Depression can affect the body as much as the mind. Symptoms of depression can range from sadness, anxiety, helplessness, tiredness and insomnia to irritability and loss of interest or appetite. But it can also include headaches, digestive problems and various kinds of chronic pain which can have a serious impact on someone’s quality of life.
Studies have shown that people with more severe depression may experience more intense bodily pain, with some research suggesting that this could be due to higher levels of proteins called cytokines in people with depression (Hartman 2006). These proteins are responsible for regulating various inflammatory responses in the body and could therefore be the link between depression and pain or illness.
There are various standard treatment approaches for people who experience both depression and chronic pain including:
- Counselling, psychotherapy or cognitive behavioural therapy (CBT).
- Antidepressants such as selective seratonin reuptake inhibitors (SSRI) and serotonin and norepinephrine reuptake inhibitors (SNRI).
- Combination therapy: combining both a talking therapy with antidepressants.
In a recent study of patients with depression and pain (Hopton et al. 2014a), one group of patients received counselling and another group received acupuncture treatment. Patients receiving acupuncture commonly reported receiving treatment for physical symptoms of pain as part of the treatment, where as those receiving counselling were more likely to get help on gaining an understanding of themselves and their situation.
Patients in both groups felt that they had received support in coping with their depression and pain independently of the specific treatment they were getting, through lifestyle and behaviour change support. In other words, the therapeutic relationship developed through the course of the treatments was itself a likely important source of treatment, as well as the active engagement of the patients themselves in the process of healing.
A related study (Hopton et al. 2014b) found that patients that started their treatment with both depression and pain had less of a recovery after 3 months than patients with only depression and no pain. It also found that patients with both depression and pain improved the most through acupuncture treatment, followed by patients receiving counselling and finally patients following “usual care”.
In other words, patients with both depression and pain may benefit more from an acupuncture treatment than from counselling or usual care. Improvements will take longer however for patients with both depression and pain than for patients with depression only. The first of these two papers concludes that: “Patients who present with depression and physical symptoms of care may wish to consider a short course of acupuncture to relieve symptoms prior to a referral for counselling if needed.”
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Hartman, JM., et al. 2006. Quality of life and pain in premenopausal women with major depressive disorder: the POWER Study. Health Quality Life Outcomes.Vol.4:2.
Hopton, A., Eldred, J., MacPherson, H. 2014a. Patients’ experiences of acupuncture and counselling for depression and comorbid pain: a qualitative study nested within a randomised controlled trial. BMJ Open; 4:e005144.
Hopton, A., MacPherson, H., Keding, A., Morley, S., 2014b. Acupuncture, counselling or usual care for depression and comorbid pain: secondary analysis of a randomised controlled trial. BMJ Open; 4:e004964.