Fibromyalgia is Not
caused by Depression

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Fibromyalgia vs. Depression:

Let me say at the onset, that FM often causes depression, but is not caused BY depression. ( Most recent studies )

Many tests have been done on this, often on very large groups of people. Those with FM, those with FM and depression, those with depression only, all countered by healthy normals as controls. The results ?

18-25% of persons with FM, fit the classic criteria for clinical depression and of these persons, nearly everyone of them: Lives alone, has no support group and is often not being treated for their FM. " Depressed patients with FM were significantly more likely to live alone, report elevated functional limitations, and display maladaptive thoughts, than non depressed patients." Sherman JJ

It begs the question however, if FM is a disorder of depression, shouldn't all persons with FM fit the criteria for clinical depression? Fact is of course, they don't. Nor does the presence or absence of depression, make any difference in FM's progression or status.

Brain scan results, depression is not a factor:

"In a MRI study done by University of Michigan rheumatologist Dr. Daniel Clauw, pain can be seen registering in the brains of fibromyalgia patients when a small amount of pressure is applied to their thumbs; however, healthy subjects did not show pain at this level of pressure. Researchers have also found that people with this illness have increased levels of substance P, a pain neurotransmitter and low levels of serotonin and norepinephrine which help reduce pain sensations, when pain is present .

Other researchers believe(d) all this does not prove fibromyalgia is not caused by psychological factors. In order to show this is not the case, Dr. Thorsten Giesecke, a member of Dr. Clauw’s research team, performed a second MRI study. In this similar study, Dr. Giesecke compared depressed FM patients to FM patients who were not depressed, and found both groups showed pain activation on the MRI. He rated 30 patients depression levels and found no correlation, no matter how severely depressed the patient was (DeNoon, 2003)." Dr. Daniel Clauw University of Michigan


Treatment of concurrent depression, does not cure Fibromyalgia:

If FM is a depressive disorder and you treat (cure) the depression, it stands to reason, the FM would go away right? The results ? What you end up with is a person with FM, who is no longer depressed, but it has made no difference, whatsoever in their FM. Other than how well they might be able to handle it. What you have is a happier, more functional person with FM, but they still have Fibromyalgia.

"Functional imaging of the brain has shown that the level of depression has little influence on the intensity of pain experienced by patients with the chronic pain syndrome fibromyalgia, researchers at the University of Michigan Health System and the University of Cologne, Germany, have found. This could be one of the reasons that an antidepressant, that has no analgesic (pain-killing) properties may have little or no impact on a patient's pain. ...

"There is an incorrect impression among many doctors that if you treat a patients depression, it will make their pain better. Not so," says Daniel J. Clauw, M.D., director of the U-M Chronic Pain and Fatigue Research Center and professor of rheumatology at the U-M Medical School. "If someone has pain and depression, you have to treat both."

"We have seen that if you give antidepressants to the average depressed patient with fibromyalgia, they'll come back a couple of months later and say, 'My pain isn't any better, but I don't feel so sad about it,'" Clauw says. "Our research provides further evidence that these pathways are quite independent." Thorsten Giesecke, M.D"


Types of depression:

There is a common mis-conception in the mind of most people, when they hear the word, depression. Their first thought is, Clinical depression. But there are many types, the main difference is, severity and how long it lasts, and is there a traceable factor. Clinical depression is like so:

  • Loss of interest in daily activities
  • Persistent sadness or feeling of emptiness
  • Sleep disturbances
  • Significant weight loss or gain
  • Loss of concentration
  • Fatigue
  • Suicidal thoughts or behavior
If you have severe symptoms that interfere with normal functioning for more than a few weeks, that are not traceable to a life event, you may be suffering from clinical depression. Clinical depression can last indefinitely. Interventions are usually required for one to overcome clinical depression.

Situational depression: This is one that literally everyone has happen to them, at some point in their life.

The death of a loved one, or the loss of primary job or other financial support for instance, can create this. Loss of your home to fire or flood etc. may produce intense and temporarily debilitating depressive symptoms, similar to clinical depression. Accent on "temporary." 

You are depressed in other words, for a reason that has to do with a life event and you can trace it back to that life event as to when it began. Such depression is normally self limiting and will go away on it's own. This state can lead to clinical depression however, if it goes on for too long.

Dysthymia, chronic, low-grade depression:

  • Appetite decreased or increased
  • Sleep decreased or increased
  • Fatigue or low energy
  • Poor self-image
  • Reduced concentration or indecisiveness
  • Feels hopeless or pessimistic
This is often seen, in very young people, that travels with them into adulthood. They have never known life, without feeling this way. To them, this is normal. It's called, "sneaky" depression, as the depressed person doesn't even realize that they are depressed.

