Today I will be going over some of the more researched and scientifically backed purposed relationships between Endometriosis and Depression. Now, let me put a warning in now. I am majoring in Neuropsychology. I have worked in a medical research microbiology lab and under three different professors for research assistance. I am what you could call a full fledged nerd. A little hazard of this is that I have become very comfortable with the language and formats of scientific research. So today, although I will be citing resources and discussing papers, I will be trying my absolute best to remain as plain language as possible. If there is anything you do not understand, PLEASE email me or leave a comment. That way, I can fix it for everyone. My goal is to write this for other people--not myself!
First off, there are many confounding factors that make it difficult to ascertain exactly why there are such high rates of depression in women with endometriosis. I am still looking for the exact number (if you know the study, please email me the reference!) but it has been found that women with endometriosis DO report much higher rates of depression. That much is clear. It's the why that has everyone so boggled.
The main problem is that without advances in endometriosis (good animal models, more funds, etc.), the exact nature of the relationship between depression and endometriosis is a mystery. In fact, some have even proposed that it may even be possible that women that are not vulnerable to depression experience less pain than women who are. Meaning the pain you feel with endometriosis could have more to do with anxiety/depression and less to do with endometriosis. This does not mean that it is a 'fake' disease; that is not what I am saying. But the experience of pain ('how bad it feels') may differ depending on one's mental state. Anyone with endometriosis can tell you that the amount of physical pain felt often has little correlation with the progress of the disease. Meaning a women with little endometriosis could be experiencing much more pain than a women with highly advanced endometriosis. Part of it has to do with where the endometriosis is. But another part may have to do with your personality type(1). Past research suggested that personality type could lead to endometriosis, but more recent research is suggesting that depression/anxiety is more likely a consequence of endometriosis.
Personally, for me, from what I can discern from more modern research, is that endometriosis-depression is a dangerous cycle. Persistent pain from illness increases the likelihood of developing secondary disorders--such as mental conditions like depression and anxiety. Meaning hurting all the time takes a toll on your mental state. These mental dysfunctions (such as mild depression) increase the severity of pain sensation (i.e., it hurts more than it used to). Then this pain furthers the risks for mental conditions. Which then increase the subjective sensations of pain(2). To put it simply, you could be caught in a dangerous downward spiral of pain and depression. To me, this is the biggest reason for why it is important to address both when trying to deal with the complications/difficulties/tragedies of endometriosis.
Other aspects of endometriosis also increase the risks of depression. Such as the restrictions that the pain causes on one's life. One primary reason is the social dysfunction(3). When a patient is experiencing chronic pain, it prevents them from being able to socialize normally. Meaning the pain keeps them from making and keeping connections with friends and loved ones. Without that support net, you are more susceptible to depression. Not to mention to other immunological hiccups. Meaning, people who frequently socialize or maintain strong friendships are not only more protected against depression, but also infections. The link is still being studied, but for whatever reason, people who socialize more recover/heal/defend better than those who socialize less. The exact reasons for the relationship is not clear, but that the relationship exists is a fact. Try not to let the pain keep you from loved ones.
Speaking of pain, aside from social dysfunction, pain alone can lead to higher rates of depression. As I said earlier, depression can increase the severity of how pain 'feels'. Studies have found, in comparing endometriosis women with and without pelvic pain, the rates of depression are over twice as high in women with pelvic pain(4). This relationship between chronic pain and depression has been repeatedly researched; however, there is no agreement on whether the disease/disorder causes the depression or depression causes the disease/disorder. For our purposes, it is simply beneficial to keep this relationship in mind and be cautious of the risks of depression when dealing with a chronically painful illness. Like I said earlier, you want to avoid the cycle. Also, as I hinted earlier, it has been suggested that the degree of pain can be an indication of the severity of depression; however, this relationship has not been explored fully. Additionally, keep in mind that the stage of endometriosis is not linked to the risks of depression(5). Meaning that pain is a greater implication for depression than the stage of the disease.
Research will continue to explore the medical links between endometriosis and depression. Current research is attempting to discern the relationship between endometriosis and unbalanced chemicals/hormones. As one endometriosis fighter once said, there is a horrible imbalance of hormones in an endo-sufferers body. That alone can trigger mood swings and social difficulties. However, these imbalances are often different between woman and it is difficult to see if it is a cause or reaction. As I said, there are too many variables--too many things to get in the way of what is being studied. What really needs to happen for endometriosis, what could really lead to substantial break throughs, is a suitable animal model. That is the only way to control the environment and explore all the many factors of endometriosis. They have rat models for ADHD even (and I have ADHD--I'm not saying it's not important. But I wish endometriosis got the same research funds that ADHD does). There needs to be an endometriosis model. I found a study with an experimental endometriosis model, but I have yet to find research announcing a ready-for-testing model(6). For now, the chemical perpetrators of endometriosis are elusive.
That is majority of current research I found. I am sure there are more. But I have responsibilities to attend to. Please read this over. This is an uphill battle that women with endometriosis are fighting--every single one in pain is at risk for depression. Know that risk. And know how to fight it. And if you are in the place of a supporter, know these risks too. It helps to have a support team that knows little things to help.
For Part 3, later this week, I will cover ways to deal with pain related depression. Keep on fighting.
References (Sorry, I haven't converted these all into APA yet--ran out of time!)
- BULLETIN OF EXPERIMENTAL BIOLOGY AND MEDICINE Volume 152, Number 1, 93-97, DOI: 10.1007/s10517-011-1463-0
- Psychoimmune Interactions in Women of Reproductive Age with EndometriosisGomibuchi H, Taketani Y, Doi M, Yoshida K, Mizukawa H, Kaneko M, et al. Is personality involved in the expression of dysmenorrhea in patients with endometriosis? Am J Obstet Gynecol. 1993;169: / 723 / /
- Peveler R, Edwards J, Daddow J, Thomas E. Psychosocialfactors and chronic pelvic pain: a comparison of women withendometriosis and with unexplained pain. J Psychosom Res.1995;40: / 305 / /15
- Lorençatto, C., Petta, C., Navarro, M., Bahamondes, L., & Matos, A. (2006). Depression in women with endometriosis with and without chronic pelvic pain. Acta Obstetricia Et Gynecologica Scandinavica, 85(1), 88-92.
- Depressive symptoms, anxiety, and quality of life in women with pelvic endometriosis Rodrigo de P. Sepulcri, Vivian F. do Amaral European journal of obstetrics, gynecology, and reproductive biology 1 January 2009 (volume 142 issue 1 Pages 53-56 DOI: 10.1016/j.ejogrb.2008.09.003