Depression’s Relationship with Pain

People with a depressive illness cannot merely “pull themselves together”
and get better.

It’s Not Just the Blues

A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely “pull themselves together” and get better.

Depressed woman in front of a bench

Mary Larson explains, “I was experiencing extreme pain in my lower back, right leg and lower abdomen. Since I had no insurance, I stoically dealt with it. On a day-to-day basis, my pain was at a 9 or 10. After three months at my new job with health benefits, I was finally able to see an orthopedic surgeon. The MRI showed a 90% compression on two sections of the lumbar region. Two weeks later, I was in surgery. Over the next six years, I had another back surgery and a cervical fusion on two sections of my neck.”

Her depression returned and now at 45 years old, Mary is taking antidepressants and anti-anxiety medications to help her cope. “I face pain every day and have a numb right leg. The medication makes a huge difference in my ability to cope, but I have found that exercise, minimizing my ‛alone’ time, and building a relationship that entails excellent communication with my health care professionals is as important as the medication itself.”

When diagnosing a patient it is important for doctors to evaluate if the back pain caused the depression, or if back pain is a result of the depression.


Anatomy of male back pain in blue

Depression Can Lead to Back Pain

It’s not a surprise that most people suffering from chronic pain also experience depression, but did you know the reverse can be true as well? A 2004 University of Alberta study revealed that depression is a risk factor for the onset of severe neck and low back pain. Researchers followed a random sample of nearly 800 adults without neck and low back pain and found that people who suffer from depression are four times as likely to develop intense or disabling neck and low back pain as those who are not depressed.

When diagnosing a patient, it is important for doctors to evaluate if the back pain caused the depression, or if back pain is a result of the depression.

Sharing Your Symptoms with Your Health Care Provider

Since it is common for the symptoms of depressive conditions to wax and wane, it’s important to deal with them before they become troublesome and lead to a vicious cycle. Unfortunately, many don’t recognize the signs and symptoms of depression, nor are they aware of the various treatments.

Watch for these symptoms of depression:

  • Change of appetite, with either significant weight loss not attributable to dieting or weight gain.
  • Change in sleep patterns, such as fitful sleep, inability to sleep, early morning awakening, or sleeping too much.
  • Loss of interest and pleasure in activities formerly enjoyed.
  • Fatigue, loss of energy.
  • Feelings of worthlessness.
  • Persistent feelings of hopelessness.
  • Feelings of inappropriate guilt.
  • Inability to concentrate or think, indecisiveness.
  • Recurring thoughts of death or suicide, wishing to die, or attempting suicide. (Note: People suffering with this symptom should receive treatment immediately!)
  • Melancholia (defined as overwhelming feelings of sadness and grief), accompanied by waking at least two hours earlier than normal in the morning, feeling more depressed in the morning, and moving significantly more slowly.
  • Disturbed thinking is a symptom developed by some severely depressed persons. For example, severely depressed people sometimes have beliefs not based in reality about physical disease, sinfulness, or poverty.
  • Physical symptoms such as headaches or stomachaches. (Depression can also exacerbate existing physical symptoms such as backaches, headaches and aching joints.)

Remember to keep track of your symptoms in writing and share them with your health care provider prior to your office visit, so they can be reviewed before your appointment.