Mild depression:

  • Apathetic
  • Apprehensive
  • Feeling Guilty
  • Pessimistic thoughts
  • Irritability or easily angered
  • Negative in emotions
  • Feelings of Helplessness
  • Low self-esteem
Now, many Fmers, could relate to this list and given the factors we deal with on a daily basis, it really shouldn't surprise anyone. In point of fact, it would be very surprising, if this were not so. The reasons are fairly simple:

"people with chronic pain frequently report a wide range of limitations in family and social roles, such as the inability to perform household or workplace chores, take care of children, or engage in leisure activities. In turn, spouses, children, and co-workers often have to take over these responsibilities. Such changes often lead to depression, agitation, resentment, and anger"

When you take these things into account, along with pain, our constant battle for proper medical care, fending off those who think we are malingering, reduced earning capacity and more .... It becomes perfectly reasonable and understandable for us to feel any of the above.

Notice, most of the signs above have to do with mood. We have good days and bad days and sometimes the load gets to be a little too much and we slide into a mild depressive state. In fact, to be too happy all the time, sends up a huge red flag. As no one, who is in a chronic pain state is going to present a smiling face all the time. If they do, they either qualify for sainthood or ... they are in major denial, which can be a serious problem in and of itself.

What can and does complicate matters, is some of the more typical signs of major depressive states, such as, reduced concentration, fatigue, sleep disturbances, are commonly found in FM. 

It is these factors, which tends to lead doctors to the assumption that they are brought on by depression and therefore, by extension, that FM is brought on by depression. However, all of these factors have other explanations, based on the dysfunctional neurochemistry one has with FM. Treatment for mild depression, it should be noted, is NOT typically done with medications.


FM is no different regarding depression, than any other chronic condition, other than perhaps, in the eyes of some doctors:

"... illnesses such as cancer are known to be made worse by these same factors yet doctors do not label cancer as a psychological illness ... Illnesses such as rheumatoid arthritis, multiple sclerosis, even diabetes were once thought to be caused by a psychological disorder. Nowadays doctors know better and it's time to stop manipulating the facts on fibromyalgia. These people deserve to be treated as patients living with a chronic illness, not as hypochondriacs, who are out to waste a doctor's time. In his research on FM Dr. Yunus has found a new syndrome known as “Disturbed Physician Syndrome” or DPS. With this syndrome Dr. Yunus says, “It is not the FM patients who are disturbed, it is the physicians” Dr Yunus research

"... labeling fibromyalgia as a sub category of depression, would be the same as labeling diabetes as a sub category of depression, because 25% of people with diabetes are depressed. Most chronic medical illnesses will lead to a higher rate of depression, than in the general population. In terms of psychological impact, fibromyalgia is really not any different from chronic low back pain or a variety of other chronic pain states. A percentage of people with any kind of chronic pain or illness will be depressed, and that does not mean that the depression and the chronic illness are the same disease." Dr. Daniel Clauw University of Michigan


The sleep disorders, commonly seen in FM, are different than the sort seen in people with depression:

" Most FMS patients have an associated sleep disorder known as the "alpha-EEG anomaly." This condition was uncovered in a sleep lab with the aid of a machine that recorded the brain waves of patients during sleep. Researchers found that FMS patients could fall asleep without much trouble, but their deep level sleep (or stage 4 sleep) was constantly interrupted by bursts of awake-like brain activity. Patients appeared to spend the night with one foot in sleep and the other one out of it. ...

"It should be noted that the sleep pattern for a clinically depressed patient is distinctly different from that found in an FMS or a CFS patient. This fact can help physicians that treat FMS as seriously as it should be treated, to distinguish FMS from depression." Sleep disorders

Sleep disorders and FM on site link


Why doesn't my doctor know this stuff ?

Most of what you just read, your doctor often does not know. Almost any doctor in practice to today, is working off of research on FM, that was done years ago. Whatever was the accepted "facts" when they went to medical school, is what they know. Any Dr. worth their license ... knows this to be true, for any disorder.

Ready for a shock ? The fact is, the medical community is, on average, a good 17 years behind the current facts on the medicine they practice. This gap is narrowing, with the current day speed of information sharing, but there is still a significant gap. The longer the doctor is in practice, quite frankly, the more likely they are to become obsolete, unless they make a serious effort to counter this effect.

A new doctor, fresh out of medical school, while lacking in practical hands on experience, is likely to know a great deal more of the current day tactics and facts, than their peers who have been in the field for years.

There is also the problem of Publication bias, which is the failure of studies being published in the most commonly read medical journals. Or, being published too late. It is common to see as long as 2 years and more pass by, before a study sees the light of day in any publication, much less the common ones most Dr's read. 

Which, given such a long time lag, if the study is to be challenged, faces many problems. The people who participated in it, can seldom be recalled. The research team, often created ad hoc, just for the study alone, have returned to their practices and cannot be reached for direct consult. Not to mention, just plain failure to recall, as it's been over two years since the study was done. ( Which makes retracting poorly done studies ... even harder )

So, as I have made note of before, you, the person with FM most likely know more about your condition and the research into it, than your doctor does. The above is exactly why you do and you should not hesitate to use that knowledge. 

If your doctor is honest, they know full well, they are not up to speed on everything and they also know why they are not ... and will take your introduction of new information, seriously. If they fail to at least give you a decent hearing, it might be time to find a new doctor ... one who is more aware of their own information limitations, and is not afraid to listen to you.