July 5th, 2011
11:56 AM ET

Can physical injury cause depression?

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.

Question asked by John H., Georgia

I suffered a pretty serious compound fracture to my ankle last year, followed by an infection, five surgeries, three rounds of IV treatment with PICC lines, hyperbaric oxygen treatment, and now physical therapy and oral antibiotics.

I feel like I've let my family, my company and myself down. I find it hard to concentrate and my limited mobility makes everything worse. I am in constant pain (bone-on-bone in the ankle) and even though the infection is finally gone, I find that an alarming amount of my thoughts are related to doing away with myself. When I was really hurt, I had getting better to look forward to. Now that I am there (sort of) it isn't that much better. Right now my life seems pretty joyless.

Is this typical for a Type A after an injury? Should I be (even more) worried?

Expert answer

Dear John,

I am really sorry to hear of your difficulties. I've recently had a close family member undergo a prolonged period of chronic pain, so I am especially sensitive to your situation. Until one has experienced the horror of prolonged physical pain, its endless, grinding hours and sense of hopeless eternity, one cannot understand how easy it is to become clinically depressed.

I am very concerned about your suicidal thoughts, but know also that these types of thoughts are very common at the bad crossroads where physical and emotional pain meet.

Let me make some practical recommendations aimed at improving your situation. First, it is absolutely imperative that you get treatment for your depression ASAP. In addition to the grave danger posed by suicidal thoughts, emotional pain has been shown in study after study to worsen the perception of physical pain.

Scientists have shown that the brain uses the same areas to register both types of pain - essentially treating them as being to a large degree equivalent - which may explain why physical pain so often produces depression and why depression worsens physical pain.

One particular class of antidepressant, called serotonin-norepinephrine reuptake inhibitors, or SNRIs, has been shown to help reduce several types of physical pain in addition to treating depression. Although your type of post-fracture-related pain has not been studied, you might still receive some relief from your physical pain in addition to the depression with this type of antidepressant.

Your pain might also benefit from treating with either gabapentin or pregabalin, both of which affect a type of calcium channel. In the case of my family member who has recently struggled with chronic pain, use of one of these calcium channel agents and an antidepressant has significantly improved her situation both physically and emotionally.

Just as treating your depression will help with the physical pain, continuing to do all you can to improve the physical pain will help greatly with your depression. One word of caution here, however, is that standard "pain pills" (officially known as opiates), while providing short-term benefit, may actually make pain worse over the long term and can also worsen depression.

For this reason, I strongly recommend trying very hard to avoid a taking an opiate on a regular basis if possible. If you are already taking opiates regularly, I recommend talking with your doctor about any potential behavioral/physical therapy type interventions that might help you reduce your need for these medications.

Finally, it is probably harder for Type A (that is driven, focused) individuals to cope with the way bad pain brings life to a crashing halt. The trick, and it's not an easy one, is to use your Type A nature to your benefit by exploring ways you can optimally re-engage with your life despite your pain.

Not only will this give you at least a portion of your life back, but studies have shown that not focusing on pain actually reduces its intensity.

soundoff (54 Responses)
  1. DM

    Depression sucks ... plain and simple. Do get help, do talk about it – don't hide things or you really aren't getting help. But most of all, depression not only affects you – it affects your family. the medical practice should wake up and include immediate family members in teh treatment of depression. If they don't know what's going on in the persons head, if they don't know how to handle it ... it will only get worse. Depressions, PTSD, Post-Partum .... the family must be informed and involved.

