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March 22nd, 2011
04:15 PM ET

What meds work for depression caused by physical pain?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Asked by Greg Urban, London, Ohio

I have a stainless steel shoulder joint that causes me constant chronic pain. I've also had a small stroke, prostate and skin cancer that required three surgeries and I have two stents in my heart. All of this caused me to have depression and anxiety attacks. One doctor had me on Cymbalta and Xanax, but they didn't help. A different doctor put me on Wellbutrin 150 mg. and Zoloft a month later. For the next six months I felt better than I had for about eight years, but now the depression and anxiety issues are coming back. I most likely need a change in my medication or an adjustment in dosage. What is your advice? I am a 65-year-old retired man who rarely leaves my house and has trouble sleeping.

Expert answer

Dear Greg,

Unfortunately, the story you tell really highlights how closely depression and anxiety are related to physical pain and medical illness. Especially later in life, pain and sickness drive many people into depression, even those who never have had this problem when younger.

I agree that you probably need to explore ways to change your medication regimen with your clinician. There are a number of possible medications and medication combinations that might help you. It is promising that you had a good response to Wellbutrin and Zoloft, at least for a while.

I can't tell you which medication or combination of medications is going to work for you because we never know this in advance. It's always a matter of trial and error. While all antidepressants are about equally effective when looked at in big groups of people, individuals can have wildly different responses, even to agents that are fairly similar to each other. Given your pain complaints, however, you might talk to your clinician about adding a medication like gabapentin (brand name Neurontin) or pregabalin (sold as Lyrica), both of which can help with chronic pain, and often anxiety.

If the medications require a bit of trial and error, there are other very important treatments for depression that are more certain and that I highly recommend for you. If you are still having problems with shoulder pain, you need to do everything you can to diminish this pain, (except for taking chronic opiate medications if you can help it), because these can worsen depression. Have you made maximal use of physical therapy?

Here are two very important interventions you should try to apply to yourself:

First, you need to find a way to get out of the house and try to do things you enjoy with people you like seeing. I realize this might not be easy, but in fact getting out and being as active as you can be within the limitations imposed by your health is probably the single most powerful thing you could do to help yourself feel better. This can be hard when you are feeling down, and it's not very high-tech, but there's lots of evidence that being proactive in these ways can powerfully combat depression.

Second, you should try to improve your sleep. I recommend getting a book or going online to learn of simple behavioral techniques for sleeping better. If these don't work, I'd talk to your doctor about one of the newer sleeping medications. It is almost impossible not to be depressed if your sleep is disturbed and you are isolated and lonely. Please try to address these issues. Medications are good, but don't think of them as the end-all and be-all of how you can get better.


soundoff (36 Responses)
  1. AKchic

    I am bi-polar and have a chronic pain condition. It's a struggle to deal with constant pain. I wake up in pain, I work in pain, I play with my kids in pain, I go to bed in pain. And that's with medication, including powerful narcotics that are supposed to help.
    For those who don't suffer from chronic pain, it is hard to understand what we go through. Especially when they are spine-related. When you can't turn your neck and your hands go numb but your arms are tingly and can feel some things. Or your lower back has locked up thanks to multiple ruptured discs and you can't walk and you can barely breathe because it hurts to do so (all while medicated).
    It gets very depressing. Pain medications don't help either. Pain medications alter our brain chemistry. If a person is already predisposed to depression or bipolar disorder, it can be worse. I was on Lyrica for a while. Never again. Gained 60lbs in 6 weeks. Still trying to lose that weight 3 years later. That is depressing enough.
    Being in pain all the time is tiring. It slows you down, both mentally and physically. You start to guilt trip yourself for not being able to keep up like you feel you should be able to. It is a horrible spiral to get into.

    I hope the LW finds a good balance of medications soon. It is terrible to have to deal with wrong mix of meds. Find out if the doc will try a nerve ablation or steroid/cortizone shot to help relieve pain/swelling/inflammation in the affected areas. It may help.

