Can fibromyalgia lead to depression?

Fibromyalgia is a chronic condition characterized by generalized pain and soreness, persistent fatigue, and sleep challenges.

The cause of fibromyalgia has not been established yet, but experts suspect it may be a combination of mental health stressors, genetics, and environmental factors.

Research suggests people with fibromyalgia often report symptoms of depression, and these, in turn, may trigger or intensify fibromyalgia symptoms.

Is depression common in people with fibromyalgia?

Research suggests that having depression makes you more likely to develop fibromyalgia later in life. The exact mechanisms are not yet understood, though.

Experts have also found that living with fibromyalgia may increase your chance of experiencing depression. A 2018 research review showed that more than half of the people with fibromyalgia involved in the review experienced depression at some point in their lifetime.

The cause of depression is not yet established. It may be a combination of genetics, life experiences, and environmental factors.

Living with chronic pain often interferes with your daily life and may make most activities challenging. You may also be more likely to socially isolate when you experience severe pain and fatigue. All of this may have a negative effect on your mood.

Sleep disturbances, common in people with fibromyalgia, are also often associated with low mood.

Symptoms of depression

Depression goes beyond feeling sad. It is a formal mental health diagnosis established by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR). This is a reference handbook used by U.S. mental health professionals to help make accurate diagnoses.

According to the DSM-5-TR, the symptoms of depression include:

• low mood, including sadness, helplessness, and hopelessness
• loss of interest in most or all activities that you used to enjoy
• changes in weight and appetite
• changes in sleep patterns
• loss of energy and fatigue
• guilt and shame
• cognitive difficulties, including poor concentration and challenged decision-making
• changes in the way you move
• thoughts or attempts of suicide

Before confirming a diagnosis, your healthcare professional will want to ensure you have experienced five or more of these symptoms for at least 2 weeks.

Some symptoms, like sleep disturbances and fatigue, are common in people with fibromyalgia, even when they do not have depression.

If you are considering self-harm, including suicide, please seek help. You are not alone.

• Call a crisis hotline, such as the National Suicide Prevention Lifeline, at 988 or 800-273-8255.
• Text HOME to the Crisis Textline at 741741.
• Contact a trusted friend, family member, or healthcare professional if you feel you’re at immediate risk. Consider calling 911 or your local emergency number if you can’t get in touch with them.

How is depression treated?

Treatment for depression is effective. Relief is possible.

Your healthcare professional may suggest one or more of these treatment options for depression:

1. Talk therapy

Psychotherapy is the first line of treatment for depression. It may be effective on its own for mild symptoms of depression. For moderate or severe depression, therapy is often used alongside medication.

The National Institutes of Mental Health (NIH) suggests that cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy (PST) are all effective treatments for depression.

2. Medications

If your symptoms do not improve with therapy alone, your doctor may suggest medications, including:

• selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft), fluoxetine (Prozac), and escitalopram (Lexapro)
• serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor) and duloxetine (Cymbalta)
• monoamine oxidase inhibitors (MAOIs) like isocarboxazid (Marplan)

3. Lifestyle changes

Lifestyle modifications may help relieve symptoms of depression. These may include:

• regular physical activity, especially low impact if you have fibromyalgia
• mindfulness and meditation to help boost your mood and lower stress levels
• nutrient-dense diets to help improve your mood
• limiting alcohol and avoiding tobacco use to help decrease the chance of more intense symptoms

How is fibromyalgia treated?

Besides the same lifestyle modifications and psychotherapy, fibromyalgia treatment aims to reduce pain and fatigue with medications. Some of these may also help with depression symptoms.

These medications may include:

• serotonin and norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta) 
• selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa) and fluoxetine (Prozac)
• anti-seizure drugs like pregabalin (Lyrica) and gabapentin (Neurontin)
• pain relievers like acetaminophen or tramadol (Ultram)
• muscle relaxants like cyclobenzaprine (Amrix)

Treatments for depression and fibromyalgia may overlap. A combined effort may increase your chance of experiencing relief.

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Summary

Research suggests fibromyalgia and depression may be associated. You may be more likely to develop fibromyalgia if you’ve lived with depression, and you may have an increased chance of depression symptoms when you live with fibromyalgia.

Treatment for both conditions usually involves medication, talk therapy, and lifestyle modifications. Your healthcare professional can help create the best treatment plan for you.

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