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How Depression and Pain are Connected

It's not mental, it's physical too.


You might have heard that depression, or any mental illness for that matter, should be taken as seriously as a physical illness would.


In fact, ask any person with depression and they may tell you that depression feels physically painful at times. Aside from the emotional symptoms of low moods, lack of interest or motivation, feelings of hopelessness and helplessness, there also exists physical symptoms experienced as aches, fatigue, or a general sense of being unwell called "malaise".



In fact, studies have shown that depression causes specific brain regions to either shrink or swell over time.



Brain shrinkages are caused by a loss of neuronal connection points called synapses, which are in turn caused by hormones released during periods of stress or anxiety and other neurochemical imbalances, leading to slower thinking, tiredness and fatigue, and frequent mood swings or dips.


But it is the brain swelling that provides a better explanation for physical pain. Swelling in the brain is caused by inflammation, and inflammation in brain regions disrupts functions of said specific regions. Let us take a closer look at this process, and what it means for the person suffering from depression.


Within the brain, there exist cells whose main function is to police and patrol the area, scanning and looking around for problems such as viruses or bacteria. When they find a problem, they pump out a bunch of chemicals, signalling your immune cells to flood the area, causing inflammation. But these chemicals also do something else. They cause something called a sickness response [1].


A sickness response is the state you enter when you fall ill - like when you catch the flu. It causes you to have body aches, feel tired, experience sleep disturbances, low moods, heightened anxiety, and a general lack of heightened discomfort, or malaise as mentioned earlier. It makes you want to stay at home and avoid meeting others. It’s the body’s way of telling you to rest and recover.


A sickness response is the state you enter when you fall ill - like when you catch the flu.

The problem arises when neurochemical imbalance and stress hormones, both present in depression, cause these policing cells to enter into what we call a primed state. They become angry, hypersensitive cells, and it takes very little to set them off and induce a sickness response [1].


Simple things like going out for a walk, meeting friends, or simply trying to do your homework can set them off and cause you to feel like you’ve caught the flu, making you feel horrible. Now we know why people suffering from depression don’t want to go out, or don’t feel like doing things they used to enjoy!



So knowing this, what can we do about it?



As we see above, we need to treat the two mechanical sources of depression within the brain: neurochemical imbalances and stress hormones [2].


If you are clinically diagnosed with depression, continue taking your prescribed anti-depressant medications. If you suspect you might have depression, speaking to a mental health professional would be the first step to take.


As for the stress hormones, it can be caused by a huge variety of things; from the environment, to work or studies, to family, to relationships… the causes are endless!


But you need not bear these alone. Counselling is a great source of help where a counsellor or therapist would be able to help you navigate through these issues.


Depression is debilitating and filled with pain; some of which are physically felt. But there are treatments to combat them.


Don’t suffer alone. If you suspect, or are suffering from depression, reach out for help at It All Starts Hear or Mindline Singapore.

Contributed by Christ Lai, Hear Bud Volunteer

(PhD Psychology-in-progress)



References

1. Torres-Platas, S. G., Cruceanu, C., Chen, G. G., Turecki, G., & Mechawar, N. (2014). Evidence for increased microglial priming and macrophage recruitment in the dorsal anterior cingulate white matter of depressed suicides. Brain, behavior, and immunity, 42, 50-59.


2. Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds III, C. F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. Focus, 12(3), 347-358.