By Dr. Jill Harkavy-Friedman
Vice President of Research, American Foundation for Suicide Prevention
“It’s all in your head.” If you’re living with chronic pain, this is probably the most frustrating thing someone could say to you. Of course the pain isn’t just in your head; it’s in your leg, arm, neck or wherever it hurts. But chronic pain can affect your head: it puts you at higher risk for depression, which if left untreated can have serious consequences.
People who live with chronic pain know the importance of coping strategies. Building a support team, pacing your activities, setting goals, exercising, using relaxation techniques: all these can help manage pain conditions, but these strategies have their limits. When these strategies are not enough, the pain can interfere with sleep and your ability to manage stress, which can compromise your mental health and possibly lead to depression.
And not only can chronic pain lead to depression, but it can also mask it – because, let’s face it, pain is depressing: it hurts, it’s stressful, and, because it limits activities, it can isolate you socially. Some medications to treat pain can impair concentration, make you drowsy, or cause a depressed mood. These realities of chronic pain make it more difficult for even your primary care doctor to identify symptoms of clinical depression, which is a health condition that can severely impact your physical health, and if left untreated can be fatal.
So how do you distinguish between feeling depressed and clinical depression? The key is to assess your mood during your better moments. If the pain has momentarily subsided and you still feel down, or you’re not interested in the things you normally enjoy, or you have trouble concentrating and/or sleeping, or your appetite is gone, or you are thinking about death or suicide, you may have clinical depression.
Depression is a common illness that affects one in five people. But many people don’t seek treatment, either because they don’t have access to mental health care, or they don’t recognize their symptoms as depression. And people with chronic pain often face an additional barrier: their own “I can get through this” resilience that comes from living with chronic pain. Those of you accustomed to toughing it out may believe you can tough it out with depression, too – but you can’t fight depression with resilience alone. Depression attacks your capacity for resilience, making you susceptible to feelings of hopelessness, worthlessness and the belief that nothing will ever change.
So check in with yourself and be honest about your symptoms. If you’re concerned that you may have depression, call your doctor today and request an evaluation or a referral to a mental health professional. If you need an excuse: May is Mental Health Month, a reminder that we all need to take care of our mental health.
Jill Harkavy-Friedman, PhD has been studying suicidal behavior for more than 25 years and has more than 90 publications. She is the Vice President of Research at the American Foundation for Suicide Prevention and is also a practicing psychologist. She works with patients who suffer from chronic pain and has delivered several lectures on chronic pain and mental health.