    July 5, 2011 at 13:43 | Report abuse | Reply
    • Richard

      Wouldn't it be nice to be so wealthy as to be able to hire someone to listen to me whine on about my pain! For those of us not in Congress with premium health care what? I wrecked my back in 2001 at the time I was up beat and working hard with my doctors to get better,, in 2002 that all ended when I was declared perment and stationay, a health insurance term that means i won't get better, I at first didn't buy into that, and tried things on my own, till I went bankrupt in 2006 since then my only choice is to take the pills my workers comp doctor gives and shut up, or not he doesn't listen either way.
      I do at least have a job but as I am not as perky as the kids I have found myself sidelined, not in any real danger of getting sacked it's a state job but all I have to do is lookout and count trees, till I eventually commit sucide from boredom, weather I take a few with me i have yet to decide. Yes it's safe to say I'm depressed. I used to be type a with a good job and a purpuse in life that's pretty much gone, the only joy i get is fostering cats, who have become family.
      As I read this back it's so sad, who says life is worth living didn't have to live alone with cronic pain, day in and day out.
      Well that's my rant, back to work taking the next breath, I expect i'll carry on for awhile yet, the cats are waiting for me to get home for the next meal.

      July 5, 2011 at 18:50 | Report abuse |
    • abby

      The problem might be that people cannot afford psychotherapy even if they have insurance. What do you do if you can't afford that?

      July 5, 2011 at 21:54 | Report abuse |
    • John

      Hey Richard, I get it and I relate to an unfortunate degree. Wellbutrin is working ok for me for controlling the constant negative thoughts. I'm at the point that I'm trying to find some purpose/reason for continuing to exist, beyond my cat, but I am "trying" and I think that has a lot to do with the Wellbutrin. You can get it generic for not too much, Doctors don't have a problem perscribing it since it has zero abuse potential ,and it has pretty much no side effects. Give it a shot, your cats need you 😉

      July 6, 2011 at 07:58 | Report abuse |
  2. elcantil

    Been there myself – incompetent and indifferent neurosurgeon. Osteomyelitis of the spine – absolutely excruciating and completely debilitating for 5 months. Had my wife hide our pistol where I couldn't find or reach it. Got to the point where I would rather have been dead – have since, of course, reconsidered. A truly horrible experience. Get help now – and even more importantly, listen to those that are helping you. Stay away from your surgeon – they caused the problem – go elsewhere..

    July 5, 2011 at 14:55 | Report abuse | Reply
  3. Jim in DC

    Also Been there - My entire Lower back from L1, L2, L3, L4 and S1 are now fused. What I thought was going to be a 6 hour suegery became 16 and what I thought was going to be a 3 month recovery turned into 3 years before I could even get off the pain Meds.
    Prior to my Surgery I was a 20 mile a day runner and 150+ mile a week cyclist. I went from that to nothing at all. By the time I realized that I was completely depressed, I went from 165lbs to 320lbs in just over 3 years. and I too felt like a failure and just wanted to Die Quickly.

    With help from my really great friends and family, Today I am down over a hundred lbs, and have started running again albeit slowly. I am a 48 year old male and my goal is to be fit enough on 50th to compete in and complete and Iron Man Triathlon!

    Stay strong and Talk Talk Talk to friends and family..... You may think of it as whining at first.... but therapy in any form will say your life.

    July 5, 2011 at 15:29 | Report abuse | Reply
  4. chpn

    I work at a rehabilitation center for those with chronic pain. Many of our patients have similar experiences as you do. It may behoof you to look at Functional Rehabilitation Programs or FRP. These programs often include help with medications, psychological, and physical therapies all under the same roof in one program. These programs are in existance because there are so many people suffering with similar ripple effects of their injury. I hope this can give you some hope. Best of luck to you.

    July 5, 2011 at 15:29 | Report abuse | Reply
  5. momomiester

    I love stupid questions like this. Your injured and you are depressed cause you can't do things like work or whatever..How freaking stupid. It is common sense. What is next..Does playing with fire result in burns? Cnn minions wanna know.

    July 5, 2011 at 16:22 | Report abuse | Reply
    • CFS Facts

      Yes, it's common sense, and it tends to elude many doctors. I came in with a bunch of physical/neurological complaints, including inability to sleep due to pain, and the quack concluded that there was no need to do x-rays to look for the cause of the pain, just diagnose depression. Anti-depressants just made me sicker, some made me violently ill. Several doctors and several years later, finally someone did x-rays and found three fractured vertebrae. Obvious source of the pain, but no one had bothered to look for it because diagnosing depression was easier.

