Research Brief
People with fibromyalgia have long battled assumptions that they're "just depressed," but a new study demonstrates a distinct difference between fibromyalgia and major depressive disorder (MDD).
Two key features of fibromyalgia are low pain thresholds (feeling pain from stimulus that wouldn't cause pain in other people) and a deficit in pain inhibition -- which means that instead of feeling less pain from repeated or prolonged sensation, we feel more. For example, most people "tune out" pain from a tight waistband after awhile, but to us the pain gets worse and worse.
Some doctors have speculated that, because of the link between MDD and chronic pain, MDD may also feature a deficit in pain inhibition. It's even been speculated that fibromyalgia is merely "masked MDD" (in spite of the fact that many of us are never clinically depressed.)
This study should help put those hypotheses to rest. Researchers found that:
- Fibromyalgia & MDD are both linked to low pain thresholds;
- However, pain thresholds were lower in fibromyalgia;
- And the pain inhibition abnormality is not linked to MDD -- it's specific to fibromyalgia.
We've known for decades that a lot of people with fibromyalgia also have MDD, but this study adds to the evidence that while there's a distinct overlap, fibromyalgia is separate and distinguishable from depression and needs to be diagnosed and treated in its own right.
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I battled this misperception with family and friends, and am lucky enough to have a doctor who knows the difference.
Oh how well I understand this. I have actually been depressed for most of the time I’ve had FM but only because my active life of caring for my 4 children came to an abrupt stop when I developed it. When your outgoing personality suddenly changes to a fearful one because you don’t know what on earth has happened to you (not diagnosed for 1 1/2 years) and then you spend heaps of money on supplements that don’t work, why wouldn’t you get depressed. So then everyone thinks the depression is the cause. Because of constant pain you become unable to deal very well with life’s normal stresses – ah, another sign you are depressed. If you tell people you have FM they usually don’t know what it is and suggest you just need to start exercising because you have often put on weight from reduced activity, sheer exhaustion to the point you rely more on takeaway food and comfort eating. Get fat – get more depressed. I have put on 40 kg in the 17 years I have had FM. I have tried to blame Xanax but I can’t do without it. I need it to keep up my ‘public’ face. I am currently seeing a psychologist as I was diagnosed officially with major depression (which I’ve probably had the whole time). I have also been on and off Lexapro – hate the loss of orgasms on the rare occasions I feel like sex (what else can this vile disease take away from me?). It is a lonely place but luckily I have an understanding husband, but even he doesn’t understand why no one can help me.
Why is it we are struggling SO HARD to fight that depression is not a part of FMS or CFS. Which white coats and patients think it is only situational.
If the doctors would admit in public the actual medical evidence and relationship of depression and serotonin and norepinephrine, natural substances in the brain that help maintain mental balance –these have been found to be LOW in such patients.
Yes extreme Major Depressive Disorder (one of the subsets or partners of Bipolarism) that is occurring in a patient MAY find that the patient also has FMS or ME/CFS.
Sadly I know of two patients that have the MDD AND the ME/CFS. Which came first the chicken or the egg. Psychiatrists are not trained in virology and metabolic impact on the immune system which can be damaged by some amino acid problems and ultimately generate organic depression not situational.
To me this is just another example that researchers and doctors do not know what they are really looking at and have been making lots of assumptions –wrong ones for years.
The worst thing that can happen to any patient is when a doctor pulls down any of the diagnostic tools used by psychiatrists and try to use them on FMS or ME/FMS patients. That doctor should be sent back to medical school.
I spent 9 years in a major depression. The only reason I did not kill myself was because even though I was going through holy he** I had enough concern in me for my loved ones that I could not put them into a situation where they might go through what I was going through. I had been out of that condition for almost 10 years when I developed fibro.
There is a major difference between spending every day wishing you could go to sleep and never wake up and wishing you could wake up one morning and do the things you so want to do but your body has betrayed you and won’t let you anymore. Sure it makes me depressed at times, especially if I have been pushing myself too hard to do things and have gotten myself into a flare.
