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To the EMT Who Told Me Fibromyalgia Is 'Just Depression'

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To one of the EMTs in my mental health first aid certification class,

I was anticipating it. I knew that when we got to the section on depression that someone would say that fibromyalgia is caused by depression. “Just the physical symptoms of depression,” as you put it. I knew it would happen. I was prepared.

What I wasn’t prepared for was after I said that not all fibromyalgia is caused by depression, that you’d say that I was in denial. And yet I should have been prepared.

Ever since I have been diagnosed with fibromyalgia, I have had to deal with health professionals like you. Health professionals who, ironically, believe in mental illness but don’t believe in physical illness. Health professionals who tell me I’m not trying hard enough to treat my “obvious” depression. Never mind that approximately 80 percent of depression patients using antidepressants (a standard treatment for depression and the antidepressant used for fibromyalgia) improve with use, while only 30-40 percent of fibromyalgia patients improve on the same treatment. Never mind that there are plenty of studies suggesting that fibromyalgia is caused by other factors like trauma, capillary malformation, nerve sensitization, or cerebrospinal fluid pressure imbalances. Never mind that fibromyalgia is a diagnosis by exclusion, which means that it can be caused by thousands of reasons, including mental health issues that don’t show up in standard medical tests. But that means that are many causes of fibromyalgia, not “just depression.”

For me, when health professionals discount my physical symptoms, it’s especially infuriating because I decided to take a scientific approach to my illness once I got diagnosed. I did a lot of research and when I learnt that fibromyalgia and depression are often comorbid disorders, I got busy. I started exercising five or more times a week. I went on antidepressants (in secret, by the way, because my parents have both stated at one time or another that people with mental health problems should be sterilized or culled for their own good). I ate healthily. I worked on improving my sleep. I worked on improving my mental health in every way I could. It did not improve my pain.

In fact, exercise became a problem. See, exercise is known to improve back pain (especially lower back) and depression through endorphins and stretching. But when you have fibromyalgia, something very interesting happens. Exercise makes your pain worse. I would come into the gym with a standard level of pain and often, within the hour, be dry heaving, shaking, and have trouble seeing. To exercise, I would take up to seven extra strength pain killers and I’d still end up having trouble breathing from the pain. Still do. But I still work out because I know that working out lessens my mental pain which in turn lets me mentally handle my physical pain better. Not everyone with fibromyalgia can do this because not everyone likes feeling like they’re about to pass out from pain or being bed ridden for three days after a workout. But even then, it doesn’t mean that their fibromyalgia is caused by depression.

I challenge you to remember how common it is for people who struggle with chronic pain from other causes to develop mental health issues like depression. How often do we talk about giving car accident victims, paraplegic or quadriplegic patients mental health support as they are very likely to develop depression due to their constant pain or loss of function? Then think about how often we tell those people that their pain and physical ailments are caused by their depression. We don’t because depression often develops as a result of chronic pain – it is not always the cause of it. And when there is evidence that chronic pain is not due to depression, such as by proactively treating depression with no effect on pain, we need to reconsider the role mental illness as the cause of the patient’s pain.

Perhaps the part of this that makes me the angriest is that by saying that fibromyalgia is “just depression,” you not only ignore the very real physical elements of fibromyalgia, but you also make depression sound like some sort of easy, breezy, beautifully simple disorder. It is not. Depression is not easy. It is not simple to treat, and it most certainly isn’t fibromyalgia nor is fibromyalgia depression. They may exist together but they are not one. You can get some very weird physical symptoms from fibromyalgia which can’t be explained by depression – things like allodynia (where things that shouldn’t hurt like clothing, really hurt) or double vision or neuropathic pain. Symptoms which are clearly connected to central nervous system issues, not chemical imbalances in brain.

In short, dear EMT, we spent the first class talking about how mental health issues are as real and can be as devastating as physical health issues. I hope you recognize the irony of what you said when you said I’m imagining physical pain and mistaking it for mental pain.

Getty Image by piyapong sayduang

Originally published: March 16, 2018
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