    March 22, 2011 at 17:49 | Report abuse | Reply
  2. Gerald

    After being off and on of antideperessants from 10-20 years ago....I found chromium piclonate. Getting rid of depression through a lot of "brain activity" speeds up the multiple immune systems. Get a faster metabalisim. That is hard to do when being depressed. But the chromium let me burn a lot on the neuro transmitters. Pushing a lot of water under the bridge will help to alleviate depression. Time is the best healer sometimes. Educate yourself on psychology, theology, and pholosophy.

    Maybe the best thing to occupy your mind is to see if you can get to the bottom of your own dilema so that you can help others. That is one of the strongest things that can get you out of your rut. Try to realise and know that you want to balance the chemestry in your brain as well as balancing the nerves of both brain and heart.

    March 22, 2011 at 20:55 | Report abuse | Reply
  3. Harold R. Linde, Psy.D.

    I'm amazed that the Dr. Raison doesn't recommend psychotherapy. I treat many chronic pain patient's who have depression. They repond well to psychptherapy that works to shore up coping skills and provide a way to express oneself in a safe environment. Patient I see use less medication and increase their functioning. Also, it saves marriages that are challanged by the suffering of one partner.

    March 22, 2011 at 22:11 | Report abuse | Reply
  4. Frederica

    Praying for you, Mr. Urban. God understands you because He went through pain and suffering for you. I hope you will find eternal, unshakable joy by trusting in Jesus. If you are that age, you must have contributed one way or another for all of us to have a safer world. Look around the beautiful world that God has created and take delight even in seeing a child's smile. There are still a lot of wonderful, constructive things you can do for the people who came into this world after you even if you yourself are in pain now.

    March 22, 2011 at 22:33 | Report abuse | Reply
  5. Patricia A. Williams

    It is so very easy to empathize with both Greg and AK chic. In September I finally managed to have both of my hips
    replaced. Having followed very bad medical advice some three years ago I foolishly postponed surgery and went for
    the prescribed "excercise" regimen....."just build up those muscles and you won't feel anything baby!" It was downhill
    all the way. Severe arthritis had literally destroyed both of my hips. The surgeon was horrified that any of the doctors
    who had previously treated me had advised me to postpone surgery. Like Greg, I also have ruptured discs, degenerative
    disc disease and spinal stenosis. The last year prior to surgery the pain was excruciating. My pain management
    specialist continued to use epidurals on my spine. They ceased to work, as did the oral medication. Not only
    was the oral medication highly addictive but it required more all the time and still was inadequate. The last three
    months prior to the surgery I was bedridden and couldn't even walk the short distance from my bed to the bathroom
    without a walker. My primary care physician (who I shook myself free of by the time it dawned upon me what a nut
    she really was) told me to see a psychiatrist for my depression and anxiety. I became so physically ill that I was
    no longer able to eat and had a drastic weight loss. I couldn't turn over in bed. My husband had to put his arms
    under my body and turn me over. The new primary care physician immediately changed my
    diabetes medication and then began to treat me with wellbutrin and lyrica. Finally I was able to sleep at night and
    my mental outlook began to change. He told me depression and anxiety usually go together. Talk therapy is
    useless because it does nothing to restore the seratonin in your brain. In spite of the problems with my spine,
    once my hips were replaced, the pain evaporated. Most of it was gone immediately after the first replacement.
    I was out and about and returning to my former self in record time. (Both replacements were frontal approach
    which is far less traumatic than the other way.) I bounded back after the second surgery and was only in
    pt for about ten days. My life is completely changed. I'm 73 years old and now have more energy than I've
    had in years and dream of doing things I had given up on. People who have never experienced terrible pain,
    especially when it endures for week in and week out, month in and month out, and year in and year out, have
    no idea what it does to you mentally. It colors the way you see everything. It also physically exhausts you
    because of the effort required just to do the simplest thing. I thank God for the quality of my life today. The
    good doctor (What is a psy.d?) obviously has no idea what is really going on with his patients. Thankfully
    I was never foolish enough to allow him or anyone like him into my life. He's nuttier than my first primary
    care physician.

    March 22, 2011 at 22:43 | Report abuse | Reply
    • Lola

      When you have pain in a central balance point like a hip, your body will try to compensate by tightening muscles...you get completely off balance, and you end up hurting your back, your knees, your feet, your neck. Your first doctor was correct, in part. The worst thing to do when your body is seizing up like that is to take to bed. You need to move, stretch, strengthen. If you are free of pain now, it's likely because you are moving better because your hips stopped hurting.

