MENTAL HEALTH NEWS AND ARTICLES                                     

Journal Article 

Do antidepressants really increase suicide rates in childhood and adolescence?

 

     The use of antidepressant in depressive illness results in a reduction of suicidal attempts and deaths due to suicide, conditions that are generally present in this disorder. Recently, the Federal Drug Administration (FDA) prohibited the use of antidepressants during childhood and adolescence. This decision was based on a supposed increase in suicidal thinking in these age groups. However, the evidence came from flawed clinical studies, some of them not even published, in which no significant differences were observed when compared to placebo. It is not possible to ascribe a direct responsibility to antidepressants, because depression, by definition, has suicidal ideation. On the contrary, the reduction of suicidal rates supports the effectiveness of these medications.

 

Silva H, Martinez JC. Rev Med Chile 2007; 135(9): 1195-201.Affiliation:

Cli­nica Psiquiatrica Universitaria, Facultad de Medicina, Universidad de ChileConcepcion, Chile. (Copyright © 2007, Sociedad Medica De San

Suicide Risk Factors: Pain and Depression

By Jennifer DeLeon

 

 

·         About 32 million people in the U.S. report having had pain lasting longer than one year (WebMD).

·         Excluding arthritis, people with chronic pain are four times more likely to attempt suicide than other adults (National Pain Foundation).

·         Of the population that complains of pain to their doctors, one-quarter to more than half, are depressed (WebMD).

·         Of those who die by suicide, over 60 percent suffer from major depression (American Foundation for Suicide Prevention).

 

Pain and Depression: Suicide Risk Factors

 

The correlation between chronic pain, depression, and suicide, is significant.  Those who suffer from pain are likely to suffer from depression, and those who suffer from depression will likely have increased pain.    Both pain and depression are factors that put individuals at substantial risk for suicide, specifically due to     the cycle of pain and depression, loss of control, and insufficient coping (WebMD). Additionally, other co-existing risk factors may increase their risk of suicide (Centers for Disease Control - 1).

 

Suicide Risk Factors (Centers for Disease Control – 1)

·         Family history of suicide

·         Family history of child maltreatment

·         Previous suicide attempt(s)

·         History of mental disorders, particularly clinical depression

·         History of alcohol and substance abuse

·         Feelings of hopelessness

·         Impulsive or aggressive tendencies

·         Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal dilemma)

·         Local epidemics of suicide

·         Isolation, a feeling of being cut off from other people

·         Barriers to accessing mental health treatment

·         Loss (relational, social, work, or financial)

·         Physical illness

·         Easy access to lethal methods

·         Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts

This article will explore the relationship between pain and depression, specifically, how to intervene in the pain/depression cycle, how to regain control, and how to develop healthy coping strategies.   Special attention will be given to the role that support groups play in helping individuals manage pain and depression, ultimately reducing their suicide risk factors. Additional relevant resources will be listed at the end of this article.

 

Pain and Depression: A Vicious Cycle

 

It is important to understand that there is both a physiological and psychological relationship between pain and depression, and each component, of this relationship, affects the other, creating a cycle. 

 

Pain is more intense for those suffering from chronic pain and depression, because physiologically-speaking, both pain and depression share some of the same nerve pathways and neurotransmitters (WebMD). 

 

 “Brain pathways that handle the reception of pain signals…use some of the same neurotransmitters involved in the regulation of mood…When regulation fails, pain is intensified along with sadness, hopelessness, and anxiety. And chronic pain, like chronic depression, can alter the functioning of the nervous system and perpetuate itself” (Harvard Health Publications, 2004, para. 9).  Additionally, these neurochemical changes in your body not only heighten your sensitivity to pain, but also create pain in previously pain-free areas (WebMD).

 

 Pain is also more intense for those who experience higher levels of stress, which is commonly associated with chronic pain and depression.  People with chronic pain, find themselves caught in a cycle where their stress increases their pain, and their pain increases their stress (Gatchel, 2004). Additionally, the severity of pain is increased by stress, thereby, decreasing the threshold of pain (Gatchel, 2004). 

 

(Bishop, Chronic Pain Cycle Diagram)

 

Is there a way to intervene in this cycle, and if so, how?

