Fibromyalgia or Depression?

Introduction

Many studies link fibromyalgia and depression. In fact, people with fibromyalgia are up to three times more likely to have depression at the time of their diagnosis than someone without fibromyalgia.

Some researchers feel that depression leads to changes in brain chemistry. Others look at abnormalities of the sympathetic nervous system -- the part of the nervous system that determines how you handle stress and emergencies. These abnormalities, they contend, may lead to the release of substances that cause more sensitivity to pain. The result is fibromyalgia with its chronic pain and feelings of depression.

Learning more about the connection between fibromyalgia and depression can help you seek appropriate medical treatment from your doctor. That includes asking your doctor about antidepressants. By following an appropriate fibromyalgia treatment plan and getting the support of family and friends, you can take control of your fibromyalgia. You can also get control over your symptoms of depression and improve your quality of life.

Substantial mood disturbances are common features of clinical picture of fibromyalgia syndrome. Low mood is very common however, serious depression is not infrequent. Fibromyalgia is chronic widespread pain syndrome with accompanying several, manifold vegetative aliments. The pain and vegetative complains hardly or not at all react to common treatment. The pain and vegetative complains hardly or not at all react to common treatment. It is needed several years of disease continuation to diagnose fibromyalgia and launching appropriate treatment, usually. The family, social, occupational relationships could be damaged within this period of time. All that sooner and later would have negative impact on mental condition of patient. Significant mood lowering is found in considerable number of cases. In some cases depression is also diagnosed.

Complex Character of Fibromyalgia

It seems that fibromyalgia nosologically* is not a single disease unit (morbus) but disease syndrome (syndroma) that has many and various causes (ethiology**) and common, often very complex, clinical picture (symptomatology***). Persons with widespread pain of periarticular (joint surrounding) tissues of "fibromyalgia type" often have numerous and manifold multiorgan functional (vegetative) disorders that also accompany fibromyalgia and also correspond to physical symptoms of depression (PDF file, 5 pages). Threfore some scietists propose an assumption that fibromyalgia could be a specific form of depression, formerly called masked depression.

Depression is quite common and affect at least 10% of our community. Depression affect at least 10% of our community. Depression is something different than transient (temporarily) deterioration of mood. It may last weeks or months and its commonly known symptoms like sadness and lack of energy might be masked by fear and anxiety, sleeping disorders, gastro-intestinal disorders, and chronic pain.

It has been found that over 50% of fibromyalgia patients has depressed mood and fulfils criteria for a major depressive episode. Common coexistence of fibromyalgia and depression does not raise any doubts. It has been demonstrated that both fibromyalgia syndrome and major depression disorder have mutual family determinants and risk factors. Coexistence of fibromyalgia syndrome and affective disorders among closely related persons and also family incidence of fibromyalgia has been confirmed.

Seventy eight percent up to 94 % of fibromyalgia patients reports chronic tiredness. It has been also fund that concurrent depression has a major impact on feeling of chronic tiredness. It has been demonstrated also vicious circle mechanism that is pretty common in fibromyalgia (76–92%) sleep disorders constitute intermediate factor between pain and fatigue, and moreover these ailments amplify themselves mutually. The other symptoms that frequently accompany fibromyalgia belong: headache, dizziness, feeling of cold limbs, dryness in mouth, feeling of a lump in the throat, gastrointestinal disorder, breathlessness, feeling of arrhythmic heart beating, dysaesthesia*, dysuria**.

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More about link between depression and fibromyalgia one can read in: Anxiety, depression and fibromyalgia pain and severity Aparicio VA, Ortega FB et al University of Granada (Spain), Behavioral Psychology,2013:2;381-392

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Depression – Initial Comments

Low mood or sadness has been experienced by anyone, some days. Depression is much more than just common low mood or sadness. Depression is a serious life threatening disease that must be treated seriously and professionally. Depression often develops in a hidden way and might be not diagnosed properly in its early form unless enters into more advanced stage.

Classification of depression symptoms into somatic and mental seems to be arbitral to large degree and it is artificial and rooted more in linguistic customs and some theoretical concepts that in reality. Because does not exist any symptom of depression that is not strictly connected to bodiliness. If one wants to make such classification (which is not necessary nor valuable) the borderline should be drawn in another way as it used to be done usually. The somatic symptoms of depression should not include pain, constipation, loss of body mass etc but also depression type change in basic mood, change in basic emotional reactivity, anxiety increase related to depression, and also some other symptoms incorrectly classified as "mental".

