Reactive Depression and its Connection with Lower Back Pain
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 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.
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.
Are you suffering from lower back pain associated with reactive depression?
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Narcotic and Muscle Relaxant Use Linked to 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 physical 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.
If you live in the Vail, Aspen, Denver and Grand Junction, Colorado area and would like to discuss reactive depression and lower back pain with a spine specialist and back doctor, please contact the office of Dr. Donald Corenman.