 

Pain and Depression: Breaking the Cycle

 

Cognitive therapy is very useful in breaking the pain-stress cycle.  Cognitive therapy teaches individuals to recognize their negative thoughts, surrounding their chronic pain experience, and change these patterns in order to improve the experience of pain (WebMD).  Likewise, these same cognitive skills have proven successful for treating depression, and anxiety, in those with chronic pain. You can control your pain, through behavior awareness, by using rational thought and relaxation to help break the pain-stress cycle (Gatchel, 2004).  

 

 

(Mind Over Mood Cognitive-Behavioral-Therapy (CBT) Cycle Diagram)

In order to learn these skills it is important to locate a cognitive therapist who specializes in chronic pain (WebMD).  You can ask your primary healthcare provider for a referral or contact the resources located at the end of this article. With enough practice, you will learn the skills to intervene in the pain-stress cycle and improve your depression and pain, thereby decreasing your suicide risk factors. 

 

Pain and Depression: Losing Control

 

Individuals who suffer from chronic pain and depression lose control over many aspects of their lives, namely, their independence.  They may find it necessary to rely partially, or solely, on friends and family to take care of the many activities that they used to be able to do themselves, such as: errands, childcare, housework, and even personal hygiene.  Many sufferers of pain and depression end up needing to quit work completely, resulting in loss of control over their finances, relying on disability or welfare instead.  Pain and depression can cause loss of control of behavior, sometimes resulting in estrangement from family and friends. The loss of control pain and depression sufferers endure can be immense.  This loss of control decreases individuals’ self-esteem and feelings of self-worth, exacerbating existing pain and depression.

 

How can individuals regain control of their lives under these circumstances?

 

Pain and Depression: Regaining Control

 

Being actively involved in one’s own healthcare is the first step to regaining control over pain and depression.  This requires making important decisions regarding healthcare providers and treatment plans. 

 

Steps toward empowerment (WebMD)    

 

·         Choose a healthcare provider who views you as a “healthy person with pain” and not as a “helpless victim.”

·         Explicitly tell your healthcare provider that you want to gain control over your chronic pain and depression

·         Play an active role in the creation of your treatment plan and make sure all affected areas of your life are addressed

·         Empower yourself by utilizing all available resources  

·         Fully commit yourself to the treatment plan

 

You will regain control over multiple aspects of your life by being actively involved in your own healthcare.  This will result in decreased depression and pain, and will reduce your suicide risk factors. 

 

 

 

Pain and Depression: Unhealthy Coping Strategies

 

Chronic pain and depression disrupt the quantity and quality of all areas of the individuals’ life by decreasing accessibility of healthy coping skills, and increasing the development of unhealthy coping skills (WebMD).  This change in coping skills, detrimentally impacts all areas of life including:  physical and mental health, interpersonal relationships, occupation, recreation, academia, and spirituality. 

 

Whereas the individual may have once managed stress by exercising, spending time with family and friends, or playing a musical instrument, pain and depression have made it impossible to engage in any of these activities.  In another example, whereas, the individual may have once followed a healthy diet, they now consume junk food to satiate their emotional and physical distress.

 

Unfortunately, unhealthy coping mechanisms result in increased pain and depression, thereby increasing suicide risk factors.

 

How do individuals learn healthy coping strategies, avoid unhealthy coping strategies, and find the motivation and guidance to do so?

 

Pain and Depression: Healthy Coping Strategies

Connectedness is the key to accessing and learning healthy coping strategies, avoiding unhealthy coping strategies, and finding the motivation and guidance to do so (Center for Disease Control - 2).  Two areas of connectedness are emphasized: connectedness between individuals and connectedness between individuals, and families, to community organizations (Center for Disease Control - 2).

 

The number and quality of an individual’s social relationships (connectedness between individuals), during times of stress, significantly increases the ability of the individual to positively cope with the stress, as is often associated with depression and pain (Center for Disease Control - 2).  Close supportive relationships increase the person’s ability to cope with stress in healthy ways, such as seeking professional help, and likewise, discourages unhealthy coping mechanisms, such as substance abuse (Center for Disease Control - 2). 