      March 23, 2011 at 00:46 | Report abuse |
    • tj

      sounds like a candidate for Medical Marijuana – attack both the pain and depression issues with one treatment.... you might even muster up the energy to hang out in the park and feed the pigeons.... hope you find relief

      March 23, 2011 at 01:36 | Report abuse |
    • sherrillynn

      PsyD is Psychological Doctorate. I wondered how he got that far educationally without learning the correct use of the apostrophe. In addition to all the valid points you bring up.

      July 9, 2016 at 16:43 | Report abuse |
  6. Greg

    I use Wellbutrin and Lamictal for the depression and marijuana for the pain. There are a lot less side effects.

    March 22, 2011 at 23:09 | Report abuse | Reply
  7. charles s

    Millionaire Howard Hughes was injured in an airplane accident and suffered severe pain for the rest of his life. He was able to live for over 30 years with this pain by self-administrating very large does of opoids. Here is an article that about his pain treatment:
    http://www.europad.org/journal/2008/Tennant%2010%283%292008.pdf
    What this article clearly shows is that pain control is possible even in severe cases if the patient has access to sufficient pain medication. Unfortunately too many people who do not have severe pain are afraid that a patient may become addicted. This fear of addiction prevent sufficient pain medication being given to people in severe pain and it also leads to criminal prosecution of doctors who are trying to help their patients. Our society is perfectly willing to allow many people to suffer with severe pain in the mistaken belief that these people are addicts because they require such large amounts of pain killers. It is a very sad situation.

    March 22, 2011 at 23:46 | Report abuse | Reply
    • Patricia A. Williams

      Amen. I have witnessed this so many times, even in oncology wards where the patients were terminal. Time and
      again the explanation (excuse) they offered was that the patient would become addicted. The patient was terminal.
      If the patient is terminal the issue of addiction is moot. My former pain management specialist was terrified of
      criminal prosecution and said so more than once. He, like many other physicians in Houston....especially those
      specializing in pain management.....was under constant surveillance by the district attorney's office. What does
      a county district attorney know about pain management? This is more than sad. It's tragic. My mother died
      with breast cancer. Her doctor promised me he would not allow her to suffer, and he kept his promise. That
      was forty years ago. I'm not sure how much surveillance he was subjected to, but I suspect probably more than
      today. Her death was a blessed release. My best friend wasn't that fortunate. Three years ago she died in
      agony. My son in law's mother has terminal uterine cancer. She is in constant excruciating pain. The "she
      might become addicted" argument is being used again. Watching her suffering is torture for her family. She
      is the daughter of a physician.

      March 23, 2011 at 00:29 | Report abuse |
    • Lola

      Fear of being addicted? No. Fear of being mentally fogged, more likely. I can get a prescription for narcotic pain relief, but I want to be able to function, drive a car...think clearly.

      March 23, 2011 at 00:31 | Report abuse |
    • Lola

      Patricia W., pain management for terminal patients is an entirely different subject. I have lost several family members to cancer. All received morphine toward the end. Opiate patches are another option. I have never seen a terminally ill person refuse a narcotic for fear of addiction. I have, however, seen them delay accepting the drug in order to remain clear headed for as long as possible.

      March 23, 2011 at 00:38 | Report abuse |
    • miked0138

      well said charles , it is very sad to see in 2011 doctors are afraid to treat pain due to an over zealous dea that obviously cant control or do anything about street drugs so now to keep up their quotas go after doctors, i guess a law abiding guy in a lab coat with an office is a much easier target to pick on than violent drug dealers. so now millions must suffer in pain because the dea now thinks they are medical professionals. and have decided to give up on the war on drugs to focus on doctors and making their patients suffer. great job guys!!!!

