Fibromyalgia or Depression?

There are many peo­ple, espe­cial­ly doc­tors, who claim that fibromyal­gia is just a symp­tom of depres­sion. I’ve had both, and I know the dif­fer­ence quite well. They are very, very dif­fer­ent.

Being in pain all the time can cer­tain­ly lead to depres­sion. That’s just log­i­cal. There are, how­ev­er, peo­ple who have fibromyal­gia who are not clin­i­cal­ly depressed. Depres­sion can also man­i­fest as phys­i­cal pain, but it is does not meet the cri­te­ria for fibromyal­gia.

I was treat­ed for depres­sion for years before I devel­oped FMS, though, and I tru­ly believe that if I’d got­ten prop­er treat­ment for men­tal health issues in my child­hood (post-trau­mat­ic stress dis­or­der and all the com­pli­ca­tions it brought, includ­ing major depres­sive dis­or­der) I prob­a­bly would­n’t have devel­oped FMS.

I nev­er have trou­ble dis­tin­guish­ing between the two, or between either of them and CFS/ME, which I also have. They’re all quite dif­fer­ent.

With FMS, the pain caus­es fatigue, and togeth­er they can (but don’t always) have an affect on your emo­tions. You may feel like doing some­thing, but your body absolute­ly will not coop­er­ate. There have been times when I’ve been feel­ing great, gone out to do some­thing I was SO look­ing for­ward to–and near­ly col­lapsed in the mid­dle of every­thing when my body said, “All right, that’s it, no more. Done. Where’s the bed?” (We’ve joked that if I ever man­age to get a scoot­er or elec­tric wheel­chair, it will have to have a remote con­trol fea­ture so that Sam can steer me on home when I’ve passed out.)

But seri­ous clin­i­cal depression…it does­n’t mat­ter whether you’ve got the phys­i­cal ener­gy or not. Log­ic does­n’t mat­ter. Know­ing that you’d feel bet­ter for hav­ing a nice, hot show­er is utter­ly irrel­e­vant. The fact that the tele­phone ring­ing is con­tribut­ing to your headache, and you could make it stop by mere­ly lift­ing up your arm up push­ing a but­ton, is irrel­e­vant, because lift­ing your arm would take too much damned effort. Yes, some­where, on some lev­el, you may know that you’ll lose yet more func­tion for not get­ting up and doing your exer­cis­es, but it’s less impor­tant than star­ing at the ceil­ing, or the pil­low, or what­ev­er is in front of your face right now. Not that you real­ly make any kind of con­scious val­ue judg­ment or any­thing, but the star­ing has iner­tia going for it. Even if noth­ing IS hurt­ing, even if you have all the ener­gy in the world and you could do any­thing you just don’t care.

Remem­ber that, the next time you hear some­one claim­ing that FMS and depres­sion are the same.

Cortisol and FMS and CFS/ME?

There’s been a lot of buzz over the past week about a study pub­lished in the Jour­nal of Chron­ic Fatigue Syn­drome that sug­gests treat­ing fibromyal­gia and ME/CFS with cor­ti­sol (a steroid), based on the fact that most patients have low cor­ti­sol lev­els. I do not have access to that pub­li­ca­tion, but would like to point out some con­cerns.

First, most of the reports are not clear about the fact that this was a lit­er­a­ture study, rather than a con­trolled clin­i­cal study.

Sec­ond, while at least one sto­ry did claim that the lit­er­a­ture study was fol­lowed up with an “obser­va­tion­al study” in which all of the FMS/CFS/ME patients in a par­tic­u­lar clin­ic were giv­en cor­ti­sol. That does not meet the stan­dards of a con­trolled, clin­i­cal study, which would require an untreat­ed con­trol group and a group receiv­ing place­bos instead of cor­ti­sol.

There have been mul­ti­ple clin­i­cal stud­ies of the effects of steroids on FMS/CFS/ME. I found records of stud­ies of pred­nisone and hydro­cor­ti­sone, in par­tic­u­lar. Those stud­ies did not find any pos­i­tive effects from treat­ment com­pared to place­bos, and in some cas­es there were sig­nif­i­cant prob­lems result­ing from the treat­ments. I did not find a study specif­i­cal­ly involv­ing cor­ti­sol, but I don’t know if that’s because there has­n’t been one or because I don’t have access to the appro­pri­ate data­bas­es. (I’m sure there are more stud­ies out there, but I don’t have access to Med­line.)

I’d strong­ly sug­gest wait­ing for the results of repeat­able, con­trolled clin­i­cal tests of cor­ti­sol before try­ing steroid treat­ment. Steroids have seri­ous side effects, and should not be tak­en light­ly.