To me it is a simple equation:
Depression = not wanting to do anything, just wanting to quit.
Fibromyalgia = wanting to do things but being depressed at times because you can.
but then I haven’t had that eight years of training to teach me that the patient doesn’t know what they are talking about. You can only trust the test results!
Sorry I meant because you can’t not can.
Fibro fog when trying to write things anyone? Adrienne I really don’t know how you manage it!
Nitalynn: You have made succinct definitions of FM and Major Depression. However when you have tried and failed over many years because of your body’s limitations, I believe you stop even wanting to try any more because you know it will end in failure. I used to go to bed every night thinking, “I might be better in the morning” for a very long time but eventually you realise it’s not going to happen. When that hope fades depression sets in and you lose the desire to even get out of bed in the morning to face another day of struggle, and knowing this isn’t going to go away unless some miracle cure appears. The two do become blurred.
I’m sorry Linda. I should have put in a disclaimer to the effect that I can understand how the condition could result in a major depression. I don’t mean to infer that people with fibro or CFS aren’t severely depressed especially when their disability is severe. It would only be a natural reaction both emotionally and physically.
The problem I have seen with Doctors in the past though is they seem to have had the idea if they treated the depression the Fibro/CFS should respond. To me that is backwards though and not only that but if the reason you are depressed is because your life has come to a screeching halt how do they expect to make very much headway treating the depression without at least addressing the disability itself?
Because of my past history with depression I can pick out what is depression and what is fibro pretty easily but I will be the first to admit without that experience I probably could not. Along that same vein I was warned by my PCP when I was diagnosed with the fibro that I would always need to be very careful because people with fibro tended to just lump all pain together after a while and could become seriously ill because they just ignored pain from other conditions. In spite of being warned I missed the fact that I had severe osteoarthritis for almost 2 years before I realized something besides fibro was affecting me.
Linda, I do hope you are seeing someone about the depression. I suffered mine over 20 years ago now and there are so many new ways of treating it now than there were then. I will say this looking back at my own depression, that if I had to go back there again I would make sure I was treated by a psychologists as well as the psychiatrists who treated me. The reason is why is when you are depressed for a very long time not only do they need to address the chemical imbalances of the body but also the inappropriate thinking patterns the of the mind as well. I actually had to teach myself not to “think” depressed all the time and it was definitely a difficult habit to break.
I wish you all the best Linda and I truly hope that “miracle cure” does come about, not only for me but for all of us now and the ones in the future as well.
Before my Dr put two and two togeather my GP handed me a perscription for venalafexine (spelling?) and sent me on my way. I was devistated because I knew I wasnt depressed. I just hurt everywhere and was tired. He ran a blood test or two and just assumed it was depression. He did ask me if I was moody or short tempered … and yes I had been…. because I was in pain and having to bend down to pick up my sons shoes after I told him a billion times to pick it up… well Id become snarky…. definetly not depressed. Finally my specialist said its fibro. I let out a sigh of releif thinking “ok great ” Until he said I’d almost be better off with MDD because Fibro is so much harder to treat. Sigh.
With me it doesn’t feel so much like “depression” as it does a grieving process, loosing the way of life as I once knew it or expected it to be. I don’t remember the exact steps of the grieving process by Kubler Ross but I know that some days I accept the way things are and that this day, week, or month I can’t do much more than stuff on the computer. The denial days are when I feel a little better and I’m pushing to the extreme and cutting small tree limbs down with a chain saw or digging holes to plant flowers (which also require an axe due to all the roots left from dead trees)! Then I pay for it with extreme pain and fatigue and get so angry that I can’t do the things I used to be able to before I got sick and have to rely on others to do things for me. The thing that probably does make me depressed is the fact that my daughter is showing a lot of the symptoms of FM and she has moved in to take care of me but who will be there to take care of her!
