Fibromyalgia and Depression

Several weeks ago I read a post on a blog called Seriously entitled "Fibromyalgia and Depression" which gave me a great deal to consider. The post was apparently inspired by the authorization of a new medication for the treatment of Fibromyalgia, presumably Lyrica. The author has been treated in the past for Depression so she understands how much that condition can affect daily living. However, she is less sympathetic in her treatment of the other titular disorder.The post basically suggests that 1) Fibromyalgia is not a real disorder and those who claim to have it are wasting medical time and money on unnecessary tests; 2) most of these people really have Depression and are refusing to take anti-depressants which will help them because they really want narcotics; 3) people claiming to have Fibromyalgia are just attention seekers. I posted a non-combative response but I’ve had a hard time getting this out of my mind.

I admit that I used to believe that Fibromyalgia was a catchall phrase for undiagnosed pain problems. I didn’t yet know anyone personally who had it, though I sometimes sold books to customers on the subject. My primary reason for visiting the doctor regularly was treatment for insomnia. When I eventually mentioned the extreme pain in my shoulders during the same visit, it clicked for my doctor and he gave me the diagnosis. I didn’t want to accept this, of course.

Nevertheless I did my research. Though it is true that the symptoms of Fibromyalgia, which include pain, sleep problems, IBS, depression, headaches, and fatigue are similar to many other disorders, these disorders are not all the same. Rheumatoid Arthritis shows disfigurement in the joints on x-rays, for example, and according to one of my doctors, ME/CFS often starts as Mononucleosis, or at least with similar symptoms. A simple test exists to distinguish Fibromyalgia: 18 tender points along the front and back of the body at certain joints are specific to this and no other condition. I can guarantee they are real, as my cats have a knack for stepping on them, particularly on my legs and shoulders, when the points are particularly painful. One inch to the left or right of the points, the sensation where they step is simply pressure.

At least one biochemical difference has been found in Fibromyalgia patients that differs from those who do not have the disorder: they have elevated levels of a chemical P in their spinal fluid. I don’t pretend to understand what this substance does, but the scientists who study it presumable have an idea of its function in our bodies. As I understand from doctors, our sleep rhythms are also distinct because we lack a particular stage of restful sleep prior to REM sleep. No doubt remains in my mind that this disease is real and distinct from other pain disorders.

I also accept the reality of depression. I have suffered several major depressive episodes myself, lasting for years. Most occurred during times when I felt my life was out of control and I believed I had no power to change it. Often I really couldn’t make a difference in my circumstances, particularly when I was a child and teenager. I did see psychologists and eventually they did help me to see that I could take charge of my own fate. Meanwhile, though, I lived with anxiety, the knowledge that I was a worthless individual and unable to figure out how to live in the world. Sometimes I lived nocturnal hours to avoid everyone. I had few friends and I was emotionally distant from my family who were frequently the source of my anxiety. Eventually I sorted out the issues that were the sources of my depression and created a better life for myself when I moved to North Carolina. The dark clouds lifted and I learned to be truly happy.

Unfortunately, that was when I started to notice the pain. It had been there all along, starting with lower back pain almost constantly after my initial accident. Later one hip or the other would hurt for months on end, as would my feet. I suffered what I thought were sinus headaches which I now know were migraines. The pain did not interfere with my life too much; I blamed my sore feet on inadequate shoes, for example. Once my life was more settled, it was my shoulders that bothered me, and the doctor diagnosed it as bursitis. I accepted that and adjusted my lifestyle.

The sleep problems became a real issue later still. I cannot remember a time in my life when sleep came easily. At age 9, I would typically lay awake for 3 hours after going to bed. So when I decided I needed medical assistance to sleep, the deprivation had really begun to interfere with my life. This was the reason I finally went on anti-depressants, not for the depression of my earlier years. My doctor wanted to regulate my serotonin levels rather than put me on sleeping pills. I had to change anti-depressants more than once when they ceased helping me sleep. Since my diagnosis of Restless Leg Syndrome, I had to add an additional medication to my regimen to help me sleep properly. I would love to stop taking Cymbalta, but the unfortunate side effect of anti-depressants is that they are physically addictive. If I skip doses for more than a couple days I plunge into a withdrawal-induced depression which is less controllable and more difficult to deal with than my old dark cloud days.

As for pain medication, I certainly have never sought narcotics to cope. Most of the time I need painkillers just once per week and I prefer Aleve. Granted, I take more than the recommended dosage on the bottle, but I have discussed that with my doctor. For migraines I take Tramadol, sometimes with an extra-strength Tylenol to increase the effects, also as recommended by my doctor. While Tramadol is classified as in the class of opioids which are usually classified as narcotic, it is not a controlled substance and has little apparent danger of addiction. I don’t take enough to concern me; a 30 pill refill from the pharmacist lasts me for 3 months.

Does it sound like I am an attention-seeking wannabe narcotic addict? I hope not. As a rule, I don’t talk about my Fibromyalgia often, unless the symptoms are extreme or interfering with my life. I try not to call my doctor too much, even. I tend to avoid support systems, not out of pride, but because I don’t want to wallow in my situation. I try to be sympathetic to those people I know with other “invisible” diseases since I understand what they’re going through. That is the best way I know how to cope.