The close association between fibromyalgia and depression/anxiety is a sensitive issue for many people. We often face skepticism about how "real" the condition is, and people with fibromyalgia (FM) often are told that they're "just depressed." These common misconceptions can make people with FM feel frustrated (and even defensive or resentful) about the frequently discussed links between these conditions. Some of these misconceptions come from the fact that FM and depression can have overlapping symptoms. But this does not mean FM is caused by psychiatric illness.
In truth, depression and anxiety also are very real conditions with physiological factors, including genetic predisposition and neurotransmitter imbalances. As with all psychological conditions, they need to be taken seriously and treated appropriately.
We don't yet understand why many of us battle depression and anxiety in higher numbers than other people with chronic and debilitating pain. What's more, research shows that depression and anxiety can make our symptoms worse, and can hamper our treatment.
The misconceptions associated with FM can make it hard to accept that we're especially prone to depression and anxiety. However, the same misconception isn't attached to rheumatoid arthritis (RA), osteoarthritis (OA) and ankylosing spondylitis (AS), even though researchers have come to the same conclusions in regards to these forms of arthritis: Depression and anxiety rates are higher, they make symptoms worse, and they're an obstacle to feeling better.
An article from the website UpToDate, which is highly respected and widely used by doctors, explores psychological disorders in FM, RA, OA and AS. The following excerpt contains statistics from the findings of credible studies that are widely accepted in the medical community.
From UpToDate: Psychological Disorders & Rheumatic Diseases
"Depression and anxiety are negative psychological states that are frequently observed in patients with RA, FM, OA, and ankylosing spondylitis (AS):
- The frequency of depression and anxiety disorders diagnosed among patients with RA ranges from 14 to 42 percent. Among female patients with RA who committed suicide, 90 percent had a depressive disorder.
- The frequency of lifetime diagnoses of major depression and anxiety disorders in patients with FM ranges from 26 to 71 percent.
- Significant levels of depression are found in 14 to 23 percent of patients with OA.
- The prevalence of clinical anxiety or depression is also substantial in those with AS; among 110 such patients these psychologic disorders were present in 25 and 15 percent, respectively.
"The prevalence of these psychological disorders is substantially greater in patients with these rheumatologic conditions than among the general population. This may reflect an interaction between stress engendered by rheumatic disease and an underlying genetic predisposition to anxiety or depression."
As you can see, the rates are higher in fibromyalgia than in the other conditions (although different studies have shown widely varied rates.) Notice that the article recognizes that having conditions such as arthritis and FM may contribute to depression and anxiety and doesn't say that they are the result of depression and anxiety.
The Importance of Recognizing Psychological Disorders in Fibromyalgia
So why does it matter that depression and anxiety are common in people with fibromyalgia? Research shows that it's harder for people with these conditions, or a history of them, to deal with the stressors brought on by the condition. Chronic illness makes it harder to perform your duties, at home and at work; can cause financial hardship; can strain your relationships; and can keep you from doing the things you enjoy. That's hard for anyone to deal with, but it's harder still for those with depression or anxiety.
Part of the problem is that people with depression or anxiety may view themselves as helpless in the face of a daunting illness. FM is notoriously hard to treat, and people who feel helpless are often less likely to take control of their own treatment and make lifestyle changes that could help them feel better.
Your doctor can help you find medication and psychotherapy treatments for your depression and anxiety. Psychotherapy can also help you more successfully adapt to and cope with your illness.
Want to learn more? See UpToDate’s topic, "Psychosocial factors and rheumatic disease" for additional in-depth, current and unbiased medical information on fibromyalgia, including expert physician recommendations.
Source: "Psychosocial factors and rheumatic disease" UpToDate. Accessed: January 2009.
"Psychosocial factors and rheumatic disease" UpToDate. Accessed: January 2009.