      July 5, 2011 at 18:23 | Report abuse |
  6. Pat H

    Something I think was missed in the response is that this person has been through the worst part of struggling to get better. I'm reading that now that things are improved, he is having suicidal thoughts and is puzzled. That's what happened to me after a severe shoulder fracture and nearly a year of pain & rehab. As long as I was focused on the treatment, I was reasonably upbeat, though exhausted. Once released and "well" I became depressed. The solution for me was to start journaling, get some therapy and realize that it was just mind chatter and not something I needed to act on.

    July 5, 2011 at 16:33 | Report abuse | Reply
  7. c

    It can happen to anyone who undergoes a severe injuries. See http://www.doctoryourself.com/depression.html . Also megadoes of Niacin can help. See http://doctoryourself.com/hoffer_niacin.html

    July 5, 2011 at 16:59 | Report abuse | Reply
  8. charyl

    I have also been there, i have now had 13 ankle surgeries after breaking it 10 years ago. I have had an artificial ankle put in last summer and had to have a revision this year. Chronic pain is the worst, i have also found gabapentin to help, but i only take it at night because of the drowsiness it causes. I would also recommend talking to your doctor about a mild antidepressant it has certainly helped me. Best wishes for your recovery.

    July 5, 2011 at 17:34 | Report abuse | Reply
  9. Scott

    I find the 'expert answer' superficial at best. John H. from Georgia all I can say is "I feel ya brother". Yes it is depressing (not to mention that it HURTS!)...non-stop 24hour a day debilatating thought altering and lifestyle altering pain is beyond what one can or even wants to relate to others (so of course they cannot comprehend). They know not what they speak. Think all the sordid thoughts you want to dude, they may not be pleasurable but they do tend to keep your mind occupied when you think of all the nuances. Everyone makes it seem so nice and easy and sweet and normal to get help. Tell them about losing a job and the benefits of insurance, or if the insurance doesnt pay how it affects your credit or your next medical test or appointment, how you would be homeless if not for the largess of others. And they wonder why we turn to alcohol or god forbid that evil marijuana. Unfortunately brother, all I can offer you is you and only you have to be at peace with your life. I live with my pain because it's important to me to continue for other people in my life...and that makes me smile.

    July 5, 2011 at 18:49 | Report abuse | Reply
    • c

      Scott – I wish the best for you. My experience with severe pain was brief but it made realize how devastating it can be. Howard Hughes the millionaire lived with severe pain for over 30 years. He was able to do it by the self administration of pain killers in huge doses and the fact that he was so rich and powerful that the government let him do it. The DEA investigated his drug use but did not interfere with his self administered drug treatment. Here is the story of the investigation into his drug use: http://www.europad.org/journal/2008/Tennant%2010%283%292008.pdf . People who have severe pain need to be able to take enough pain medication in order to live their lives; only they can really know how much is enough.

      July 5, 2011 at 22:28 | Report abuse |
  10. TheLeftCoast

    John, please find a good holistic psychotherapist, I would recommend finding a Hakomi therapist, which recognizes the body – mind connection. More drugs are NOT the answer!

    July 5, 2011 at 19:26 | Report abuse | Reply
  11. abby

    If someone is in constant pain he/she cannot help but get depressed. When you hurt all the time you lose hope. Seeking out help for that depression is important. Don't be afraid of alternative treatments.

    July 5, 2011 at 21:52 | Report abuse | Reply
  12. Odessa

    CNN, why do you hide my comment? I'm just trying to help John.

    July 5, 2011 at 22:49 | Report abuse | Reply
    • Smee

      You smell funny. Do you try to bum screw sheep?

      July 5, 2011 at 23:55 | Report abuse |
  13. Odessa

    CNN. I think you have some malicious workers in you. Liberals. When will you do things right?

    July 5, 2011 at 22:56 | Report abuse | Reply
  14. Odessa

    CNN, whatever you do, everything I write is a common knowledge among Christians. Be fair and balanced. Let me write to Mr. John H. here.

