If you have chronic pain, it’s completely normal, and even appropriate, from time to time to be frustrated and angry and sad. If you have a good healthy system already in place that you can use to pull out of a funk, you have little reason to worry about your mental health. Some of my patients have learned that going to beach, even in the middle of winter, to simply sit and enjoy the quiet power of the lake will snap them out of sadness. Some of my patients know that it is the feeling of helplessness that really gets inside their head when back pain flares up and restricts them, so they find a challenging craft or skill to master, like carving figurines or crazy quilting. These folks are really coping admirably.

But what if your pain is pushing you beyond frustration and anger and sadness? What if you start having mornings that require a 20 minute pep talk to just get out of bed? What if you simply cannot find joy in ANYTHING at all? What if you feel so blue that you literally weep? Then I’d say there is a very good chance that you have major depression, a potentially fatal disease that kills thousands and thousands of people, with and without chronic pain, every year. This is beyond frustration and anger and sadness, and you need help.

My patients know that I talk openly about my own major depression, and how for years, my coping mechanism was to simply lean into it and push back. Keep going. Sooner or later, things will get better for me inside. Knowing what I now know, I see how that strategy would never work, because depression isn’t about what’s happening on the outside. It’s about what’s happening INSIDE, and you can no more fix that yourself than you could fix hemophilia or kidney failure yourself.

We now know that major depression is a neurochemical and quite possibly a neuroanatomical disorder, in which either the brain is not making enough of several critical proteins and hormones, or the body is destroying those critical proteins and hormones too quickly. The end result is the same. The part of your nervous system responsible for analyzing the outside world and creating the appropriate emotions and sensations first malfunctions and eventually fails. That malfunction and failure is major depression.

What does major depression feel like? It’s hard to capture in words, but two true masters or the English language come close. Winston Churchill called his depression “the black dog,” that shadowed his every move. The poet William Blake, who also suffered from depression, wrote this (for me, this really captures the inner awfulness that I felt until my treatment finally succeeded):

  • Every night and every morn, some to misery are born.
  • Every morn and every night, some are born to sweet delight.
  • Some are born to sweet delight
  • Some are born to endless night

I think that major depression is best expressed as “endless night,” a very private gloom deep inside. On the outside, you could make it look like the same sun others enjoyed is shining upon you as well. But on the inside, it is darkness.

How can you tell if you have the neurological disease of major depression? One simple way is to take the Beck Depression Inventory. It’s on line and in books everywhere. You answer a number of multiple choice questions and then you score yourself. It only takes a few minutes. Or, ask yourself if any or all of these statements ring a bell:

  • The world would be a happier place for the people I care about if I were to disappear or die.
  • I wish I could give all of the years I have left to live to someone else who could really enjoy them
  • If I could end my life in a way that wouldn’t hurt my family or make those whom I love feel guilty or ashamed, I’d do it.
  • There is a dark cloud that surrounds me day and night.
  • Happiness is for other people, not me, so perhaps if I can devote my life to making others happy, it won’t be such a waste.
  • I’d give anything if I could just feel an hour of real peace inside every now and again.
  • The only time I feel the way I think normal people must feel is when I drink alcohol or use drugs.
  • Can’t the doctor give me something that will make me feel different than I always feel?

If any or all of these sound familiar, you likely have major depression, and you need help. Truly, your life depends upon it. If you have chronic pain, you are AT RISK for developing major depression. Your physical pain is literally being doubled or tripled by your depression, and we now know the chemical reasons why this is.

Here are steps you can take:

  1. If these thoughts and feelings are something new within the past few months or years, talk to your primary care doctor, and make sure that you don’t have another illness causing these feelings. Hormone imbalances, subclinical infections, and diabetes (just to name a few) could be the source.
  2. If these thoughts and feelings have been around to some degree or another for a very long time, look to your family history to see if any blood relatives had been diagnosed with depression, had been hospitalized for “nervous breakdown,” or “exhaustion,” or were known to self-medicate with alcohol and/or drugs. There is a strong genetic predisposition to depression. Major depression very often runs in families.
  3. Commit to doing what you need to do to feel better, because with the right medical care, anyone and everyone with depression can feel much, much better. Read that again. I’m thinking of you here. You have not been selected out for a life of misery; you have an illness and deserve the proper care. If you’ve survived this long with major depression, you’ve already proven that you are plenty strong. Put your pride on the shelf for a while. Your primary doctor and your pain specialist doctor can guide you. Don’t treat yourself; it never works. Hand over the reins of control to them and commit to the plan they build for you. The equation is a simple one: medication+talk therapy+self help=feeling better.
  4. Find an “anchor,” to help stabilize you as you pursue the different treatment options. That could be a spouse, a family member, a friend, a therapist, or your doctor. Remember, depression distorts reality. If you are depressed, you are not thinking accurately about yourself or your life. If you find that fantasies about ending your life are starting to take the form of actual plans, you need immediate help. If you have no other choices, go to the emergency room, a crisis center, or a place where someone else can keep you safe from yourself. The vast majority of people who survive their suicide attempts end up grateful for the second chance. The world is better off with you here. It’ll take some time, but you’ll see I’m right
  5. For folks with treatment-resistant major depression, we now have unique options such as ketamine infusion therapy, transcranial magnetic stimulation therapy, and bioidentical hormone therapy. The majority of patients with the disease of major depression can achieve steady, significant relief with less aggressive approaches, but for that minority who cannot, these options are very good news.

I am open about my own depression because a few years ago I finally got full control over it, thanks to my doctors, my therapists, and a wife who never gave up on me. Now, even when I have a bad day, as we all do from time to time, comparatively it’s still pretty darn good! Too many of us even in this day and age are embarrassed or ashamed to admit that, as much as we might wish otherwise, we have a mental illness. Yes, we likely have inherited depression genes. Yes, we likely have had emotional or physical or sexual traumas that brought those genes to the surface. But it is still our own personal responsibility to own these things and to start the active pursuit of happiness. In America, we ALL have the right to pursue our happiness. Nothing more, nothing less. Happiness is a pursuit, not something just handed to us. We have to chase it down. However, with the modern, scientifically based approaches to depression now at our disposal, it’s a chase we can all win.