 

Connectedness of individuals, and families, to community organizations provides the same benefits as with individuals, but in multitude.  Additionally, being part of a group induces a feeling of belonging and self-worth that motivates individuals to utilize positive coping strategies (Center for Disease Control - 2).  Also, group members often monitor member behavior, take responsibility for member well-being, and can offer, or recommend, relevant assistance and support (Center for Disease Control - 2). A community is more likely to collectively mobilize to meet its members’ needs by helping them with prevention and treatment obstacles, such as: transportation, financial, services, stigmas, and more (Center for Disease Control -2).  All of these benefits increase the ability to positively cope with the stress of depression and pain, thereby decreasing suicide risk factors.

 

Support Groups:

Joining a support group is an excellent way to learn how to break the cycle of pain and depression, regain control in your life, and learn healthy coping strategies, thereby reducing suicide risk factors.  It is important to note that support groups are not the same as group counseling because they do not involve a licensed healthcare professional, such as a psychologist or psychiatrist (MayoClinic, 2009). 

 

Emotional and practical benefits of support groups (MayoClinic, 2009)

 

·         Connecting with others who share similarities makes you feel less isolated and more connected

·         The safety and compassion a support group offers can help you to feel less stigmatized

·         Learn coping skills from others in the group

·         Brainstorm with others to come up with new solutions

·         Encouragement to seek professional treatment

·         Learn from others how to take an active role in your healthcare

·         Encouragement to stick to your treatment plan

·         Share resource information

·         Connecting with others helps decrease depression

·         Watching other people improve their lives motivates you and gives you hope

 

Factors to consider when deciding on a support group (MayoClinic, 2009)

 

·         Is it condition specific?

·         Is the location convenient?

·         Is there a confidentiality agreement regarding the group?

·         Is the schedule convenient?

·         Is it led by a moderator, or, a facilitator?

·         Is a healthcare professional associated with the group?

·         Are there ground rules?

·         Are there fees?

 

It is always best to attend a few meetings just to observe and see if it suits your needs.  If not, keep looking -it is important that a support group sufficiently serve your needs (MayoClinic, 2009).  Also, keep in mind that support groups are not static and may change overtime, so it is important to reassess the support group from time to time (MayoClinic, 2009). 

 

A note about online support groups (MayoClinic, 2009)

 

·         Utilize the same caution with online support groups that you would with any online social media network

·         Be careful with your private information and be alert to scams and suspicious people

·         Be careful not to let online support take the place of in-person support

·         Online support groups usually include the following: live chat rooms, discussion forums, blogs, mailing lists, newsgroups, and social media sites.

 

It is important to keep in mind that information and advice shared in support groups may not always be accurate, or in your best interest (MayoClinic, 2009).  Always check with your healthcare provider before making any changes to your treatment plan, especially with regard to medication, including vitamins, minerals, and herbs (MayoClinic, 2009).

 

Red flags in support groups (MayoClinic, 2009)

 

·         The group promotes healthcare treatments without solid evidence from healthcare professionals

·         The group promises quick cures that seem too good to be true

·         The group encourages you to stop conventional treatment

·         The group pressures you into trying treatments or products 

·         Meetings revolve around complaints and negativity

·         Discussions are dominated by a few people

·         Members insist that you reveal private information

·         The group charges unreasonable fees

 

How to locate a support group (MayoClinic, 2009)

 

·         Ask any of your healthcare providers

·         Contact local, state, or national organizations regarding your interest/condition

·         Check with your place of worship

·         Look in the phone book, online, or check the newspaper

·         Check with community centers and libraries

·         Get recommendations from family or friends, especially those in similar situations

 

How to get the most out of support groups (MayoClinic, 2009)

 

·         Support groups should be considered supplementary to professional healthcare treatments 

·         Always let your healthcare provider know that you are joining a support group

 

US Pain Support Groups

 

There are many reasons why US Pain support groups are so effective.   US Pain support group facilitators receive extensive 5 week training by a clinical psychologist, ongoing support from healthcare professionals, and they have personal experience with pain -so they have innate compassion and understanding for group members.

What makes US Pain support group facilitators effective?

