What Is the Fibromyalgia (FM) & Depression Connection?

Most Fibromyaglia Victims are Not Depressed, yet study after study has shown it to be higher than in comparable populations. Why is that? I suggest it is:

  • the uncertainly that goes with the diagnosis (do I have something more serious?)
  • the need for continued search for primary and secondary pain generators
  • the stigmatization that comes from having an invisible disease
  • the poverty and struggle one has when dealing with insurers

WOMEN WITH FIBROMYAGLIA!

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——————Two recent studies have shown there is more depression in FM than other comparable illnesses:

Neuropathic Pain:
Eur J Pain. 2010 Feb;14(2):127.e1-8.
Depression, anxiety, health-related quality of life and pain in patients with chronic fibromyalgia and neuropathic pain.
Gormsen L, Rosenberg R, Bach FW, Jensen TS. abstract here
Incidence of Depression: FM 7.1% Neuropathic pain – 3.3%

Rheumatoid arthritis:
J Rheumatol. 2010 Feb;37(2):305-15. Epub 2010 Jan 15.

Chronic conditions and health problems in rheumatic diseases: comparisons with rheumatoid arthritis, noninflammatory rheumatic disorders, systemic lupus erythematosus, and fibromyalgia.
Wolfe F, Michaud K, Li T, Katz RS. abstract here

Incidence of Depression:

  • FM – 39% (much higher but suspect teriary referral center patients worse)
  • Rheumatoid arthritis or Non inflammatory Rheumatic Disorders – 14%
  • SLE – 34% (this group can get pretty sick and the steroids they may be on can induce depression)

The Stigmatization

Had one case in which I ask if she would have preferred to have Multiple Sclerosis – a disease that can progress to putting one in a wheelchair. The answer was yes – then you would know what you are dealing with, the treatments are more well defined, and it is a more recognized disorder. Insurance issues are less confrontational.

We know that FM is not an insurance related disease:

The Amish have it at same or maybe more frequent incidence of Fibromyalgia:
J Rheumatol. 2003 Aug;30(8):1835-40.
Fibromyalgia syndrome in an Amish community: a controlled study to determine disease and symptom prevalence.
White KP, Thompson J abstract here

It has same prevalence in third world countries despite no insurance coverage:

Prevalence of rheumatic diseases in Brazil: a study using the COPCORD approach.
Erika Rodrigues Senna, Ana Letícia P De Barros, Edvânia O Silva, Isabella F Costa, Leonardo Victor B Pereira, Rozana Mesquita Ciconelli, and Marcos Bosi Ferraz
The Journal of Rheumatology March 1, 2004 vol. 31 no. 3 594-597 abstract here

The contention Fibromyalgia might be a viral infection, refuses to die, with the contention the blood testing in the British study was inadequate.

The stigmatization that goes with the disease can be enormous with a few doctors even refusing to see such patients.

Rheumatologists can be hard on these patients and have been on occasion censored by our Medical College here.

One nauseating story was of a Rheumatologist that refused to ever consider FM disabling, yet when a secretary in his department developed FM, he refused to take her on because she was too slow and had other performance issues, would forget thengs, and may miss days at work. What a hipocrite…

I would be interested in stories of Fibromyaglia victims and their struggle… nike air max blancas nike air max blancas

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One Response to What Is the Fibromyalgia (FM) & Depression Connection?

  1. Jan Bryan says:

    I have been diagnosed with Rheumatoid Arthritis, Fibromyalgia and depression. I am trying to find a painkiller that will work. I have already tried 100mg Fentynal Patches (off them to see if anti-tnf is working) and am still on 1 morning and 1 night 10mg Morphine tablets. My Doctor has prescribed Co-Codimol (they are no help at all) I take Sulpadine but have been warned they have too much salt in them I have been on Anti TNF – Etanercept since November 2010, Naproxen 500 mg 1 in morning and am just coming off Mirtazapine 45, 30,15 mg then on to Fluoxetine 20mg going to rise to 60 mg. I had a gastric band in 2003 and have lost over 300lbs in weight. I am also asthmatic and use inhalers Sabutimol 200mg One puff morning and night.
    I work in a residential school with children and young adults who have Autism and challenging behaviour and find between pain and fatigue work more and more difficult. Between this and stress I am put under to stay well being told I will go to a board where others will decide whether I am fit for work. I have seen occupational health who assure me I am fit for purpose but will be off more than those of my own age group. I am 48 years of age Female. I have a coil to keep away early onset menopause. I do not sleep well, can do little excercise though do still walk to work (4 days a week now) and of course am kept on my toes at work. My hands and feet are becoming more deformed but the swelling in my joints have improved. The fibromyalgia affects mainly my left side esspecially my foot below my toes. Any help gratefully received.

