Lack of energy, difficulty sleeping, irritability, mood swings: when these things occur together in the same person, research shows they may reveal a relationship between depression and fibromyalgia.
We know these characteristics are symptoms of depression, but research shows they’re also symptoms of fibromyalgia. For many people, they’re life-altering challenges that result from having both conditions at the same time.
We also know mental health disorders can cause physical symptoms. Anxiety can cause sleep disruptions and muscle tension. Posttraumatic stress disorder (PTSD) can cause dizziness, nausea, and various types of physical pain. And panic disorder can cause chest pains, breathing difficulties, and other effects that can lead a person to believe they’re having a heart attack.
Conversely, medical issues such as life-threatening illnesses or major surgery can lead to the development of clinical anxiety, depression, and PTSD.
For depression and fibromyalgia, the cause-effect relationship works in both directions. Depressive disorders are risk factors for fibromyalgia, while people with fibromyalgia have an elevated likelihood of developing depression.
What is Fibromyalgia?
Fibromyalgia is a chronic medical condition that causes substantial musculoskeletal pain. Other common terms for this condition are fibromyalgia syndrome, FMS, and FM.
Symptoms of Fibromyalgia
Primary symptoms include:
- Incessant pain, either throughout the body or in several distinct areas
- Insomnia
- Persistent fatigue and exhaustion
Additional symptoms may include:
- Stiffness in muscles and joints
- Tingling or numbness in arms and legs
- Elevated sensitivity to various stimuli, including light, sound, and touch
- Digestive problems such as constipation
- Impaired focus and concentrate
- Memory problems
- Irritability
- Mood swings
To underscore the disruption that fibromyalgia can cause, one longitudinal study found that more than one of every four participants with FM had received at least one type of disability payment as a result of their condition.
Risk Factors for Fibromyalgia
The cause of fibromyalgia is unknown. Risk factors include:
- Gender: Fibromyalgia is more common among women than among men.
- Age: Fibromyalgia diagnoses are most common between ages 35-45, though most patients experience symptoms for several years before receiving a diagnosis.
- Genetics: The risk of FM appears to be higher among people with close family members who also have the condition.
- Trauma: Experiencing physical or psychological trauma can increase the likelihood that a person will develop fibromyalgia.
- Health: People with fibromyalgia often have other health-related concerns, including obesity, autoimmune diseases, and neurological problems.
Prevalence of Fibromyalgia
Worldwide:
- 5% total have fibromyalgia, though the prevalence of this condition varies;
- About 2.64% in Europe
- About 1.62% in parts of Asia
United States:
- Around 2% of adults 18+
- Women: 3.98%
- Men: 2.4%
That’s about 5.2 million adults in the U.S. with FM.
Fibromyalgia and Depression
Considering the profound impact that fibromyalgia can have on quality of life, it’s not surprising that many people with FM also experience symptoms of depression. However, as mentioned above, people with both conditions don’t always develop fibromyalgia first.
A meta-analysis in the Journal of Affective Disorders found:
- Patients with major depressive disorder (MDD) when diagnosed with FM: 25%
- Lifetime rate of MDD among fibromyalgia patients: 50%.
To put these statistics into context, the past-year prevalence of major depressive disorder among all adults in the U.S. is 8.3%.
Though they reinforce the strong link between fibromyalgia and depression, neither of these statistics establish a cause-effect relationship between the two conditions.
Several sources, including a May 2022 literature review, report that the association is bidirectional, with FM increasing risk of depression, and depression increasing likelihood of developing fibromyalgia.
Two potential influences on the development of both depression and fibromyalgia are variations in brain function and chronic exposure to stress.
Brain Variations in Fibromyalgia
According to the May 2022 literature review mentioned earlier, a person’s risk of fibromyalgia may be linked to several variations in the brain and central nervous system (CNS), such as:
- Increased levels of excitatory neurotransmitters, which speed up communication in the CNS
- Decreased levels of serotonin and norepinephrine, which are neurotransmitters that affect mood, memory, learning, and the fight or flight response
- Altered circadian rhythms involving cortisol, which is a hormone that is also involved with the “fight or flight” response
- Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis, a neuroendocrine system that plays an essential role in the body’s response to stress
Researchers have also linked many of these variations, including those affecting neurotransmitter functions and the HPA axis, with depressive disorders.
