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.