    I find it very difficult to discuss someone I have not seen, but here are some obvious factors you need to consider:
    1) Gastic banding could change vitamin and mineral requirements – you should have Vit. B12, folate, Calcium, magnesium levels checked.
    see – ASMBS Bariatric Nutrition Guidelines at:
    http://www.scribd.com/doc/50827033/Vitamin-and-Nutrition-Guidelines-bariatric-surgery
    2) One would also wonder if you are getting enough omega 3 in diet – it has anti-inflammatory and anti-depressant properties. For depression, an average of 1.2 gm of EPA was used to treat depression. – see metanalysis at:
    http://freeradicalmd.com/files/scurry2-Omega-3.pdf
    http://www.bepress.com/jcim/vol7/iss1/35/
    A recent trial found it helpful in Fibromyalgia:
    Administration of Omega-3 Fatty Acids Reduces Positive Tender Point Count in Chronic Musculoskeletal Pain Patients – see at:
    http://www.bepress.com/jcim/vol7/iss1/35/

    An earlier open trial of 4.5 gm fish/day for 4 weeks in 12 FM subjects “showed marked improvement in pain, fatigue, depression, and tender points”
    Int J Clin Pharmacol Ther. 2000 Jul;38(7):362-3.Effect of omega-3 fatty acids in the management of fibromyalgia syndrome. Ozgocmen S, Catal SA, Ardicoglu O, Kamanli A.

    It is not a panacea – for depression, it will drop beck depression scores one level – eg- from moderate to mild
    3) I would suspect you might has some version of sleep apnea. In town, one company will check you for that for free just to get your business re cpap later. Some oxygen supply companies might do a basic nighttime home oxygen testing (noctural oximetry). Sleep apnea is more common in Rheumatoid cases. – see:
    http://jrheum.org/content/36/9/1869.abstract
    If you snore – really watch out, although a dumbed down version of sleep apnea (sleep disordered breathing) does not need to snore. Treatment of this would help your pains and mood alot.
    3) With chronic pain, sleep apnea, and opioid use, testosterone levels are low. Many of my female chronic pain patients have unmeasurably low levels. Replacement with 0.2-0.3 mls of testim gel/day helps energy and maybe pain.
    re use in FM see:
    http://www.freepatentsonline.com/7799769.html
    4) DHEAs is an androgen pro-drug. Low levels are associated with aging. A blood test can measure its level. You can buy it at health food stores in US or ebay( in Canada better get your doctor to order it from ebay as might not make it through customs otherwise). Supplementation ( like 100 mg three times a day) will help your mood without serotonin side-effects.
    Dehydroepiandrosterone Monotherapy in Midlife-Onset Major and Minor Depression
    Peter J. Schmidt, MD; Robert C. Daly, MD; Miki Bloch, MD; Mark J. Smith, MD, PhD; Merry A. Danaceau, RN; Linda Simpson St. Clair, RN; Jean H. Murphy, RN, MSN; Nazli Haq, MA; David R. Rubinow, MD
    Arch Gen Psychiatry. 2005;62:154-162. Free article at:
    http://archpsyc.ama-assn.org/cgi/content/full/62/2/154
    5) About 20% of patients with RA will have Fibromyalgia. There is now good evidence of small nerve damage in FM that leads to neuropathic (nerve damage)pain
    see:
    http://painmuse.org/?p=810
    Particularly if there is numbness, an auto-immune process might be involved at might respond to IV immunoglobulins:

    A subset of fibromyalgia patients have findings suggestive of chronic inflammatory demyelinating polyneuropathy and appear to respond to IVIg – see free article at:
    http://rheumatology.oxfordjournals.org/content/47/2/208.full.pdf+html

    6) It appears that you are not on any treatment for Fibromylagia – the least you should be on amitirptyline 10- 30 mg at bedtime daily.

    7) Local injections could help your pains some as could padding in your feet. The pain you have in your feet could be intermetatarsal bursitis
    eg – Magnetic resonance imaging appearance of the hands and feet in patients with early rheumatoid arthritis. – see:
    http://www.jrheum.org/content/30/4/671.short

    – this bursitis can press on the toe nerves especially between the base of 3-4 toes (are those toes numb some?) and cause a morton’s neuroma – very painful
    Steroid injections could be helpful and enbrel helps the bursitis as well.

    8) Most FM sufferers have a variety of mechanical issues that need work.
    – subtle neck “sciatica” that might be helped by a cervical inflatable traction unit. (check ebay)
    – C4/5/6 facet pains – I inject them with botox and it helps but is not cheap
    scalene – 1st rib area pains helped by manual techniques
    Sacroliac joint problems – a Sacroiliac belt and manual work to area might help
    Piriformis – a massage therapist might help
    I could go on and on – you alsoi need a good assessment of your muscle / myofascial complaints – massage and perhaps trigger injections could help as well.
    9) I see you are on large doses of antidepressants. About 1/4 of Fibromyalgia sufferers have bipolar disease. see:
    The high frequency of manic symptoms in fibromyalgia does influence the choice of treatment? – free article here:
    http://archive.biomedcentral.com/content/pdf/1745-0179-2-36.pdf

    Lithium carbonate is useful for that and has painkilling effects – I recently put one bipolar case on lithium and she is 50% better.
    mentioned re pain here:
    Journal of Musculoskeletal Pain, 11(1) 2003, 69-70. Lithium and Fibromyalgia. John M. Lewis et al
    and
    Lithium for Fibromyalgia at:
    http://www.anesthesia-analgesia.org/content/98/5/1505.full

    There is so much more to say, but that’s enough for now…

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