Reactive Depression

Reactive Depression Overview

Voltaire, the French Philosopher back in the 1700’s stated, “the lower back is at the crossroads where the psyche meets the soma” (soma meaning body). He was so right in that patients can have debilitating knee or shoulder pain and not exhibit depression. However, when a back or neck is involved, reactive depression is common.

Reactive depression is depression that is caused by a reaction to an external event. In this case, the cause is back or neck pain. Of course, there are patients with debilitating back pain without the onset of depression so there has to be a genetic predisposition in some individuals to develop this depression.

Depression is not the occasional “feeling blue”, as these feelings are short lived and pass in a temporary period of time (typically two weeks or less). True reactive depression occurs daily, interferes with daily life and makes normal day-to-day functioning extremely hard.

Major depression (a psychological disorder not related to reactive depression) can be found in some of these back patients. This depression existed prior to the onset of spine pain. Major depression is a disorder of the brain that is not brought on by external sources (but can be aggravated by external forces).

If there were no significant signs of depression prior to the onset of lower back or neck pain and the onset of depression occurred due to this pain, reactive depression is the common cause in this type of onset.

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(Please keep reading below for more information on this condition.)

Anhedonia, Insomnia, Irritability, Lethargy

Anhedonia, insomnia, irritability and lethargy are the four key features of reactive depression.

Hedonism of course is the personal drive to satisfy the cravings of pleasure. Anhedonia is the lack of this desire to enjoy life. Commonly is heard from these patients, “Nothing seems fun anymore” and “nothing is going to change or get better.”

Insomnia is the difficulty in getting to sleep or staying asleep. The common refrain heard here is “I was tired all the time, and I wasn’t sleeping well at night” and “I’m so tired that it was really hard to get out of bed in the morning”.

Irritability is the inability to shrug off comments or “to take them the wrong way”. Snapping at your wife, husband or children is common and the comment, “It’s hard to tolerate them anymore” is not unusual. Anger outbursts often occur. Tears and crying are common.

Finally, tiredness or lethargy is profound in depression patients. Patients report, “I feel like I am walking through mud all the time” or “It was hard but I knew I had to keep going because I’ve got to go to work and raise the kids”.

Other symptoms also can be associated with reactive depression such as over or under-eating, loss of sex drive, loss of memory and even thoughts of suicide. Interestingly, depression seems to magnify pain symptoms out of proportion.

Narcotic and Muscle Relaxant Use and Depression

Narcotic drug use to “treat” symptoms of depression is more common than doctors think. Even though these patients had the narcotics prescribed initially for pain reduction, certain patients gain a euphoria or “high” from narcotics, which can compensate for the lows of depression.

The problem with narcotic usage in the long term to “treat” depression is that this “high” (from a dopaminergic effect) is short lived and actually habituates the patient. The stopping of narcotics in this patient will create a much “lower low” so the use of narcotics becomes difficult to reduce without help.

Muscle relaxants on the other hand are depressants. These medications reduce the activity of the nervous system. Patients with depression commonly also have anxiety. This group of medications will reduce anxiety and “numb’ the patient. This allows the patient to “relax”. These medications can also lead to habituation.

Treatment of Reactive Depression

Treatment of reactive depression revolves around resolving the trigger for the depression. In this type of reactive depression, spine pain is the trigger. Treatment of the spinal disorder should help to resolve the depression.

However, it might take months to resolve the pain, either through therapy or surgery. In this instance, antidepressant medications might be helpful. There are various ones available and family practitioners or mental health professionals can be instrumental in selection of the proper medication.

Some patients might benefit from talk therapy and visits to a psychologist or psychiatrist might be in order.

For more resources on reactive depression and its association with back and neck pain, please contact the office of Dr. Donald Corenman, spine specialist and neck doctor offering diagnostic and surgical second opinions to patients in the USA and around the world.

Donald Corenman MD DC | Spine Surgeon Colorado | Vail, Denver, Aspen

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Donald Corenman, MD, DC

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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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