Chronic pain and depression often go hand-in-hand, posing a double challenge for those affected. It is known that both physical and emotional pain are processed in the same areas of the brain and involve the same neurotransmitters. Combine this biological fact with the situational conditions imposed on individuals with chronic pain and you have a recipe for depression.
By far, the most common treatment modality for chronic pain, depression and the combination of the two is medication. Antidepressants manipulate the brain’s chemistry by creating more feel-good neurotransmitters, theoretically reducing both pain and depression.
It is true that there are a number of studies with opposite conclusions, but this shouldn’t obscure the importance of the above results. Conflicting evidence indicates a lack of evidence. Aside from questionable effectiveness, antidepressants carry with them a host of risks from minor side effects like nausea, constipation, headache, insomnia or sedative effects to more serious risks like weight gain, tolerance, dependency, increased depression and suicide. The most concerning fact about antidepressant risks is that we likely don’t know them all; the medications saturated the market before being subjected to long-term study. The FDA didn’t announce the risk of increased suicidality in young people associated with antidepressant use until 2004, well after the drugs had been prescribed en masse to children and teens.
Despite the dangers associated with these drugs, it is still hard to get patients and physicians to consider the legitimacy of other treatments. We know antidepressants change our brain chemistry, and in the age of invasive medicine, this seems like the most valid approach. However, there is another treatment that affects the brain, though in a different way, and can be used to treat pain and depression.
Cognitive behavioral therapy (CBT) is a talk therapy approach that focuses on identifying negative thought and behavioral patterns that patients have toward their life situations. The patient works with the therapist to identify harmful patterns and, gradually, replace them with more accurate, productive patterns. Unrealistic or negative thought patterns have been linked to both increased pain sensitivity and depression. Unlike medications that forcibly alter the amount of certain neurotransmitters in the brain, CBT effects change by increasing the activity of the cortex, the section of your brain that activates when you assess and react to stimuli. This change in activity indicates that CBT teaches patients skills to better control how they respond to pain, emotional or physical. See www.psychologytoday.com for more on this.
Cognitive behavioral therapy may not be a sufficient treatment for patients with major depression, but it shows promise for those with mild depression. In a number of studies it wins out over antidepressants in the treatment of pain. One study, comparing CBT to antidepressants in the treatment of 11 different pain syndromes, found CBT to have more consistently positive results. See www.ncbi.nlm.nih.gov for more on this study.
Though it has become a standard form of treatment for ailments small or large, physical or emotional, the antidepressant should be reserved for cases of severe depression that pose an immediate risk to health and life. This conservative prescription policy is a far way off from where we are today, with physicians offering free samples of antidepressants to patients upon their first visit for nearly any ailment.
Talk with your doctor about cognitive behavioral therapy for pain and depression treatment. This type of treatment comes with no risks and puts the tools for coping in your own hands.