Oh Debbie, you have expressed exactly how I feel about it being a grieving process. Your frustration about relying on others, loss of strength and resorting to using the computer (it does distract but I feel guilty that I am wasting time when my home is a complete shambles – piles of clean laundry all over the place, boxes of stuff everywhere that need sorting etc). I am ashamed for people to visit when we used to socialise a lot. I was a keen gardener too. I could lift a hardwood sleeper when I was younger.
My daughter was showing similar signs when in her teens. It turned out she had extremely low iron levels which proved almost impossible to raise. I forced the doctor to do every test under the sun. She is better now (23) but does not have the high energy levels I had when I was her age. She has had to suffer a mother who has had little energy and cries alot since she was 5. Her 3 older brothers were lucky. They got my good years. She is a wonderful girl though and the joy in my life. She is very sympathetic and positive so maybe it hasn’t harmed her. I hope your daughter finds a loving partner to help her.
This forum is so good for helping you feel you are not alone.
Linda, I’m so glad your daughter is doing better and hopefully she never gets this awful disease. My daughter, Christy, who will be 35 next month, just found out her Vit D level is low which can cause a lot of the same symptoms of FM and I pray this takes care of it for her. She is my only child and such an Angel but Linda I know we always worry about what this does to our kids and I feel so quilty having to have her move in but as she says, “I want to be here for you”. I guess it does help that I’ve been a single parent since she was 3 so we are very close. As far as your husband Linda, let him know the most frustrating part, even for the doctors (well some any way), is that what works for a few may not work for the next few. It is such a trial and error to some degree and it is hard to patient. Plus sometimes it takes awhile to find the right MD that is willing to work with you and not just think you are depressed or that if you could just sleep well the pain would just naturally go away.
I feel very blessed in that I worked with my MD for many years before I became sick so she knew me from before, back when I could ride a bicycle over a hundred miles on the weekend, and did a century ride (114 miles), and that was after working all week many times more than 40hrs/wk. Then after a few years of that learned how to ride a motorcycle and actually worked up to a Honda Sabre 1100 and did long weekend trips, went skydiving, etc.. Now when I go in to see her I have to look to my daughter most of the time for the answers because I don’t remember, I don’t drive much anymore, maybe once a month and no more than a few miles from home. I have trouble baking now because it is too over whelming (which has been so so hard). My daughter has to leave a list of a few simple chores that need to done, like empty dishwasher, fold towels in dryer. There are days I can’t even do that much then I cry because she has to do it when she gets home from work. The wonderful child that she is always says “Mom, I know you would if you could”, which yes I cry and that is depressing, she has suddenly become the Mom and I feel like the child. She handles all my finances, medications, MD appts, did all the paperwork for my disability which was no small task! Thank God I did get it, yea!!
Wow, I sure got long winded, it’s nice to have someone else to talk to so it isn’t always my daughter so I do thank you all. I did have quite a bit more I rambled on about but it seemed to have got lost. Of course by now I don’t remember what it was. Linda and all thanks again for putting up with my windyness, Soft Hugs, Debbie
Should change my name to Wendy
in my situation all of my life my mum was there to help me.When i was nine i couldn’t was myself without her help. My family used to say i’m spoilt but my mum used to see how i struggle in the mornings with pain and stiffness. I went to see family Dr and he never knew what was wrong. At 12 they say i have juvenile “poly” arthritis.You can imagine that big word for a 12yr old,so i used to attend physio and uses splits.It vanish for some years and came back after 10yrs. Now the pain was 24/7 without any help from painkillers.
when i was told it’s FMS & i started to learn more about it until i come up with this colum. i really thank you all for sharing the information with me now i know i am not alone.
I just wish for a miracle to happen atleast we can be out of pain. This condition has change me to be other person, i cannot clothe or wash myself sometime.I’m still working and it is so bad cause no one knows about this condition.They think i just made up stories when i said i have pains all over my body and i’m tired of expalin my self all the time