Pain and Depression


I read somewhere that the neurochemical pathways for pain and for depression are almost identical.  What I saw on inpatient psychiatry were a lot of patients suffering both from chronic pain and from depression.  The two seem to go together.

One day I was talking with a friend who was very upset because her son was suicidal.  In the past, he had sometimes been depressed but never suicidal.  Then she said that he was a construction worker and a few days previously had sustained a lower-back injury in a construction accident and was in severe pain.  It has been my observation that the pain triggers for depression are lower back injuries and chronic pain.  In other words, a terrible toothache or acute heartburn don’t seem to trigger depression.

The depression is not about the pain, which is how most doctors treat it.  It is not the idea of pain that you are depressed about.  The pain causes the depression in the same way that an abscessed tooth causes pain.  They are inseparable cause-and-effect issues, therefore the way to heal the depression is to eliminate the pain.  Aggressively treat the pain and the depression will heal itself.

These ruminations come to you today courtesy of an injury I suffered when I pulled a muscle in my hip on Monday morning.  By Monday afternoon it seemed all better so I went to my exercise class.  Tuesday morning, it hurt.  By Wednesday morning I was in terrible pain and by Wednesday afternoon I was paralyzed by depression.

I have long maintained that depression is a social disease that should not be treated with medicine.  This is one of the few exceptions in which I think depression arises from the body, not the mind, but again the medical treatment should not be primarily for the depression but for the pain.  However, I would support limited, short-term use of antidepressants, which might be very helpful in alleviating the depression while working on the pain.

Antidepressant manufacturers and the FDA agree that antidepressants should only be used for six months.  So why are physicians keeping patients on antidepressants for years at a time?  And why aren’t they being disciplined and sued for prescribing antidepressants in violation of their intended usage?

You should work aggressively to identify and eliminate the source of your pain, with the expectation that your depression will then clear up.

As for me—I will stay off my feet, use a heating pad, take aspirin and expect to feel better in a couple days.

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About annecwoodlen

I am a tenth generation American, descended from a family that has been working a farm that was deeded to us by William Penn. The country has changed around us but we have held true. I stand in my grandmother’s kitchen, look down the valley to her brother’s farm and see my great-great-great-great-great-grandmother Hannah standing on the porch. She is holding the baby, surrounded by four other children, and saying goodbye to her husband and oldest son who are going off to fight in the Revolutionary War. The war is twenty miles away and her husband will die fighting. We are not the Daughters of the American Revolution; we were its mothers. My father, Milton C. Woodlen, got his doctorate from Temple University in the 1940’s when—in his words—“a doctorate still meant something.” He became an education professor at West Chester State Teachers College, where my mother, Elizabeth Hope Copeland, had graduated. My mother raised four girls and one boy, of which I am the middle child. My parents are deceased and my siblings are estranged. My fiancé, Robert H. Dobrow, was a fighter pilot in the Marine Corps. In 1974, his plane crashed, his parachute did not open, and we buried him in a cemetery on Long Island. I could say a great deal about him, or nothing; there is no middle ground. I have loved other men; Bob was my soul mate. The single greatest determinate of who I am and what my life has been is that I inherited my father’s gene for bipolar disorder, type II. Associated with all bipolar disorders is executive dysfunction, a learning disability that interferes with the ability to sort and organize. Despite an I.Q. of 139, I failed twelve subjects and got expelled from high school and prep school. I attended Syracuse University and Onondaga Community College and got an associate’s degree after twenty-five years. I am nothing if not tenacious. Gifted with intelligence, constrained by disability, and compromised by depression, my employment was limited to entry level jobs. Being female in the 1960’s meant that I did office work—billing at the university library, calling out telegrams at Western Union, and filing papers at a law firm. During one decade, I worked at about a hundred different places as a temporary secretary. I worked for hospitals, banks, manufacturers and others, including the county government. I quit the District Attorney’s Office to manage a gas station; it was more honest work. After Bob’s death, I started taking antidepressants. Following doctor’s orders, I took them every day for twenty-six years. During that time, I attempted%2
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