How Depression and Pain Are Connected

There's a very close relationship between pain and depression. You can think of it as Bi-directional meaning that each entity influences the other. Pain worsens or can even cause depression and depression worsens your pain tolerance.

This worsening of your pain is not just your perception because you feel down. Depression increases your sensitivity to pain. So it's as though you feel pain more intensely when you're depressed then you would if you were not depressed. This is related to what we call the somatization of depression or the tendency to feel depression in your body.

Depression can affect you physically. Even if you don't have a pain problem, when you get depressed you can be more sensitive to body sensations and experience them in a negative way. So some depressed people can complain of joint pain, headaches or dizziness. You may feel bloated or constipated. It's not because depression makes you constipated but when you're depressed you can get neglect your fluid intake, then have slower moving bowels. Then your mental state magnifies the intensity of the experience.

The second relationship between pain and depression is chronic pain that goes unresolved for months can cause depression. Usually chronic pain is pain that lasts more than three months.

What can be done about this?
When you have a combination of pain and depression, you have to use different approaches to treat both.

As for non-medication options there is cognitive behavioral therapy that is targeted for pain and depression. The focus is usually on helping you reframe your thoughts around your pain and develop better coping skills to manage the pain.

Then there is relaxation training using things like progressive muscle relaxation, mindfulness and yoga.

Hypnotherapy is a specialized therapy where therapist gets you into a trancelike state and then speaks positive suggestions about your pain that you internalize and act on. Hypnosis is something you can learn to do yourself.

As for medications, there are 3 types of medications that have been studied to treat both depression, anxiety and pain. These are the serotonin-norepinephrine reuptake inhibitors like duloxetine and venalafaxine; the tricyclic antidepressants like amitryptline and some anticonvulsant mood stabilizers like lamotrigine.

References
Sheng J, Liu S, Wang Y, Cui R, Zhang X. The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural Plast. 2017;2017:9724371.

Gerrits MM, van Oppen P, Leone SS, van Marwijk HW, van der Horst HE, Penninx BW. Pain, not chronic disease, is associated with the recurrence of depressive and anxiety disorders. BMC Psychiatry. 2014;14:187. Published 2014 Jun 25.

Hermesdorf M, Berger K, Baune BT, Wellmann J, Ruscheweyh R, Wersching H. Pain Sensitivity in Patients With Major Depression: Differential Effect of Pain Sensitivity Measures, Somatic Cofactors, and Disease Characteristics. J Pain. 2016 May;17(5):606-16.

Adrienne L. Adler-Neal, Nichole M. Emerson, Suzan R. Farris, Youngkyoo Jung, Robert C. Coghill, Fadel Zeidan. Brain moderators supporting the relationship between depressive mood and pain. PAIN, 2019;

Kapfhammer HP. Somatic symptoms in depression. Dialogues Clin Neurosci. 2006;8(2):227-239. doi:10.31887/DCNS.2006.8.2/hpkapfhammer

Disclaimer: All of the information on this channel is for educational purposes and not intended to be specific/personal medical advice from me to you. Watching the videos or getting answers to comments/question, does not establish a doctor-patient relationship. If you have your own doctor, perhaps these videos can help prepare you for your discussion with your doctor.

[DrDuzzy]

Me, who’s depressed and in pain, seeing this video: Don’t mind if I do!

[frozengamer]

During these hard times it's very difficult to stay positive and depression levels are very high.

[adamlauver]

I've never commented on anything before, but I have to take a moment and thank you for making these videos. I've struggled with depression my whole life and I really appreciate the help and hope you've given me to not give up and continue to seek treatment. Again, thank you!

[babylonbabel]

I've had chronic pain from severe ankylosing spondylitis for 28 years and learned that I own my pain. I'm not sure why but that really helped me and I'm naturally a happy person with a high tolerance for pain . A paper cut can be worse than my pain for a person who has a low tolerance for pain . We all own our pain and cannot really compared each others pain. I feel very lucky to be happy ...