      April 12, 2011 at 22:44 | Report abuse |
  8. Lola

    I suffer from chronic pain in my cervical spine, shouder and back. I have gone through many medications (for migraine as well), including gabapentin. When my pain level is up, and my nerves are firing away, I get muscle spasms, which make everything worse. Acupuncture has helped somewhat. Yoga does as well. But the simplest thing I've found is self- administer accupressure. I purchased simple guides for reflexology (acupressure points on the feet) and accupressure points on the hands. I can feel muscles release and nerves calm when I apply pressure, for instance, to the base of my pinky between it and the next finger. It releases the jaw, which you tend to clench when you're in pain. Try it...it works wonders.

    March 23, 2011 at 00:28 | Report abuse | Reply
    • Marilyn

      @ Lola, I read your response and I too suffer from chronic pain in the C-spine, ociptipal nerve pain and facial pain, shoulder left arm and lower back pain, I've been suffering w/ vertigo for 3 weeks now and feel myself getting deeper into depression, I take a lot of meds, and was doing decent w/ what I was taking until this vertigo hit me and I cant seem to get rid of it.....staying in bed all the time and not being able to get out and just drive a car right now has put me in a tail spin, If you can put some pointer's on here w/ the pressure points that help you I would greatly appreciate it....I suffer from myofascial pain syndrome and fibromyalgia....Depression and pain go hand in hand, I was never depressed until I was injured and countless surgeries later when my dr. said this is as good as you will be....I need help...any type....I feel very desperate right now with all this dizziness...and pain to boot...thanks...Lola and I hope to hear from you soon.

      July 18, 2011 at 17:22 | Report abuse |
  9. Mike

    Has anyone been prescribed Provigil or Nuvigil for assistance with pain. I experience pain most of the time from spinal stenosis. My brothers also have the same issue. Mine is compounded by 2 surgeries for herniated discs. I was diagnosed with sleep apnea to top it off. I personally think that was a result of the back discomfort. I was prescribed Provigil by what I consider my very good family doctor. It made all the difference in the world to my motivation and focus. I am able to work thru pain. I'm now taking the less expensive Nuvigil with same results

    March 23, 2011 at 06:02 | Report abuse | Reply
  10. JmyJon

    I'm always surprised that biofeedback never comes up in discussions of chronic pain. I had Perthes Disease as a child and experienced chronic hip pain for almost 20 years. I finally had my hip replaced last year at the tender age of 44. I spent years on Lodine and Vicodin (Vicodin is good stuff as long as you can keep it under control.). It wasn't until a year before my surgery that I learned about biofeedback for pain management. I know it sounds a little "woo hoo" but it works...almost miraculously. There were 2 times immediately after my surgery that the pain and discomfort almost got the best of me. I put my biofeedback training to the test. Within 10 or 15 minutes, the pain had abated and I was able to sleep until it was safe for my next round of painkillers.

    Looking back, I'm a little disappointed and frustrated that my family physician and various orthopedic doctors didn't recommend biofeedback sooner. It's easy, doesn't take long to learn, and has no side effects.

    March 23, 2011 at 09:45 | Report abuse | Reply
  11. CG

    I'm surprised that no body has considered looking into Chiropractic care, I've heard many stories of people being able to come off of or lower the amount of pain medications they were on on by seeing a Chiropractor consistent basis.

    March 23, 2011 at 10:27 | Report abuse | Reply
    • CG

      and/or their depression medication as well.

      March 23, 2011 at 10:34 | Report abuse |
  12. Rikka K. Smith

    I'm 69 yrs old. I have lived with asthma, chronic migraines, osteoporosis, hyperparathyroidism, chemotherapy for breast cancer, high blood pressure ,lyme disease and recently fibromialgia. I have had as many as 20 8 hr, type headaches a month for over 5 years. I've tried a lot of medications and therapies. I've recently been taking a RX Tramadol which is not an opiate, nor pain reliever. What it does is affect the way pain is transmitted. It seems to have no side affects. I've been on it for 3 mos. and I'm AMAZINGLY pain free.

    March 23, 2011 at 11:40 | Report abuse | Reply
  13. tina

    Marijuana: helps with pain AND depression

    March 23, 2011 at 16:09 | Report abuse | Reply
  14. bnakka

    I love how drugs that aim to cure one ailment have 10's if not 100's of side effects much worse than the ailment itself.