Stress and Stigma Associated With Fibromyalgia
Having fibromyalgia can cause stress for several reasons, including the impact of the disorder itself, the difficulty of receiving an accurate diagnosis, and persistent stigma.
An October 2021 article described fibromyalgia as a controversial disorder in part because of diagnostic challenges:
“There is no obvious cut-off point that distinguishes FM from non-FM. The diagnosis of fibromyalgia has been complicated by several factors, including patients’ health-seeking behavior, symptom identification, and physician labelling of the disease.”
The American College of Rheumatology (ACR) established a set of diagnostic criteria and guidance for treatment, but a survey of 286 doctors from 43 countries found that only one out of every ten clinicians adhere to these standards.
Something as simple as discussing symptoms with a doctor can be a long process for people with fibromyalgia. A survey of 800 patients and 1,622 physicians from eight nations found that:
- Patients experienced symptoms for an average of 11 months before seeking medical help.
- After initial meetings with a doctor to discuss symptoms, it took an average of 2.3 years before diagnosis.
- During those 2.3 years, patients saw an average of 3.7 physicians.
- About 75% of patients said doctors should spend more time with patients and focus more on their symptoms.
Receiving a diagnosis and finding appropriate treatment should signal the start of a healthier future for patients with FM, but many find that these steps lead to further stigmatization.
Jenny Dutton, a fibromyalgia expert diagnosed with FM three decades ago, described her experience:
“A lot of people who have fibromyalgia start to find themselves being alienated from their family and friends. Those situations only increase our stress and depress us more, which feeds the symptoms of fibromyalgia.”
This type of alienation can exacerbate the symptoms of depression. For example:
- A 2017 study found “a significant and unique association” between social isolation, loneliness, and depression, even after the researchers controlled for age, gender, employment status, and other influences.
- The American Medical Association (AMA) reports that loneliness and isolation can lead to a 25% increase in risk of developing depression and a host of additional “significant health issues.”
Treatment Options for Co-Occurring FM and Depression
Comprehensive treatment for depression and co-occurring fibromyalgia often involves both medication and therapy.
Medication
Physicians may prescribe antidepressants to patients with fibromyalgia, even if the patients do not have co-occurring depression. The two most common types of antidepressants for this purpose are:
- Selective serotonin reuptake inhibitors (SSRIs), including paroxetine (Paxil), sertraline (Zoloft), and fluoxetine (Prozac)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs), including venlafaxine (Effexor), desvenlafaxine (Pristiq), and duloxetine (Cymbalta)
Other medications that can alleviate fibromyalgia pain include muscle relaxants such as cyclobenzaprine (Flexeril) and anti-seizure meds such as gabapentin (Neurotonin).
Therapy
Psychotherapy, or talk therapy, can be an integral element of care for both fibromyalgia and depression.
Cognitive behavioral therapy (CBT) is one of the most effective therapeutic approaches for people with either or both conditions.
CBT addresses maladaptive thought patterns, including negative thoughts about oneself, the world, and the future.
The U.S. Department of Veterans Affairs reports that CBT can help pain patients:
- Increase participation in meaningful activities
- Manage pain flare-ups effectively
- Minimize intensity of pain
- Improve overall quality of life
For individuals with depression, the benefits of CBT include:
- Modifying beliefs that contribute to depression
- Symptom reduction
- Addressing depression-related problems such as relationship conflicts and work stress
- Increasing adherence to treatment
CBT is one of many therapeutic interventions that can help people with co-occurring depression and fibromyalgia. This underscores the importance of finding a treatment provider capable of assessing the full scope of individual needs, then identifying the medications, therapies, and support services that can help them reduce symptoms and improve quality of life.
Depression Treatment in Southern California
Crownview Psychiatric Institute offers comprehensive, personalized care for adults with acute symptoms of depression and other complex mental illnesses. We also serve patients with co-occurring chronic pain associated with fibromyalgia.
Our dynamic approach integrates therapy, medication, education, case management, and wraparound support. In our welcoming community-like environment, all patients receive compassionate, empathetic support combined with effective evidence-based treatment.
To learn more about how we can help you or a loved one, please visit our Contact page or call us today.
Gianna Melendez
Jodie Dahl, CpHT