Knowledge of the self-help process based on the following assumptions

·         Each member contributes to the group

·         Each member is the ultimate authority on his/her needs

·         Communication must be open and honest to promote a positive group experience

 

Ability to distinguish personal views and needs from those of the group

·         Maintain objective viewpoints

·         Refrain from expressing personal agendas or making authoritative statements. 

·         Facilitate group without controlling it

 

Ability to assist the group in defining its own goals and objectives

·         Committed to the group’s success

·         Actively looks for way to empower member to reach their goals

·         Define ways to accomplish these goals

 

Ability to initiate and promote discussion

·         Develop shared responsibility among group members

·         Keep group discussions focused and productive 

·         Redirect all activity back to the group for reflection and sharing

 

Comfort with emotional expression and conflict resolution

·         Understand how to allow emotional expression without “fixing” or stifling it

·         Assist group in processing uncomfortable feelings that may arise from these expressions

·         Instigate conflict resolution when necessary

 

Ability to emphasize the positive

·         Help the group stay focused on problem solving, coping strategies, and the importance of meaning and hope

·         Seek to move each group member to a realistic and balanced view of pain as it fits into one’s entire life

 

Knowledge of a range of pain management resources

·         Broad understanding of pain research, pain treatments, and area resources, that they share with the group when appropriate 

·         Encourage group members to identify and evaluate options and alternatives for themselves 

·         Facilitate the sharing of coping strategies, community resources, and, any and all ideas that can be helpful in managing pain and improving quality of life

 

Resources

 

These organizations provide information, advocacy, and support for chronic pain sufferers and their families, including referrals to support groups and to other useful organizations.

 

American Academy of Pain Management
www.aapainmanage.org
209-533-9744

 

National Foundation for the Treatment of Pain
http://www.paincare.org/

713-862-9332

 

American Chronic Pain Association
www.theacpa.org
1-800-533-3231

 

American Pain Foundation
www.painfoundation.org
1-888-665-PAIN (7246)

 

US Pain Foundation

www.uspainfoundation.org

1-800-910-2462Reference List

 

American Foundation for Suicide Prevention.  National statistics: Facts and statistics.  Retrieved May 17,    2011, from            http://www.afsp.org/index.cfm?fuseaction=home.viewPage&page_id=050FEA9F-B064-4092-B1135C3A70DE1FDA

Bishop, Steve.  Chronic Pain Cycle Diagram.  Chronic back pain:  A patient’s guide.  Retrieved from Cambridge Arthritis Research Endeavour, on May 17, 2011, from  http://www.cambridge-arthritis.org.uk/chronicpain.php

Centers for Disease Control - 1.  Suicide: Risk and prevention factors.  Retrieved May 17^th, 2011, from            http://www.cdc.gov/ViolencePrevention/suicide/riskprotectivefactors.html

Centers for Disease Control - 2.  Promoting individual, family, and community connectedness to prevent       suicidal behavior.  Retrieved May 17, 2011, from  http://www.cdc.gov/ViolencePrevention/pdf/Suicide_Strategic_Direction_Full_Version-a.pdf

Gatchel, Robert J.  (2004).  Clinical essentials of pain management.  Washington, DC: American  Psychology Association.

Harvard Health Publications.  (September, 2004).  Depression and pain.   Retrieved from Harvard Medical School.  Website:  http://www.health.harvard.edu/newsweek/Depression_and_pain.htm

MayoClinic.  (August, 2009).  Support groups:  Share experiences about depression, mental health  conditions.  Website:  http://www.mayoclinic.com/health/support-groups/MH00044

Mind Over Mood.  Cognitive-Behavioral-Therapy (CBT) Cycle Diagram.  Retrieved May 17, 2011, from            http://www.mindovermood.com/ct_model.htm

National Pain Foundation.  Chronic pain and suicide risk.  Retrieved May 17^th, 2011, from            http://www.nationalpainfoundation.org/articles/290/chronic-pain-and-suicide-risk

Tearnan, PhD., Blake H. (Summer, 2001).  Pain, disease and suicide.  Pain Practitioner.   11(2), 6-8.           Website:  http://aapainmanage.org/literature/PainPrac/V11N2_Tearnan_PainDisease.pdf

WebMD.  Depression and chronic pain.  Retrieved May 17, 2011, from       http://www.webmd.com/depression/guide/depression-chronic-pain?page=3