. There is some evidence that supplementation with this also acts as an antidepressant. But as Adrienne sayd that is a narrow course of treatment and not backed up by many studies. Also for me personally, I tend to break down my T4 into too much anti-T3 and not enough T3. That is why I am taking plain old T3 and not T4 (synthroid is the synthetic) and the previous tried T4/T3. There is some evidence (not studies) that T3 is also helpful for those with bipolar symptoms.
Valetudinarian,
Here’s the information from Dr. Cheney that I mentioned:
Dr. Cheney Goes His Own Way: the Virginia 2009 Lecture, by Cort Johnson.
Because of the computer use age and its effects on neurotransmitters many people are coming up with behavioral symptoms not understood by the medical profession and that are not effectively treated by medication. I was a casualty. I have recorded my insight from my experience in my book “Lessons I Learned the Hard Way – How to identify, minimize, manage and treat computer related health issue” it is available at http://www.strategicbookpublishing.com/LessonsILearnedtheHardWay.html. I believe it is a must read for all computer users. I have written this book to alert other computer users as well as their doctors to the health dangers inherent in computer use and explain solutions that I found worked to minimize and or manage the situation and how to identify symptoms. I can be reached at lessonsilearnedthehardway@gmail.com for further discussions. I wish you all the best.
I am very wary of information about neurotransmitters. Maybe someone can help me understand better.
Are we able to MEASURE neurotransmitters? How do we know for sure what their functions are?
I think drug companies have an amazing influence over medicine and I think that may have been my quote in the article. From what I’ve read (particularly Dr. Peter Breggin), the subject of depression is not so clear-cut and drug companies are not so forthcoming in their research data, either.
It sounds more to me that these anti-depressants may work for some people, but the mechanism of their action is UNKNOWN. Maybe the question isn’t whether or not depression is chemical. Maybe the question is more, are we regulating the RIGHT chemicals in the RIGHT amounts SAFELY?
If we really had a good understanding of depression, I think you’d see fewer patients with side-effects from drugs. These drugs don’t seem very targeted in that they have so many wide-ranging unintended effects. If we really had a good understanding of depression, these same drugs that are supposed to treat it would not come with ‘black box warnings’ that depression may worsen and could lead to suicide.
Do anti-depressants have a significant effect on depression? Recent studies investigating this have called this into question.
I think sometimes that doctors give anti-depressants because it’s all they know to do and patients will readily accept pills nowadays. And, because if they DIDN’T give pills and their patient committed suicide, they could get sued. The doctor gets to say, “Well, I tried, I helped, I gave them a pill.” Honestly, Dr. Breggin’s books are eye-opening.
I have a wonderful, wonderful therapist. I wish there were more like her out there, but I was fortunate.
When I get depressed now, I use enjoyable activities, problem-solving, distraction, meditation, journaling, soothing exercises like yoga/t’ai chi/stretching, hot soaks in the tubs, getting a massage… Gosh, I have a whole ARSENAL, because life with fibro can kinda suck so I have to MAKE my life as enjoyable as I can, DESPITE my illness.
I think there’s a reason for the way I’m feeling even if the reason seems vague — unclear. Journaling and problem-solving are my best bets, then. Maybe what I’m saying is there is an EXTERNAL reason for why I feel depressed, and sometimes my emotions reflect a reluctance to identify and deal with the reason for my sadness… Depression for me is often a response to when my life isn’t living up to my “ideal image” of what life should be and I feel powerless to change it.
So, that’s where counseling comes in for me.
Are there brain chemicals involved? Probably. Is depression PURELY chemical, without basis in our external lives? I have my doubts and I think doctors pretend to be certain when it just hasn’t been proven.
My doctor basically told me he’s not a therapist and doesn’t want to be. His solution for me was to put me on medication, and he said that his “lawyers would want (me) on medication.”
Is this good medical practice? What happened to the mind-body connection?
Heather,
Measuring neurotransmitters is possible, but it’s not generally used in clinical practice. What we know about them has come from studies showing that abnormal levels of certain neurotransmitters in certain areas are linked to certain symptoms.
The problem with antidepressant drugs is that, even if they’re targeting certain neurotransmitters, they don’t only raise levels in the parts of the brain that are deficient. Each neurotransmitter has many different roles, depending on where it is and what type of receptor it attaches to, and that’s what seems to cause all the side effects.
Of course there are external reasons for depression, and counseling is great for working through those — but it’s not always enough. I agree that doctors hand out antidepressants too readily and don’t recommend counseling for depressed patients like they should. The physical and emotional parts each need to be recognized and treated.
At the same time, though, I don’t think meds are the best way to go for a lot of people. If they work for someone, that’s great, but they don’t work and cause problems for others. That’s why I favor supplements for regulating my neurotransmitters — they work with my body to gently boost and balance brain chemistry, instead of forcing changes that may not be beneficial.
As for your question about the mind-body connection, sadly it’s absent from most modern medicine. With micro-specialization becoming more and more standard, most doctors only look at one part of the body. They often don’t even consider how that part interacts with other parts, let alone with our minds and emotions. Because depression is outside the specialty of most primary care providers, they want to write a prescription and move on — and yes, it makes the lawyers happy like you point out. It’s decidedly not good medicine in my opinion.
That’s why I want people to understand that emotions impact us physically and physical conditions impact us emotionally. In reality, it’s impossible to neatly separate physical and emotional because they interact so much with each other in our brains.
For example, say someone is having problems at work and is afraid of losing his job. The emotions he experiences change his brain chemistry. A few weeks later, things turn around dramatically and he’s given a promotion. He should be happy, but he still feels depressed. Why? Some people’s brains seem to be unable to get themselves out of the mechanics of depression. External forces lead to depression, but physical forces maintain it after the causal factor is gong.
Now apply that to us — we have a chronic illness that’s hard to treat and changes our lives drastically. That external force isn’t going to change. Add in that we already have physical issues in our brains that appear to make us more easily depressed than other people, and suddenly you’ve got the perfect recipe for on-going depression.
The one upside of this is that, at least in theory, correcting our neurotransmitter balance should help with both conditions. I don’t have depression problems, but I do have multiple conditions tied to neurotransmitters. When I take the supplements that balance them, all of those problems improve. When I don’t, they all get worse. So hopefully, if we recognize that it takes both physical and emotional changes to help us feel better, more of us will take the necessary steps.
God bless you for that cogent clarification of things. It’s nice to see when people actually pay attention to the vast body of scientific evidence for an interplay between the vegetative aspects of the brain, the immune system and the endocrine system. Of course CFS causes depression and there are mountains of evidence to help understand why this is. Again, thank you for your efforts at the clarification of things.
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