Putting Psychological Aspects of Fibromyalgia in Context

Link to Depression & Anxiety

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When talking about anxiety and depression in people with fibromyalgia (FM), two things are true:

  1. those psychological issues are especially likely in us
  2. statement #1 will make a lot of people angry

Why the anger? Because, all too often, we're told that FM is just a fancy name for depression. Some of us have been misdiagnosed with depression and had our other symptoms dismissed.

The phrase "just depressed" is a common one, and it does a disservice to BOTH conditions. Major depressive disorder, which is what's usually meant by "depressed," is a serious medical condition. There's no "just" about it. Also, the extreme pain and many other symptoms of FM are beyond the scope of depression symptoms and can be incredibly debilitating.

So, understandably, this is a touchy subject for some people. They feel like making an association with mental health problems is the same as saying FM is a mental health problem.

Take heart, though. No one wonders about the real and physiological natures of rheumatoid arthritis (RA), osteoarthritis (OA), and ankylosing spondylitis (AS). And they have the same associations with depression and anxiety as FM.

However, FM appears to come with a higher risk of depression and anxiety, possibly because of a physiological feature they all have in common: an imbalance of the neurotransmitters serotonin, norepinephrine, and dopamine.

Regardless, it's crucial for us to recognize these associations, get proper diagnoses, and seek effective treatments. Resesarch shows, in all of the above-named rheumatic conditions, depression and anxiety exacerbate our symptoms and can seriously hamper our treatment.

An article from the website UpToDate, which is highly respected and widely used by doctors, explores psychological disorders in FM, RA, OA and AS. The following excerpt contains statistics from the findings of credible studies that are widely accepted in the medical community.

From UpToDate: Psychological Disorders & Rheumatic Diseases

"Depression and anxiety are negative psychological states that are frequently observed in patients with RA, FM, OA, and ankylosing spondylitis (AS):

  • The frequency of depression and anxiety disorders diagnosed among patients with RA ranges from 14 to 42 percent. Among female patients with RA who committed suicide, 90 percent had a depressive disorder.
  • The frequency of lifetime diagnoses of major depression and anxiety disorders in patients with FM ranges from 26 to 71 percent.
  • Significant levels of depression are found in 14 to 23 percent of patients with OA.
  • The prevalence of clinical anxiety or depression is also substantial in those with AS; among 110 such patients these psychologic disorders were present in 25 and 15 percent, respectively.

"The prevalence of these psychological disorders is substantially greater in patients with these rheumatologic conditions than among the general population. This may reflect an interaction between stress engendered by rheumatic disease and an underlying genetic predisposition to anxiety or depression."

As you can see, the rates are higher in FM than in the other conditions (although different studies have shown widely varied rates.) Notice that the article recognizes that having conditions such as arthritis and FM may contribute to depression and anxiety and doesn't say the conditions are the result of depression and anxiety.

The Importance of Recognizing Psychological Disorders in Fibromyalgia

So why does it matter that depression and anxiety are common in people with FM? Research shows that it's harder for people with these conditions, or a history of them, to deal with the stressors brought on by the condition. Chronic illness:

  • makes it harder to perform your duties, at home and at work
  • can cause financial hardship
  • can strain your relationships
  • can keep you from doing the things you enjoy

That's hard for anyone to deal with, but it's harder still for those with depression or anxiety.

Part of the problem is that people with depression or anxiety may view themselves as helpless in the face of a daunting illness. FM is notoriously hard to treat, and people who feel helpless are often less likely to take control of their own treatment and make lifestyle changes that could help them feel better.

Your doctor can help you find medication and psychotherapy treatments for your depression and anxiety. Psychotherapy can also help you more successfully adapt to and cope with your illness. You may find that taking those steps enables you to better find effective ways to treat and manage your FM.

Want to learn more? See UpToDate’s topic, "Psychosocial factors and rheumatic disease" for additional in-depth, current and unbiased medical information on fibromyalgia, including expert physician recommendations.

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  • "Psychosocial factors and rheumatic disease" UpToDate. Accessed: January 2009.