    My wife and I start laughing so loud when we see commercials for a pill and the last 10 seconds of the ad will go on and on about side affects.

    I would be surprised if drugs actually cure someone 100% and I vowed to myself and my wife that the only way I will take a dangerous prescription is if I can't survive anymore unless I take it. If it is pain I will bear it until I can't anymore.

    March 23, 2011 at 17:06 | Report abuse | Reply
  15. DeeMarie

    METHADONE. Hands down the best. Don't be put off by all the naysayers.

    METHADONE
    Advantages
    * Excellent absorption – Bio-availability 41% to 90%
    * No known active metabolites
    * High potency and lipid solubility
    * Long administration intervals 24hrs
    * Less tolerance with repeated dosing than other opiates
    * Cost – oral methadone costs less than $15 a month (clinics $400 month)
    * Less psychotropic effects, minimum abuse
    * Incomplete cross tolerance
    * Antagonist of NMDA – useful in neuropathic pain
    * No histamine release

    Disadvantages
    * Social stigma (most common)
    * Large individual pharmacokinetic variation

    Does methadone treatment impair mental function? (http://www.aatod.org/faq.htm#twelve)

    Methadone treatment has no adverse effects on intelligence, mental capability, or employability. Methadone treated patients are comparable to non-patients in reaction time, in ability to learn, focus, and make complex judgments. Methadone treated patients do well in a wide array of vocational endeavors, including professional positions, service occupations, and skilled, technical and support jobs. Methadone patients are lawyers, engineers, secretaries, truck or taxi drivers, roofers, gardeners, teachers, salespersons, architects, computer programmers, etc. One recent study tested methadone patient's cognition, perceptual and motor functioning, reaction time, and attentional function, as well as performance of automobile driving behavior. It was concluded, confirming previous findings, that methadone maintenance treatment does not impair functional capacity.

    March 23, 2011 at 17:26 | Report abuse | Reply
  16. Alicia G

    I have been depressed for a very long time. The only thing that gets me out of this funk is vitamin b-12. Shots and supplements. I have tried Cymbalta and just do not like the side effects.

    March 25, 2011 at 10:18 | Report abuse | Reply
  17. Roger Federer

    Interesting topic. A few months ago I read an article in Findrxonline where mentioned that these drugs – vicodin, lortab, or oxycodone – controlled pain but do not solve the disease. Also indicated that the side effects are dangerous and not recommended to buy online and over-the-counter because the abuse of these meds can cause death.

    April 1, 2011 at 11:17 | Report abuse | Reply
  18. miked0138

    Wow,, I thought I had seen the bottom of american stupidity and ignorance but after reading this it is no wonder why the suicide rate among the elderly is so high here.. Let me repost the question for those of you as stunned as I was by it. What meds work for depression caused by physical pain?. WOW, can you believe someone even HAS to ask this, that alone should tell you the state of modern medicine in the usa. allow me to state the obvious, TREAT THE %^&*#%^ PAIN!!!!!!! for crying out loud, just reading this makes me want to die young for fear of aging. you mean when i am older and in even more pain than now,. i will get no help and no relief other than to be told to take anti depressants so i'm not so depressed about having my life ruined by pain? in 2011 there is nothing that can be done to ease pain, nothing at all eh? Now this insane idea that someone in pain and 'dependant' on any opiate is an addict or something is just simply absurd, that's like saying a diabetic is an addict because they depend on insulin. pain killers reduce pain to a bearable level ,so many depend on them to do just that so they can live a somewhat normal life and not be miserable and in pain all the time.But honestly I think many doctors simply enjoy knowing you are in pain and they can stand between you and relief (well they think they can lool) and just continue to play around with you experimenting on you like a lab rat with everything under the sun except anything that will actually stop pain.. well anyway, i ended up just ranting and venting by the end of this. sorry just enrages me to see this knowing people that suffer daily. I will leave you with this though, self medicate if needed or if you can, screw these idiot doctors and their sadistic ways. america has booming drug trade fine you a good dealer and be pain free yourself!!!.
    peace and best wishes to you all , MIKED

    April 12, 2011 at 21:23 | Report abuse | Reply
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