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 serving the Vail, Aspen, Denver and Grand Junction, Colorado area.