The Link Between Depression and Chronic Pain

It Works Both Ways

Shuji Kobayashi/Taxi/Getty Images

It is no secret that there is a link between chronic pain and depression. In fact, depression is often one of the first conditions that doctors try to rule out when diagnosing chronic pain. Here's what you should know about how depression causes chronic pain and how chronic pain can lead to depression — plus what you can do about it.

Clinical Depression and Chronic Pain

As many as half of all people who suffer from chronic pain also have recurrent clinical depression.

More than a feeling of sadness or low mood, clinical depression is a psychological state that causes fatigue, lack of motivation, appetite changes, slowed response time and feelings of helplessness. Depression has physical symptoms as well, including aches, pains and difficulty sleeping.

But chronic pain is more than a side effect of depression: the two diagnoses are often so interwoven so that they can be difficult to separate. And while it is possible to be in pain without ever becoming depressed, it is very likely that if you suffer from chronic pain, you will also battle depression at some point in your life.

People who are depressed and people with chronic pain tend to be less active because their minds and bodies cause them to slow down. When the two combine, it can be hard to tell where one ends and the other begins. It can be even harder to figure out which one to treat first.

Stress, Pain and Depression

One of the reasons chronic pain and depression are so interwoven is because of the way stress works in the body.

When you're in pain, the areas of your brain that respond to stress fire up. The brain sends the body into fight or flight mode, preparing to fight off whatever is causing the pain. Normally, when the pain goes away, those stress signals turn off and your body goes back to a relaxed state.

When you have chronic pain, that fight or flight signals never turns off, and the nervous system stays in a constant state of high alert.

Too much stress without time off eventually wears the body down, which can leave you vulnerable to depression. Finding ways to deal with stress and cope with chronic pain can give you a head start in the battle against depression.

When Pain Interferes with Life

Being in pain is difficult, and often keeps you from doing many of the things in life that you enjoy, such as playing with your children, enjoying your favorite hobby, exercising and even having sex. Missing out on these things can affect your quality of life and can be an emotional drain. With few outlets available for stress relief, it is easy to fall into a downward spiral that leads to depression.

Treating Chronic Pain with Antidepressants

If you're experiencing chronic pain, even if your mood seems fine, your doctor may prescribe a low-dose antidepressant to treat your chronic pain symptoms. While this may seem strange, the use of antidepressants for pain control is scientifically based and has been standard practice for over 50 years.

Even at low doses, these medications cause chemical changes in the brain that alter the way pain is perceived.

Another reason antidepressants are commonly used to treat chronic pain is that they can stop the cycle that leads to depression before it begins, or at least provide a running start. Depression can intensify feelings of pain, leading to a lower activity level and quality of life, which in turn intensifies the feelings of depression. It is easy for this cycle to begin, and even easier for it to spin out of control.

Coping Strategies

Catching depression before it begins or in its early stages can help you get part of your life back. Early treatment of chronic pain with the right antidepressant can help fight this downward spiral.

For more information about coping with chronic pain and depression, be sure to check out these other great resources:

Chronic Pain Treatment

Have Chronic Pain? Start a Pain Journal

Exercising with Chronic Pain

Stress and Chronic Pain


Deardorff, William. "4 Tips To Help Cope With Chronic Pain and Depression."Spine Health, 8/17/05.

Clark, Michael. "Managing Chronic Pain, Depression & Antidepressants: Issues and Relationships." The John Hopkins Arthritis Center. Accessed December 20, 2008.

The Relationship Between Pain, Depression and Mood: An Interview With Rollin Gallagher, MD, MPH. National Pain Foundation. Accessed December 20, 2008.

Depression and Pain. Harvard Health Publications. Accessed December 20, 2008.

Continue Reading