On the other hand to the mental symptoms one should include mainly weakness of will (decision making inability), thinking disorder of depressive type, and loss of sense of undertaken actions. However their connection with/to bodiliness, corporealty, and physicality remains unquestionable.

Just after such comments and remarks we may try to classify depression symptoms into somatic and non-somatic (mental).

Mental Symptoms of Depression

Disturbances of Will (Volition)	Difficulty in decison making, loss of objectives, loss of values, emotional indifference, weakening or losing will to life.
Disturbances of Intellect	Disorders in thinking of depressive character: Disorders in thinking of depressive character: a new (not present before) mode of thinking about herself/himself and about world, about her/his past and future – critical, self accusing, depreciating or completely negative, neglecting any worthiness, merit, sense, etc.

Physical Symptoms of Depression and Somatic Syndrome

Physical symptoms are common in major depression and may lead to chronic pain and complicate treatment. Symptoms associated with depression include joint pain, limb pain, back pain, gastrointestinal problems, fatigue, psychomotor activity changes, and appetite changes. In the primary care setting, a high percentage of patients with depression present exclusively with physical symptoms.

Majority of depression symptoms could be recognized as somatic. Among which some particular symptoms can be highlighted and that form so called "somatic syndrome". This selection has an arbitral character, however it is motivated by the fact that they are helpful in diagnosis of depression disorder, moreover they may constitute strong rationale to set up pharmacotherapy in affected person. Thus somatic syndrome is not the same as somatic symptoms of depression.

Somatic Syndrome symptoms include:
(list according to description in ICD-10)

• Loss of interest and decrease in ability to feel pleasure
• Early waking-up (couple hours earlier than usually)
• Greater exacerbation of depression in morning hours
• Distinct psycho-motor inhibition or motor excitement (so called agitation)
• Lack or distinct decrease of appetite, loss of body mass
• Loss or decrease of sexual drive and desire

Absence of some symptoms of the somatic syndrome or difficulty in founding them does not exclude diagnosis of depression.

Depression somatic symptoms	Somatic Syndrome in depression
Changes in organism energetic output, its reactivity, and basal mood Drop in physical condition, fatigability Feeling of general weakness, sense of undetermined illness Sleepiness, sluggishness, feeling of impairment Motoric restlessness (so called psychomotor agitation) Loss or decrease in ability to experience pleasure (so called anhedony) Mood decrease, sadness, tearfulness, weepiness Lack or limitation in previous interest	Loss of interest and decrease in ability to feel pleasure Distinct psychomotor suppression or psychomotor excitement (so called agitation)
Other changes in regulation of basal emotionality Increase in general level of anxiety level, anxiety alertness Irritability Difficulty in controlling own emotional reactions Emotional lability (volatility)
Changes in general organism performance and aggravation of depression symptoms connected to circadian rhythm Exacerbation of some or all depression symptoms in morning or forenoon hours and gradual alleviation within day course	Greater exacerbation of depression in morning hours
Sleep disorders Sleeplessness (insomnia), decrease of sleep amount and distinct sleep disruption (sleep interrupted by awakings, shallow sleep, early final wake-up, better sleep quality in beginning and worse later, tiring sleep dreams, terrifying sleep dreams, nightmares, lack of sleep dreams) Somnolence, increase of sleep amount during night, drowsiness within daytime, even desire to get nap (night sleep apparently good in quality and length with no nightmares, however not giving feeling of enough sleep nor might regeneration/restoration) Particular symptoms that are accompanying morning wake-up: feeling of sleepiness, lack of energy, tiredness (wake-up could be accompanied also by mental tension, anxiety, fear, and various bodily aliments)	Early wake-up (couple hours earlier than usually)
Pain aliments • Pain or similar aliments, most often headache, neck, other muscles, abdomen, joints
Symptoms from digestive tract: Lack of appetite or rise of appetite, extremely changeably Loosing or gaining body mass Heartburn Nausea Vomiting Abdominal pain Flatulence Constipation Diarrhoea	Lack of distinct decrease of appetite, loss of body mass