Beyond Endurance

The other day in a post called “Multiple Diagnoses,” I documented the responses given from members of a fibromyalgia support group on Facebook about what other diagnoses people have besides fibromyalgia.  There were a remarkable number of responses and diagnoses, which I categorized into 37 general categories.  The top category, the most people with this type of diagnosis, was psychological.  Well over half the respondents mentioned a psychological diagnosis.  The breakdown of the actual responses are below.

Since I joined a couple fibromyalgia support groups on Facebook, I’ve seen several posts from desperate members who just essentially want to it all to end.  I started looking for articles about the correlation between fibromyalgia and suicide.  It was not difficult to find.  Lan et al (see library) performed a large, population-based study comparing patients without fibroymalgia, primary fibromyalgia patients, and patients with fibro plus additional diagnoses.  Furthermore, they broke down the additional diagnoses to compare, for example, a patient with heart disease and a patient with fibro plus heart disease.  The bottom line is that patients with fibro plus additional diagnoses are more likely to make a suicide attempt than patients with primary fibromyalgia (no other comorbidities) and patients without fibromyalgia.

Their explanation of why this may be is very interesting, although they do not really address the “which comes first?” question.  Still:

  1.  Anxiety predicts physical dysfunction – if you’re anxious, you tend to catastrophize, fear movement, etc.
  2. Anxiety and depression can affect the perception of disease severity – the more you think about pain, the more severe or dangerous it seems.
  3. Anxiety and depression enhances the perception of pain.

Further, major depressive disorders involve glutamine and GABA receptors – both of which have been identified as having a role in the fibro syndrome:  “Decreased serotonergic neurotransmission in individuals with fibromyalgia may precipitate a depressive state,” increasing the risk of suicidal behavior.  Furthermore, basic risk factors for suicide are: generalized pain (non-cancer), depression, and nonrestorative sleep.  Anyone with fibromyalgia has just said, well that’s me.  Therefore, fibromyalgia and depression are not just psychologically entwined, they are also physiologically entwined, giving people with fibromyalgia more of a risk of suicidal behaviors.

Does that mean that if you have fibromyalgia, you’re going to try to harm yourself?  No.  It means, like everything else about fibromyalgia, mindfulness, being mindful of anxiety or depression, and developing coping mechanisms are necessary.  In addition, certain medications prescribed for fibromyalgia (anti-epileptic drugs, such as gabapentin and pregabalin) have been identified as increasing the risk of suicidal behavior or thoughts (see Pereira in library), giving fibro patients an extra element to consider.

anxiety/panic disorder 52
depression 52
post-traumatic stress disorder 19
bipolar 12
borderline personality disorder 6
obsessive-compulsive disorder 5
brain fog 3
attention deficit hyperactivity disorder 3
agoraphobia 1
avoident personality disorder 1
nervous breakdown 1
schizophrenia 1
self harm issues 1


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