The Relationship Between Stress, Depression & Fibromyalgia
Stress plays a major role in both fibromyalgia and depression. While there are many similarities in fibromyalgia and depression, including brain areas that are activated and how both respond to stress, fibromyalgia is more than just depression.
When my mom was diagnosed with cancer then underwent surgery and began chemo, it was a stressful time. I’d just started a new business, and business was picking up, but then I found that I needed to put things on hold while we figured out what the situation would be with my mom.
It could have been much worse for her, so we were very lucky. Despite things turning out better than expected, I was still figuring out how to juggle a whole lot of new stuff, and that weighed on me.
Stress, Depression, & Fibromyalgia
The hold I’ve had on my health began slipping as a result. I began having more bad days. Instead of one “bad” day every few weeks where I needed to just rest, I was needing a rest day every few days. I never quite went into a full fibromyalgia flare, but I had more than enough bad days.
Thankfully, as time has progressed and the situation has leveled off into a routine I’m feeling much better and bad days are rarer.
And, stress can even be the result of something we actually enjoyed (perhaps you played too hard with your kids, or spent the day hiking).
Illness can also be a source of physical stress; something as simple as a common cold or a dormant infection.
Sometimes, it’s psychological as we let our worries and fears take over, wearing us out mentally.
Stress and the Brain
Physical stress results in activation of the locus coeruleus, while emotional stress results in activation of the HPA Axis. There is a reciprocal connection between the locus coeruleus and the HPA Axis, meaning that when the physical stress response is activated, so is the emotional stress response, and vice versa.
Studies have found various elements of the HPA axis to be abnormal in those with Fibromyalgia.
What ignites the stress system in Fibromyalgia?
These physical stressors may result in psychological stress. Of course, Fibromyalgia often co-exists with other diseases (providing their own causes of physical and psychological stress, further compounding the issue).
There is also evidence linking Fibromyalgia to a past history of physical or emotional abuse (yet another source of psychological stress). Occupational stress (being unhappy at work due to high workload, workplace bullying, or lack of ability to control outcome or make decisions) has also been linked to Fibromyalgia.Click To Tweet
Really, any sort of stress can be what sets off Fibromyalgia, but it’s going to take more than one thing. Obviously, if any stressor lead to Fibromyalgia on its own, everyone would have it. So, why do some of us end up with Fibro and others don’t?
One reason seems to be that those with Fibromyalgia perceive stress differently. The nervous system and brain of someone with fibromyalgia reacts to mild stressors as if they were more stressful. We are more likely to report stressful life events than others.
There are several other potential factors that may make us more vulnerable to developing Fibromyalgia.
Certain genes have been associated with an increased risk of Fibromyalgia.
The RGS4 gene, specifically is located in the locus coeruleus, creating a genetic anomaly in the stress system. This gene has also been associated with changes in the opioid receptor function, which may explain why some patients with Fibromyalgia are not helped by opioid pain medications. The COMT gene is also associated with Fibromyalgia. The specific variation associated with Fibromyalgia is associated with psychological stress and higher sensitivity to pain.
The ability to cope and to turn negative emotions into positive emotions is also highly associated with Fibromyalgia. Other personality traits including unhealthy perfectionism, neuroticism, and hysteria also tend to be higher in those with Fibromyalgia.
Fibromyalgia is circular. While any of these causes might feed into Fibromyalgia and might be an igniting factor, once the pain is there it continues to feed the stress monster, increasing stress (physical and psychological), making the pain worse and increasing the stress.
How are depression and Fibromyalgia related?
Patients with Fibromyalgia have a 74% likelihood of developing depression in their lifetime and a 30% chance of having major depression at the time they are diagnosed with Fibromyalgia.
[Aside: too many of us spend many years in pain before we are diagnosed, so it’s understandable that we might be suffering from major depression by that time.]Click To Tweet
Psychological stressors can trigger depression just as likely as it can Fibromyalgia.
Anti-depressants have also been successfully used to treat Fibromyalgia suggesting a shared pathophysiology.
One study suggests that there may be a genetic trait that predisposes people to both Fibromyalgia and depression. Additionally, the same patterns of HPA dysfunction have been found in both patients with Fibromyalgia and patients with depression.
Fibromyalgia is NOT depression
While there is a lot of overlap between Fibromyalgia and depression it is important to note that there are differences as well. There are specific pain pathways that are activated in Fibromyalgia that are not active in depression, thus allowing differentiation between someone who has depression and pain and someone who has Fibromyalgia and depression.
It’s important to note, that it’s the overlaps that lead to Fibromyalgia often being treated with antidepressants. There is a difference between the two and using the same treatment is not suggesting that fibromyalgia is just depression. Fibromyalgia is not just depression. Acknowledging this connection is simply acknowledging that similar brain structures are affected in both illnesses and therefor a medication that treats one may also help the other.
There’s a lot of overlap between Fibromyalgia, stress, and depression. Stress can lead to Fibromyalgia or depression, or both. Struggling with Fibromyalgia can lead to more stress and to depression. But, you can also have one without the other.
Learning to cope with stress can be a deciding factor in how badly you are affected by both Fibromyalgia and depression.
Learning to cope with stress has been huge for me in dealing with both Fibromyalgia and depression. I suffered from depression and anxiety before I was diagnosed with Fibromyalgia. Understanding how these are connected in the brain helps me see how learning to to cope with stress has helped both disorders.