Brief Update and Review of Witch Way to Murder

I’ve been doing so much read­ing because I’ve been sick and unable to do much else. We did get the girl to her doc­tor, so we know there’s no strep around here. The doc­tor would­n’t rule out mono, but would­n’t test for it either. (I don’t real­ly like this woman, and we usu­al­ly try to go when the nicer physi­cian is there.) She said that since they don’t do any­thing but treat the symp­toms if it is mono, and the con­ta­gion peri­od would have been 60–90 days ago, she does­n’t see any rea­son to run a test.
Con­tin­ue read­ing “Brief Update and Review of Witch Way to Mur­der”

Responses to various comments about ME and FMS

Some of the com­ments are pret­ty old by now, but there are cer­tain themes that come back, over and over again. I’ve decid­ed to answer them once, and that’s it.

ME and FMS are not “lifestyle” dis­eases. Researchers have found genet­ic, neu­ro­log­i­cal and car­di­o­log­i­cal anom­alies, so get off that blame-the-vic­tim bull­shit. We know bet­ter. We’ve done the diet and exer­cise dance. We’ve tried air-clean­ers and remov­ing tox­ins and nat­ur­al cleansers and vit­a­mins and health foods, and while some of them are nicer than the alter­na­tives, they can­not cure chron­ic fatigue syn­drome or fibromyal­gia because they are not part of the cause.

While we’re at it, no, alien abduc­tions don’t cause FMS, either. I know you’re laugh­ing, but there real­ly is site out there that makes such claims. No, I won’t link to it. It’s bad enough that it exists!

“Chron­ic Fatigue Syn­drome” is a total­ly inad­e­quate name for a dis­or­der whose suf­fer­ers expe­ri­ence far, far, more than a lit­tle tired­ness. That’s why we have a new and bet­ter name for CFS, as of Jan­u­ary 2007: ME/CFS, or myal­gic encephalopathy/chronic fatigue syn­drome. The dis­ease has been known as ME all along in the rest of the world, although some­times the acronym was used for myal­gic encephalomyelitis. Per­son­al­ly, I pre­ferred one of the oth­er sug­ges­tions, chron­ic neu­roen­docrineim­mune dys­func­tion syn­drome (CNDS), but I was­n’t on the com­mit­tee.

I would hap­pi­ly rename fibromyal­gia “you don’t want to be me” or “betray­al by entire body, tak­ing your mind with it,” but I don’t think any­body is sug­gest­ing that it be renamed. The name just does­n’t seem ade­quate to its impact, though it’s a lit­tle bet­ter than some of the old­er names, like “rheuma­tism.”

To oth­ers who have said “pre­ven­tion is bet­ter than cure.” Well, yes, and “a stitch in time saves 9.” Yup. I’ve got plen­ty of apho­risms, too. Tell me, pray, how one “pre­vents” dis­or­ders whose ori­gin is unclear? As I said above, researchers have iden­ti­fied genet­ic anom­alies. We have fair­ly good evi­dence that fibromyal­gia, at least, has a genet­ic com­po­nent. We’ve got brain scans show­ing that fibromites’ brains react dif­fer­ent­ly to painful stim­uli, and oth­er tests show­ing that our spinal flu­id has much high­er lev­els of a neu­ropep­tide involved in trans­mit­ting pain impuls­es than non-fibromites.

With that in mind, how would you go about “pre­vent­ing” fibromyal­gia? Advis­ing us not to breed? Many of us have already done so by the time we’re diagnosed—and, of course, that can’t help us when we’ve already got the dis­ease. We can use our own diag­noses as warn­ings that our own chil­dren may have a sus­cep­ti­bil­i­ty to fibromyal­gia, but what then? Smoth­er them in cot­ton bat­ting, to keep them from expe­ri­ence any stres­sors in life that might set off the FMS bomb in their genes?

Being fat does­n’t cause ME or FMS, either, although it’s com­mon to gain weight after devel­op­ing either dis­or­der. I don’t know any­one who is able to main­tain the lev­el of activ­i­ty he or she did before falling ill, and many of the drugs used to treat the symp­toms of these dis­or­ders cause weight gain. Los­ing weight is even more dif­fi­cult for us than for oth­er peo­ple. Telling us that we’d feel bet­ter if we lost weight is not help­ful in the least. I’ve nev­er once heard of any­one who was “cured” of FMS or ME because he or she lost weight—and if it were hap­pen­ing, I would know it, because I pay a lot of atten­tion to these things.

Even if I thought weight loss offered a “cure,” or even ame­lio­ra­tion of symp­toms, I see no rea­son to dis­cuss drugs like Xeni­cal at any length. Any drug or pro­ce­dure promis­ing weight loss will has an easy time get­ting approved because of our soci­ety’s hatred of fat peo­ple. Fen-phen, any­one? “Oh, the drug will kill some patients, or leave them with per­ma­nent heart dam­age? Hell, it’s worth it if there’s a chance of los­ing weight!” The weight-lossself-hatred indus­try has more than enough mon­ey and pow­er to lube their way past any flim­sy lit­tle reg­u­la­tions stand­ing in their way.

Diet and sports and their rela­tion to weight are anoth­er thing all togeth­er, and beyond the scope of this blog. I rec­om­mend you to peruse the worlds of the delight­ful Sandy Szwarc over at Junk­food Sci­ence, who does cov­er that top­ic, fre­quent­ly, thor­ough­ly, and well.