Depression and anxiety lock in one another

Pain plus depression: suffering in a double pack

Persistent pain causes depression and anxiety. At the same time, people with mental health problems suffer more from pain. Pain and depression create a vicious circle.

Pain is not an exclusively physical phenomenon. The strength of the perception is also determined by the subjective constitution. And she suffers when the pain has become chronic. It is understandable that depressive moods creep in in chronic pain patients and often also severe depression. It is difficult to always be positive in the face of recurring pain. The fear of the pain itself also becomes a companion in life in many cases.

Mutual influencing

Chronic pain can therefore trigger depression and the depression in turn exacerbates the pain perception. (When one speaks of depression, not only the clinical picture of the "real", severe depression is meant, but also the depressive mood). Pain and depression are mutually reinforcing and massively deteriorate the quality of life. The pain threshold and pain tolerance decrease when the psyche is affected. Depressed people feel pain earlier and more strongly than the average.
“Around half of the patients with chronic pain develop depression. Every second depressive person also suffers from physical pain over a long period of time. Not only patient perceptions, but also numerous studies confirm this, "explains the Klagenfurt anesthetist Dr. Rudolf Likar. Other experts even assume that up to two thirds of all depressed patients suffer not only from mental but also from physical pain.

Depression in disguise

Watch out for inexplicable pain. Depression can not only be a result of pain, it can also cause it or at least make it worse. Depression often disguises itself as a physical state of pain. Symptoms include unexplained pain in the neck, back, or head. “In fact, many depressed patients see their general practitioner for physical symptoms. If there is no improvement, it usually takes a long time before depression is considered, ”says Likar. After years of pain, it is often impossible to determine which came first: the pain or the depression.

Neurobiological connection

The neurobiological connection between pain and depression has been increasingly proven by studies in recent years. Accordingly, there appears to be an imbalance in serotonin and norepinephrine in both pain and depression. Both neurotransmitters play an essential role in their development. It is believed that serotonin and norepinephrine inhibit the transmission of pain to the brain at the level of the spinal cord. If there is now an imbalance between the two messenger substances, the natural pain inhibition is lost. The reason: every stimulus is then passed on to the brain unfiltered and the person affected perceives even the smallest signals as pain.


If depression is accompanied by pain, or if pain leads to depression, treatment should address both the depressive and pain symptoms in order to be successful. The fact that anxiety and depression increase pain intensity makes it clear that effective therapy cannot be limited to the administration of pain relievers. You also have to include the psychosocial living conditions, i.e. grasp the person as a whole and align the treatment with them.

Antidepressants can help

“The engine has run idle in chronic pain patients. Those affected are exhausted and the pain inhibition is also exhausted. You feel everything more intensely and the state of mind is unstable, ”says Likar. Dual effective antidepressants regulate the serotonin and noradrenaline balance. By bringing the messenger substances back into balance, the natural pain inhibition should be rebuilt. Both messenger substances are said to have a direct effect on depression and, at the same time, on pain. "The drug enables a reduction in psychological symptoms while at the same time relieving physical complaints," says the pain specialist.
Antidepressants are often rejected by pain patients because of possible side effects. First generation antidepressants (tricyclic antidepressants) actually often trigger side effects because they influence many other messenger substances in addition to serotonin and norepinephrine. “Today's third generation of dual acting antidepressants acts almost exclusively on the two messenger substances. It is therefore much easier to digest than its predecessor, ”says Likar.

Himself is the patient

Pain plus depression means suffering in a double pack. Taking pain medication and antidepressants is only one building block in coping with the problems. “To overcome chronic pain, patients need to be actively involved in recovery. Taking medication is not enough. If a patient gives up, the doctor can do little to change his condition, "says the pain medicine specialist." If there are depressive states plus chronic pain, those affected should first tackle the problem of depression, "advises Likar. It is important to get out of the" psychological hole "To come out and work on yourself. It is important to regain mindfulness and zest for life. This can best be achieved through psychotherapy, relaxation procedures, mindfulness training and as much exercise as individually possible." Working on yourself is the most important thing, "says the pain expert.

Dr. Thomas Hartl
January 2012

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‌ Last updated on May 11, 2020