    July 5, 2011 at 22:58 | Report abuse | Reply
  15. Odessa

    CNN, why don't you let Christians talk with Mr. John H.? Fine freedom of speeches you have in America. Freedom is only for liberals, isn't it?

    July 5, 2011 at 23:01 | Report abuse | Reply
  16. Frank

    Give Mr. John H. a copy of the Holy Quran. I too suffer from chronic pain and when I feel depressed I sit and read the Holy Quran and it lifts my spirits and my depression. Keep the Christians away from this person as christianity is a madhouse faith and the sight of a bible makes most people cringe..............

    July 6, 2011 at 09:24 | Report abuse | Reply
  17. jean gasman

    I had a simillar experience. Just because a surgeon can keep an ankle and foot attached doesn't mean it is always the right thing to do. Afrter 7 years of limpiing/crutches/pain/wheelchair...etc i asked for an amputation (after I saw people with prosthetic feet with a quality of life near normal) best thing I could ever have done. It is called getting on with your life. I believe this is being offered to solders who are seriously injured in war.

    July 6, 2011 at 10:20 | Report abuse | Reply
  18. Pankaj Manocha

    Dear John,
    I am really sorry for what you have felt recently after injuries and round of surgeries. I agree with you that anyone going through so much pain will have the same feeling. But as CNN expert mentioned use your driven nature to come over it slowly but surely. Taking few psychotherapy sessions with mild antidepressants for short duration will be really helpful. I am positive that if you follow expert advice, it's only matter of time that you will back to full swing in near future.

    July 6, 2011 at 22:29 | Report abuse | Reply
  19. FL555

    Maybe I'm an exception, but I just don't get depressed about anything, even during periods of excruciating physical pain. I acknowledge that people do become very depressed for various reasons, but depression is a mystery to me.

    July 6, 2011 at 22:35 | Report abuse | Reply
    • Elvis

      Your have not experienced life. Go somewhere else to post.

      June 28, 2016 at 23:35 | Report abuse |
  20. Pankaj Manocha

    Dear John,
    I am really sorry to hear about the pain and agony you are going through at this time. But I agree with the expert comments that taking few psychotherapy sessions and short duration antidepressants will definitely help you come over this slowly and surely. I feel you can use your driven personality to come over this by engaging your thought process in positive things in life. Slowly engaging yourself in physical exercise with assistance will help you in long run. I wish you best for your life ahead.

    July 6, 2011 at 22:37 | Report abuse | Reply
  21. stevangarth

    A Residential Treatment Center is a live-in facility that specializes in the treatment of chemical dependency (drug use), alcoholism, or psychological problems. Mental health issues may coexist with substance abuse, which is referred to as “Dual Diagnosis.” Psychological problems appropriate for a residential treatment center include bipolar disorder, depression, anxiety disorders, personality issues, psychological trauma such as PTSD, and self-injury behavior (cutting).

    July 16, 2011 at 06:27 | Report abuse | Reply
  22. A.R.Shams

    Any physical, mental or spiritual suffering can cause depression, which is the root of many other diseases.

    July 20, 2011 at 12:38 | Report abuse | Reply
  23. dr depression

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  24. jayme valet

    I had a fall on the ice,and fractured mywrist I went to urgentcare then they sent me to a orthopedic surgeon,he said a MRI needs to be done.I am upset because they did not tell me the results ,they said i have to make another app. when the day I had the test they said they would call on the results and they never did Ihad to call. I have missed 2 weeks so far from work because of this a cast should have been put on immeditely why didnt they do that?I have to wait another 7 days to find out my results could this fracture get worse from not being treated right away?

