Strategies for Coping With Depression and Chronic Pain

Chronic pain can be brutal, and depression, not surprisingly, often accompanies it: It's estimated that as many as 60% of chronic pain sufferers experience depression.

"We know that in some patients, depression follows the pain," says Russell K. Portenoy, MD, chairman of the Department of Pain Medicine and Palliative Care at the Beth Israel Medical Center in New York City, "And in some patients, depression seems to precede or drive the pain."

And yet there are patients who feel that because it's pain that they suffer—not a life-threatening disease—they have no right to depression. This can lead to what Lynne Nelson, 56, from Nashua, N.H., calls "a mess of thoughts."

"I feel pretty crummy," says Amanda, 39, of Manchester, N.H., who suffers from debilitating migraines. "A lot of times with the migraines, I find I'll have a lot of anxiety, depression. And after I'm two or three days into it, that of course is intensified."

Antidepressants can help two ways
Antidepressant medications are used for their direct pain-relief effect.

"Antidepressant medications can treat pain in people who are not depressed," says Dr. Portenoy. "Some of them are in fact painkillers. There have been many studies to show that antidepressants can be used to treat headache, lower back pain, fibromyalgia, and nerve pain."

But these meds do "double duty" by attacking depression itself, says Steven Feinberg, MD, a past president of the American Academy of Pain Medicine.

"If a person has depression and pain, then the antidepressants should be considered first-line drugs," adds Dr. Portenoy.

Whether the medication is for pain or depression relief, some patients resist it, because of the stigma associated with antidepressants—or because they're resistant to having to take one more pill.