Breaking the Link Between Pain and Depression

Tuesday, September 12, 2023

By Courtney Wise

Plus: 988 adds sign language service to the hotline, a peek at what a psych visit to the ER looks like, and two sisters work to sustain their bond as one navigates serious mental illness.

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Chronic pain can lead to depression and anxiety. What can acceptance do?

Enduring physical pain is a primary fact of life for 20% of American adults, according to a report published earlier this year by the CDC. That’s 51 million of our neighbors and loved ones who not only feel pain throughout their waking hours, but whose social interactions and work lives are often dictated by the amount of pain they’re able to withstand. It can be overwhelming,  Asher Pandjiris, a therapist who hosts the podcast, Living in This Queer Body, told the Los Angeles Times. Pandjiris lives with chronic pain. “It’s very hard to wrap your mind around all of what is potentially lost or not possible or going to be challenging for you if you’re living with chronic conditions or pain,” they said. 

Researchers believe  pain and depression are deeply linked – like winding roads that lead back to each other. Both psychological and physical pain stimulate some of the same areas of the brain and involve similar neurotransmitters. Still, psychologist Rona Maglian believes chronic pain sufferers can access fuller lives by “finding ways to take the pain off center stage…The way to shift your focus from pain in your life is to think about what you value. What will keep you going when life feels impossible? Freedom? Creativity? Family? This will give you purpose and meaning outside of your pain.”

Mindfulness training is one way to build mental fortitude. It trains the brain to accept the pain – and diverts energy from fear and anxiety to planning activities that bring the most quality to the day, said Fadel Zeidan, professor of anesthesiology at UC San Diego. “Instead of praying or hoping that I won’t be in pain,…I have started really trying to account for the possibility of my body’s needs and take care of them, plan for them,” Pandjiris said. “I try to accept that things might go differently than I’d hoped, and lean into the knowing that it isn’t any sort of failing on my part.” 

The lack of public support for the disabled community contributes to the mental anguish associated with chronic pain, Pandjiris added. Social isolation and not being believed are common experiences of people who live daily with pain. “What you’re experiencing is real,” Pandjiris said. “There must be a lot of grief there, and I want to validate the fact that you’re managing depression as a result of the world we live in, not as a result of your own failing or inadequacy.”

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For people in mental health crisis, a little EmPATH may go a long way

Over the past decade, the number of behavioral health patients in emergency rooms has increased a whopping 400%. Now one in seven ER patients is there for behavioral emergencies, psychiatrist Scott Zeller told Behavioral Health Business. His experiences led him to create a new form of emergency care. Known as EmPATH units, they provide an alternative to being in a standard ER in the midst of a mental health crisis. “Folks who are having maybe the worst day of their lives are getting stuck in the ER for a very long time – hours, days and in some cases, even weeks, waiting for an elusive inpatient bed to open up,” he said. 

EmPATH units, or Environment, Emergency Psychiatry Assessment, Treatment and Healing departments, are designed to support patients seeking emergency mental health care in a salmer place with less external stimuli, reclining chairs, and even a sensory area to help promote calm. These features help eliminate the stressors that might trigger frustration or agitation in someone needing behavioral health support, Zeller said. He created the first such units in 2016 in California and the model has spread to Virginia, Pennsylvania, Minnesota, South Carolina and Iowa. The New Yorker looked at the model in July.

The ability of EmPATH units to hold patients longer – for 24 or 48 hours – helps them avoid lingering poorly treated in the hospital and get home and into outpatient treatment faster, said Lewis Zeidner, system director for clinical triage and transition services, at M Health Fairview. “Often, we’re able to de-escalate the crisis,” Zeidner told Behavioral Health Business. “They’re able to regain some of their agency as an adult and get back to a higher level of functioning closer to what they were functioning before the crisis.”

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‘Friendship Project’ fosters connections

Face it, human. We’re social creatures who need each other to survive. That’s the word from US Surgeon General Vivek Murthy – who declared loneliness an epidemic just a few months ago – and a growing body of research. A need to stay connected during COVID shutdowns sparked the launch of the Friendship Project back in 2020. It’s a service of Advocates, an organization that supports people struggling with mental health, developmental and intellectual disabilities, and autism. Volunteers step in to hang out with someone doing a favorite activity. Melissa Mills often meets up with Jason Silverman, a friend with Down syndrome. Though Silverman doesn’t talk much, he and Mills enjoy getting together for weekly workouts at the gym, Mills told NPR. “We laugh and don’t worry about anything when we’re together,” she said. “There’s no stress; there’s no pressure. We’re just here to hang out.”

Silverman’s mother Stephanie Lynch said she’s seen a big difference in Jason since beginning his gym visits with Mills. He’s happier and more confident, she said. “It’s just human — people need companionship. They need to feel part of something,” says Lynch.

Not all friends in the Friendship Project leave their homes to build relationships. Sometimes, friendships grow while folding laundry or chatting while running errands to the grocery store or pharmacy. Human to human connection has been long assumed important, but recent science backs up that idea. Murthy’s office reports that loneliness increases the risk of early death as much as smoking nearly a pack of cigarettes per day. Research also shows that people regularly lacking social connection have a 29% higher risk of heart disease, a 32% greater risk of stroke and a 50% increased risk of dementia in older age. People with disabilities are often most vulnerable to social isolation, and thus at great risk amid the loneliness epidemic.

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In other news…

A tale of two sisters. Kaitlin and Natalie Prest are artists and each other’s best friend. They like each other so much, they still wear matching outfits – on purpose! But no story is perfect, and little sis Natalie reveals she almost lost herself in Kaitlin’s mental illness. In a 5-minute video story published by the New York Times, and a 5-episode podcast titled Sisters, the pair explore how they maintained a close bond of love and friendship while learning to respect one another’s needs as Kaitlin navigates borderline personality disorder. 

ASL support added to 988 hotline: The 988 crisis helpline just became more inclusive, ABC News reports. Late last week, the Substance Abuse and Mental Health Services Administration announced that American Sign Language services for the deaf and hard of hearing are now available for callers via video phone and the 988 website. “Mental health care is not a privilege but a right,” said Stephanie Logan, CEO of DeafLEAD, which will partner with SAMHSA to field ASL calls to the 988 line. “The introduction of 988 videophone services is a reflection of our collective pursuit of a society where no one feels isolated in times of crisis and ensures that the Deaf and Hard of Hearing community have equitable access to a vital and life-saving service.”

Georgia insurers fail to prove that they’ve complied with mental health parity law: In 2022, Georgia lwegislators passed a mental health parity law that requires health insurers to cover mental health care as they do physical health care. One year later, not a single insurer is in compliance, according to a report from Georgia’s insurance commissioner. At least now, advocates have a place to start from. “Until this report, we didn’t know what the insurers were doing,” Whitney Griggs, a senior policy manager at Georgians for a Healthy Future, told the Atlanta Journal-Constitution. “Now, we have a baseline. And we’ve got a long way to go.”

What a psychiatric visit to the emergency room looks like: There are sure to be differences from state to state, but North Carolina Health News shared this close look at what people can typically expect from a behavioral health experience in a hospital emergency room.

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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