Depression and anxiety impact bodily symptoms differently in patients with fibromyalgia, according to a study from the University of Iowa
This, they say, may explain why multidisciplinary treatments that include psychological interventions for fibromyalgia are effective only for a subset of patients, researchers said, suggesting that treatment should be tailored to the individual symptoms a patient is experiencing. More research is then needed to assess if such a tailored approach is beneficial for fibromyalgia patients.
The study reporting the findings, was published in the Journal of Health Psychology.
Fibromyalgia News Today continued to say that researchers recruited 191 women with a fibromyalgia diagnosis. The majority of the patients, 65 percent, had been ill for more than five years.
Half of the study participants reported they were affected by depression or anxiety. This subgroup was made up of 24 percent who had high levels of both depression and anxiety; 17 percent who reported high levels of anxiety without high levels of depression; and 9 percent who said they were depressed but did not experience anxiety.
In addition to examining the levels of depression and anxiety, the research team measured fatigue, the presence of sleep disturbance, pain catastrophizing (exaggeration), fear of movement, and pain severity using validated tools.
Data showed that pain catastrophizing, fear of pain, and pain severity were linked with both anxiety and depression and that both independently impacted pain and pain-related symptoms. The effect was, however, not addictive.
This was a surprise to the team members, who thought that anxiety and depression — when present together — would have an amplifying effect to cause even more severe symptoms.
Fatigue and sleep problems, on the other hand, appeared to be impacted only by depression. Although some studies suggest that sleep problems may trigger depression in fibromyalgia patients, there may be other explanations for this association.
Researchers said that it also is possible that common mechanisms — such as central nervous system sensitization or inflammation — may give rise to both sleep problems and depression, in addition to fibromyalgia.
The observations made the team suggest that current multidisciplinary treatments with psychological interventions may be more effective for patients with low levels of anxiety and depression and that more tailored approaches are needed for patients with higher levels of depression/anxiety.
“These results suggest the possible benefit of tailored targeted treatments for symptom management in persons with fibromyalgia. The differences identified in fatigue and sleep quality in relation to depression versus anxiety provide direction for such targeted clinical interventions,” the researchers wrote.
Future studies should now focus on evaluating if interventions, targeted for fibromyalgia patients with various levels of depression and anxiety, are more effective than current approaches.
Brian Barr Solicitors wrote People with fibromyalgia often experience lower levels of hormones, such as serotonin, which is linked to feelings of low mood. As a result, they can experience severe depression alongside their illness.
When life is a daily battle against distressing health issues, unhappiness is a normal reaction. Depression, however, surpasses sadness. Depression can leave sufferers feeling overwhelmed by despair, making fibromyalgia even more difficult to deal with.
Depression is common with all types of long-term pain, however, there is a recognised link between depression and the acute pain of fibromyalgia. Doctors know that the stress of living with unending throbbing or stabbing pain, as well as relentless fatigue, can put a person into what is termed “overload”.
Evidence indicates that the prevalence of major depression in people with chronic pain is three to four times greater than in the general population. Some people with fibromyalgia and long-term pain may be aware they are depressed. Others may not be sure. Nevertheless, they know something is wrong.
People who are depressed commonly experience some, or all, of the following symptoms:
- Loss of interest in nearly all activities
- Weight loss or gain
- Lack of energy and overwhelming tiredness
- Feelings of guilt, hopelessness or irritability
- A sense of worthlessness
- Uncontrollable tearfulness or anger
These thoughts, physical changes and feelings interfere dramatically with daily life. In severe cases, depression with long-term pain can lead to thoughts of death or suicide.
Medication can be prescribed to help ease these distressing symptoms. Antidepressants commonly used to treat depression have also been shown to be helpful in easing some fibromyalgia symptoms, as they boost the levels of certain chemicals that carry messages to and from the brain, also known as neurotransmitters.
Low levels of neurotransmitters may be a factor in fibromyalgia, and it is believed that increasing their levels may ease the widespread pain associated with the condition.
A recent landmark study published in The Lancet found that antidepressants are effective and more people should be taking them. Researchers from Oxford University analysed data from 522 separate trials involving 116,000 patients suffering from moderate to severe depression. Each of the 21 medicines tested performed better than a placebo, some with greater results than others.
Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said:
“Taking antidepressants is frequently portrayed as a negative thing or something done only when other therapies are not available or have failed. This research should reassure patients who are taking or contemplating commencing antidepressants, and the doctors that prescribe them, that they are an effective treatment.”
The top five performing antidepressants – % better than placebo (and a number of NHS prescriptions in 2016) are named in the report as:
- Amitriptyline, 113% (12.9m) – best known under the brand name Elavil.
- Mirtazapine, 89% (7.5m) – best known under the brand Remeron.
- Duloxetine, 85% (1.8m) – best known under the brand name Cymbalta, also used to treat fibromyalgia.
- Venlafaxine, 78% (3.9m) – best known under the brand name Effexor.
- Paroxetine, 75% (1.4m) – best known under the brand name Seroxat.
The overwhelmingly positive news to come out of the report is that depression can be managed successfully. The most important first step is to openly discuss any symptoms you have with your GP.