Depression

This is a mouthful isn't it...Depression. The black void that engulfs us and sometimes haunts us on a daily basis.

Many doctors tell their patients that their symptoms are related to stress or depression, but who WOULDN'T be stressed and depressed if they are in pain and deprived of restful sleep! Let's not forget the depression that the doctors give us as well.

Absolutely, Fibromyalgia symptoms get worse under stress and depression, but making symptoms worse is not the same thing as causing them.

Studies have shown that patients with
Fibromyalgia, or are going through the diagnosis process,
are no more depressed than those with other
chronic, painful and debilitating disorders!

Frequently, people with Fibromyalgia are misdiagnosed as having clinical depression as their primary disorder. In fact, most current research indicates that, while depression is often present in Fibromyalgia (accompanied by numerous other physical symptoms), it is a secondary, not a causative, condition. And while psychiatric consultation may be an appropriate recommendation for people with Fibromyalgia, it should not be the primary or the only medical response. It seems to be overlooked by too many health professionals--and family members--that depression is a not-unexpected ailment associated with chronic illnesses.

What are the factors that contribute
to the physician's difficulty in differentiating
Fibromyalgia from a primary depressive disorder?

Some of the symptoms of Fibromyalgia also occur in depression:
	Fatigue, a primary symptom of Fibromyalgia, is also a primary symptom of depression.
	Cognitive impairment is common to both diseases.

*There are similarities between depression and Fibromyalgia in presentation and diagnosis:*
	Often there is an absence of clinical and laboratory findings in both Fibromyalgia and depression.
	Both disorders are typically invisible, making the patient appear to be physically well.

Many patients with Fibromyalgia do suffer from depression, making the diagnosis an easy first call.
	The fact of having a severely debilitating chronic disease can in itself cause depression.
	There is preliminary evidence that Fibromyalgia can cause a swelling in the lining of the brain causing biochemical depression.
	It is now an accepted fact that most chronic diseases are accompanied by some form of depression.

The way Fibromyalgia has emerged
on the medical scene and the way primary
medicine works have added to the confusion:

Fibromyalgia has been slow to gain medical attention as a
distinct organic entity.

Depression has historically been the specialty of psychiatrists and consequently most general practice physicians are not experts in determining whether the depression they are seeing in a patient is a primary or secondary diagnosis. Also, some physicians, in the absence of concrete medical findings, assume that symptoms are "all in the head" and that therefore depression must be the diagnosis.

The confusion surrounding Fibromyalgia and depression is a frustrating one for physicians and patients. For example: Often people diagnosed with depression as their primary symptom are not taken seriously in general medicine. This means that a person with Fibromyalgia who is misdiagnosed with depression may not be taken seriously, leaving him/her angry and abandoned. The fact that general medical practitioners tend not to take depression seriously, whether it is related to Fibromyalgia or not, is extremely dangerous, as depression is known to be one of the most lethal diseases in medicine.

The rate of suicide in those diagnosed with severe clinical depression, regardless of the cause, can be as high as 15%. However, depression is also one of the most treatable diseases, as more than 85% of patients improved with treatment.

Once a physician suspects depression as a cause of a patient's problems, she/he is less likely to identify the more subtle and mostly invisible symptoms that could help lead to the diagnosis of other diseases. For example, the presence of depression accompanied by pain, swollen lymph glands, sudden onset, neurological difficulties, etc., would point towards a specific diagnostic picture of Fibromyalgia, not primary depressive disorder.

Depression is also an early warning sign of many other illnesses, including cancer. The diagnosis of depression in general medicine often means that the person will not be treated by a primary care medical doctor, but will be referred out to a psychiatrist or psychologist. In doing this, the physician misses the opportunity to treat physical problems which may in fact be causing the depression.

The better approach, when primary depressive disorder is not the absolute and clear diagnosis, would be to seek consultation in treating the depression to see if reducing the depression also reduces the accompanying physical symptoms. (However, since more and more "antidepressant" medications are being used for pain control and immune system moderation, the fact that such a drug works on physical symptoms does not automatically mean depression was the cause.)

The treatment for depression related to chronic diseases like Fibromyalgia is often different from that for primary depressive disorder, because in Fibromyalgia the immune and nervous systems are involved. For example, people with Fibromyalgia who take antidepressant medications for a variety of reasons (pain, immune modulation, and depression) often must take considerably lower doses of antidepressants than those with primary depressive disorder. The following information should be helpful in this discussion.

Both Fibromyalgia and primary depression have the following symptoms in common:
Symptoms of clinical depression:
		Lethargy, fatigue
		Sleep disorder
		Inability to function
		Memory loss, "foggy" brain, cognitive deficit, concentration problems.
		Aches and pains
		Sadness, hopelessness
		Weight loss or gain

Symptoms of anxiety
		shortness of breath
		shortness of breath
		diarrhea
		chest pains
		panic attacks
		numbness, tingling
		nausea

Fibromyalgia/CFIDS has the following symptoms NOT common to depression:
		mild fever
		sore throat
		painful or swollen lymph nodes
		unexplained generalized muscle weakness
		muscle pain
		migratory joint pain without swelling or redness
		sudden onset (without situational cause)
		neurological disturbances

The following are significant
differences between primary
depression and Fibromyalgia / CFIDS:

Manifestations of Depression		Manifestation of FM/CFIDS
Low motivation		High motivation
Exercise alleviates symptoms		Exercise worsens symptoms
Patient underestimates capabilities on cognitive tests		Patient overestimates capabilities on cognitive test
Memorization not impaired by brief interruption		Memorization significantly impaired by brief interruption
Performance on memorization test enhanced by cues		Memorization cues worthless