Aaah, January. The first month of the year. A month that holds so much promise and potential. A month that also, apparently, holds so much pain.
Blue Monday
While depression definitely isn’t confined to specific times of the year, researchers have discovered a phenomenon called, Blue Monday. What is Blue Monday, you ask? No, it’s not the New Order song from the 80s that was so popular. The Blue Monday we are referring to here is what is supposedly the saddest day of the year.
In 2005, Dr. Cliff Arnall, a psychologist from the University of Cardiff first proposed the idea of ‘Blue Monday’ - the third Monday that falls each January. What makes it so sad? Well, Dr. Arnall put together a combination of some of the worsts that people struggle with during the year ranked things like:
Bad weather
Longest nights
The holiday hangover (financially, speaking - not an actual hangover)
Failed New Year's Resolutions
Because the concept was reported by Sky Travel, many thought that the concept of Blue Monday was just a marketing ploy to get people to book their summer holidays early. Dr Arnall himself has since apologized saying that it was relatively meaningless and his intention was to inspire people to take action and make bold life decisions rather than “emphasizing misery”.
A Sad Start
Holidays and pseudoscience aside, it has long been recognized that January is a hard month for most people, but it can be especially difficult for those struggling with mental health issues. For many people, the holiday aftermath often brings anything but joy.
The credit card bills begin to appear in the mail; you start regretting all of those drinks you had at the company holiday party; you feel sluggish and lazy because your diet hasn’t been great and the weather has been too terrible to go out and exercise.
Throw in the stress of having to deal with often dysfunctional family dynamics and it is no wonder that we end up feeling stressed and depressed. Cue the low back pain.
The Link Between Low Back Pain And Depression
If you are someone who struggles regularly with low back pain, then the idea that stress and depression might go hand in hand with your back pain probably doesn’t come as much of a surprise.
In recent years much of the research around back pain has started looking at how it may be linked to depression. In 2017, over 1000 Canadian university students completed a depression questionnaire about depression and low back pain.
The results showed that ‘over 50% of subjects reported low back pain across grades, and both depression and somatization were significantly positively associated with low back pain’.
How Depression Affects Back Pain
In 2019, researcher Daniela Olivera and her co-authors published the results from their study that aimed to evaluate the ‘impact of anxiety and depression symptoms and their interaction on clinical outcomes’ for low back pain sufferers. What they discovered was that ‘anxiety, depression, and their interaction are associated with changes in pain disability at one-year follow-up.’
Based on these results the authors felt that pretreatment screening of anxiety and depression should be happening for all chronic low back pain patients so that they can receive more comprehensive, multidisciplinary treatments.
Low Back Pain And Depression - More Common Than You Might Think
From these studies we can see that low back pain and depression are more common than we might think. One thing to remember, however, is that when we talk about the type of depression that is associated with chronic pain conditions like chronic low back pain we are referring to ‘major depression’ or ‘clinical depression’. This type of depression is different from just feeling a bit blue after the holidays and it is different from seasonal depression that is known as seasonal affective disorder (SAD).
For people who suffer from chronic back pain, statistics show that they tend to experience major depression 4 times more often than people who don’t have chronic low back pain. The numbers also show that those who have a combination of depression and low back pain often have greater levels of disability than those who simply have one or the other.
Symptoms of Major Depression
Major depression is defined by the DSM-V as occurring when a person experiences at least 5 of the following symptoms every day for at least two weeks:
Feeling sad, hopeless, empty or tearful
Sleeping too much or not being able to sleep
Feeling tired and lacking motivation to do even the smallest of tasks
Feeling irritated or frustrated over small things
Feeling anxious and restless
Eating too much or not wanting to eat
Losing interest in things that you used to enjoy and that made you happy
Trouble making decisions, remembering things, concentrating.
Feeling worthless and fixating on your past failures
Have suicidal thoughts, attempting suicide
Chronic pain issues that don’t always have a physical cause.
Ways That Back Pain Affects Depression
As you can see, depression and low back pain are closely linked together with many people entering a depression-and-pain cycle that seems to just go on forever. Some of the ways that back pain can make depression worse include:
Makes it difficult to sleep - causing people to be tired and easily irritated.
Leads to disability and lost work opportunities - causing financial stress.
Leads to frustration when they can’t engage in usual activities that are fun.
Leads to isolation when they miss out on social engagements/ family events.
Memory issues - pain makes it hard to focus on anything else.
How To Beat The Back Pain Blues*
When it comes to managing your back pain while also dealing with depression, it is always a good idea to speak with your primary care provider first as they will have a thorough knowledge of your medical history and can make appropriate recommendations.
For those looking to explore new options or try something that they may not have thought of before, there are tried and trusted treatments that take a more holistic and biopsychosocial approach to pain management.
Treatments for low back pain with depression may include some combination of the following therapies:
Mindfulness/ meditation/ MBSR (Mindfulness-based-stress-reduction)
Psychiatric medications
Pain medications
Nutritional counseling
*Important Note
*Although we are using the term “blues” we are, in no way, diminishing the devastating effects of depression. If you are experiencing any of the symptoms listed above we highly encourage you to seek mental health support.
SAMHSA’s national helpline is free of charge and they can offer support and connect you with other resources in your area. To call SAMHSA dial: 1-800-622-HELP (4357). You can also connect with your local NAMI (National Alliance For Mental Illness) chapter by calling or texting them on: 800-950-6264.
Conclusions
Depression can make even the smallest of tasks seem impossible and it may leave you thinking that you are just doomed to a life of pain. For years, many treatments for low back pain have seen the condition as an isolated physical condition and have not taken the patient’s mental state into account.
The biopsychosocial approach to pain management is growing in popularity as it looks at all aspects of a person’s life and considers how different elements of their life might be affecting their pain.
As we can see from the extensive research that is available, addressing the behavioral health concerns of low back pain sufferers is an important first step in addressing the pain.
If you find yourself struggling with depression, you should definitely seek professional help. More and more healthcare professionals are recognizing that a multidisciplinary approach to pain management is essential in long term recovery from chronic pain conditions.
To learn more about the biopsychosocial approach you can visit www.livafortis.us