[karlsmith]

Dr. Marks, your video on the bidirectional link between depression and chronic pain (I suffer from both) helped me to understand more of what I experience daily. As a veteran and corporate IT professional, I ignored earlier signs because making money and providing for my family was paramount. Today, I have more time and reminders that chronic pain is real and isn't easy to deal with. However, thank you and I appreciate your clear and coherent explanations of these debilitating issues.

[opedromagico]

Besides pain I have chronic nausea, doctors are looking into it, this may be the cause of my depression.

[crystalherbert]

You always have perfect timing on your topics! Thank you Dr Marks. ❤️

[Demothios]

I've had chronic eye pains for 18 years and always wondered why there are days when it feels extremely exhausting, and as if I can't do anything right or think straight due to pain, and yet other days where it almost feels as if the physical pain is at the same level but the pain acts almost... motivational and I get tons of things done (though sometimes with small errors so the cognitive impairment at the time of pain spikes might be the same whether or not I feel motivated or not). I've had the brain stuff explained to me once by my doctor, but don't think I got it back then. Your video explained it in a way I could understand, so thank you for that.

[a.k.]

Thank you. I am living with chronic pain and decreases mobility in one of my hips. At the beginning there have been a muscle tension that never loosened up. No Therapie i tryed helped. Now the joint is in an arthrosis state. The muscles and tendons pressed it together for over a decade. I feel like handed down from one doctor to another. Now i get meds that prevent the reuse of serotonin. I hope they will help. I'm age 37. I love nature and walks and i hope one day i can hike again. Or at least do longer walks.
Your videos help to understand my way while i go.

[RM.....]

Living in physical and mental pain 24/7.

[lisalinnae]

She is awesome
... simplifies things. So grateful

[Tkyle]

Thanks for your great information. I am a women’s health nurse practitioner, finishing up my PMHNP. Your videos truly help me clarify so much! Happy I discovered you!

[vinodsingh-grxj]

Dr Tracy mark when ever I watch your program it's perfectly while I am in pain my siblings... sisters are toxic people and wrecked vengeance it hurt me and makes me depressed and painful, inspire of knowing I am bipolar disorders . the coping strategies you suggested is what I do, thanks Dr Tracy mark.

[MELLMAO]

I have been in pain for longer than I've been without it, and it is sucking the life out of me. It's amazing to me that I've only had a really bad depression episode at 19

[kez-chick]

You are so right I was married 38yrs
Always at Drs with pain they said it’s stress, after my marriage about 4 yrs later pain was not so chronic

[Cathy-xicb]

Remember that soldiers injured in war can have significantly diminished pain when they realize that this injury will send them off the battlefield and they will live to go home to their loved ones. Seen during all wars in which there was a good chance you would live to be shipped home. They weren't nuts; their pain was reduced by the meaning pain had for them.

[Francesco]

Thank you, Dr Marks, for your clear and encouraging explanations. I always feel a bit better after watching your videos!

[MELLMAO]

I've entered a serotonin syndrom from trying duloxetin while already being on SSRI medication.I have chronic migraines that have only gotten worse with years. I've had GAD for a long time, but when pain became worse than ever, I suddenly developed very serious depression. I am medicated and it saved my life, but pain was definitely what caused depression, not depression and anxiety causing pain, as much as doctors tried to convince me for years now

[RebelInHerOwnRight]

Im a chronic pain paitient who has been battling this for 4 years now. She is spot on. And its hard to control.

[denise]

Bless you, Dr. Marks!! Due to Failed Back Syndrome and 9 years of unrelenting pain, I know I am in a pain/depression loop. My surgeon is suggesting a pain pump implantation at this point. I am digging deep to understand how my brain works and if I can unravel the years of the same reaction to my pain in order to help myself before I make such a drastic decision. You are such a large part of the learning curve for me...warmest regards