    February 23, 2014 at 19:52 | Report abuse | Reply
  25. Juan Alvarado

    I'm sixteen and I feel the same way except I had a knee dislocation while playing soccer and it sucks so much. I'm always having flashbacks on it day and night and I can't sleep. It's really something that I wanna go back in time and prevent myself from letting it happen. And I feel like I let everyone down including myself. I was so good at the sport now it feels like it was all just a dream. I'd always be happy no matter what. I feel like I don't know what I'm feeling now....it's like really empty and it's gotten me to where I don't wanna talk to anybody nor myself. I hate it so bad like I wish I could've seen it coming. Btw it happened four months ago and I felt fine at first like oh ima get better but I don't feel that way now. It sucks so much thinking if i'll ever play again let alone have the courage to even run again. Anyways it sucks so bad but I suppose it's to soon for me to put it that way so we'll see what comes for the future 🙂

    June 29, 2014 at 05:06 | Report abuse | Reply
    • Reggie Noble

      I feel the same way. I injured my ankle and constantly dream about going back to the past to never have it happen in the first place. I was so happy before and now I'm in agony all the time. People aren't sympathetic. They just say ok you broke you're ankle get on it with it. So frustrating. What I wouldn't give for a second chance

      April 19, 2015 at 10:07 | Report abuse |
  26. melih

    i have a shoulder injury for years and while i was dealing with it i got a brand new injury in my left hip.. Now i am very depressed then ever and all i can think of is suicide.. i just want to kill myself and end all these pains.. pain sucks.. i can't bear anymore

    October 29, 2014 at 16:10 | Report abuse | Reply
  27. Val

    My depression has gotten worse over a dislocated elbow injury. I have been in therapy every week since the injury.. I have a lot of pain. When I bend the elbow it is like their is a block in the elbow. They say to relax but I can not relax because I have pain in my wrist. I have two more weeks of therapy. I feel like no one can understand what I am feeling. I am so very tired. My arm has been in a brace. Which makes my arm feel very heavy.

    February 21, 2015 at 12:53 | Report abuse | Reply
  28. Elvis

    I sympathize with everyone who is suffering with depression after an injury. It is impossible to feel good when you're in pain. I broke my arm about 8 months ago and still am in pain after months of PT, weights, a brace and sling, and massage. Sleeping is terrible which adds to depression. Forget return to 100% range of motion. It's not going to happen and I accept it. I just would like to not have pain and it's not the only part of my body that hurts.

    You have to experience an injury like this to understand how much it hurts, how disabled you become, how hard it is. People who are bragging about how they never get depressed do not belong on this thread.

    June 28, 2016 at 23:44 | Report abuse | Reply
  29. Jean

    I survived Brest cancer. I survived a tibial plateau fracture of my knee. 18 months later knee gave out, fell and now trying to recover from a proximal humerus replacement. Month 9 of pain and limited movement and on most days I feel overwhelmed tired hopeless and useless.. Did 4 months of PT and couldn't get beyond passive movements and could'nt afford it anymore. So here I am in pain and wondering what next... The last three years have been spent recovering and I am at the point of giving up. My optimism is gone and I don't like this person but this is the first day I haven't felt alone.

    August 7, 2016 at 13:27 | Report abuse | Reply
  30. Jessie Jessi

    Can A Strong Core Reduce… Even Eliminate Your Joint Pain?
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    August 9, 2016 at 07:43 | Report abuse | Reply
  31. Charlotte

    I feel your pain as I am currently in the position as you. I've had reoccurring knee dislocations for 2 years now and I've had 4 x-rays and an MRI. In total I've experienced 5 dislocations,the two most recent ones just within a month of each other. I'm a 14 yr old girl who's very sporty and loves gymnastics.
    Recently, I've been diagnosed with trochlear dysplasia and an MCL tear. This means that I have to undergo a big surgery when my growth plates have fused. In the meantime, I'm playing the waiting game. I do nothing every day and all muscle has turned to fat so that's another bonus.
    So, I'm feeling down all the time cause my friends go off places and have fun and I'm left in the corner thinking that is the waiting really worth it anymore.
    I have emotional meltdowns fairly regularly, in fact I'm crying right now writing this. I'm just tired of sitting around all day and wish I was doing gymnastics but that's not going to happen
    So, that's my life at the moment. The advice I'll give you is to stay positive as you've been through the worst of it so now all of your time can go towards gaining your life back. Don't let it go as this episode that you've experienced is a small chink in the road to a great life!
    Hope you become yourself soon,

    August 6, 2017 at 15:14 | Report abuse | Reply
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