More Psychophysiopathology

It may not be a real word, but I like it.  When looking at fibromyology, one thing becomes more and more clear: everything is intertwined, psychology, physiology, pathology, and more, I’m sure.  For the moment, I’d like to focus on these three.  I’ve been reading about the psychological aspects of fibro and am noticing that fibro shares problems with both depression (not surprising) and bipolar disorder.  As always, it does not mean that everyone with fibro is either depressed or bipolar, and not every depressed or bipolar patient also has fibro.  However, they have some physiological commonalities.

For example, in both fibromyalgia and bipolar disorder there are abnormalities in the hypothalamic-pituitary-adrenal axis, problems with oxidative and nitrosative stress, and mitochondrial dysfunction (see Bortolato et al in library).  Tryptophan (and thus serotonin and melatonin) is also affected, and all this leads to “impaired neuroplasticity.”  Makes you hurt.

In depression, COMT (catechol-O-methyl-transferase) Val 158Met polymorphism is a factor.  This, as far as I can tell is an enzyme (COMT) and a phenotype (Val 158Met). There’s a lot of contradictory research regarding COMT and fibromyalgia, but according to Desmeules et al (see library, as well as Zhang et al for opposing viewpoint) there is a connection.

So some questions/thoughts:  It is very clear (at least to me, being on an antidepressant and knowing what happens when I go off it) that depression is a chemical imbalance in the brain (in very simplistic terms).  From what I know of bipolar disorder, that seems to be the case too.  Fix the chemicals, and you control the disorder – at least you can get some relief or go into remission.  If a lot of the same chemical pathways are affected in these disorders, why doesn’t treating depression also treat fibro?  I know antidepressants (such as amitriptyline) are used to help control pain in fibro patients, and these are meds I can’t take, so I can’t say for sure that they don’t work, but when I was trying them, they didn’t work.

Also, looking at this in the same light as looking at childhood trauma, where pain processing systems are physiologically affected during development, is it possible that the same thing can happen in terms of depression/bipolar disorder?  Chicken and the egg again, but is it possible that not treating depression/bipolar disorder can affect pain pathways in a physiological way?  Is it possible to “break” the pathways with psychological stress so that they physically change?  Kind of like “broken-heart syndrome”?  I have no idea.

One thing I am thinking, however, is that this definitely indicates that fibro is a physiological disorder, much like depression and bipolar disorder – a physiological disorder that affects patients psychologically too.  I think looking at the physiological connections to mental disorders would be helpful.  Plunging back in….

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