Borderline Personality Disorder Common in Pain Patients

Borderline Personality Disorder Common in Chronic Pain Patients – MedScape – by Fran Lowry – Mar 2020

A significant proportion of patients who suffer from chronic pain also have features of borderline personality disorder (BPD), new research shows.

I really don’t know what to think about this because our healthcare system is so strongly biased against chronic pain patients and opioids that I don’t trust most of the research on it these days.

I can’t help but notice that it only says that pain patients “have features of” the disorder, but not that they have it. This is a sly way to make it sound like we all have BPD.

Psychiatric Disorders From Ehlers–Danlos Syndrome

Nationwide population-based cohort study of psychiatric disorders in individuals with Ehlers–Danlos syndrome or hypermobility syndrome and their siblings | BMC Psychiatry | Full Text – 04 July 2016

It looks like we inherit not only chronic physical pain but also a fourfold increased risk of both anxiety and depression.

Somehow, it makes sense to me that having a body “too loose” and being physically “unstable” would also manifest as being mentally “unstable”, that along with our physical pain, we also suffer from mental pain.

Abstract

To assess the risk of psychiatric disorders in Ehlers-Danlos syndrome (EDS) and hypermobility syndrome.  

Augmentation Strategies for Treatment-Resistant Depression

An Evidence-Based Approach to Augmentation and Combination Strategies for Treatment-Resistant Depression – free full-text /PMC2958866/ – Psychiatry (Edgmont). 2006 Jul;

This long paper explores all kinds of other medications that can be used in addition to the usual antidepressants. I experimented with countless medications over several decades and now operate on a cocktail of antidepressants (SNRI’s and tricyclics), mood stabilizers, and supplementary hormones (estrogen, thyroid, neurosteroids).

I’m still depressed at least half the time, but the suicidal impulses have quieted since I got my anxiety under better control using pregnenolone (and Lyrica, which also has anti-anxiety properties).

This paper is a review article that collects and synthesizes up-to-date information about the practice of augmenting and combining medications in regards to treatment-resistant major depressive disorder. 

The absurd trashing of antidepressants

Why the constant trashing of antidepressants is absurd – Vasco M Barreto | Aeon Essays

I was first prescribed antidepressants in 2000. Ever since, I have been on and off these drugs, mostly because the idea of taking them made me uncomfortable.

It was a mixture of guilt, probably not unlike the guilt some athletes must feel for taking a prohibited doping substance; shame for needing a pill that had such a profound impact on my behaviour; and frustration with the recurrent episodes of depression that would bring me back to the antidepressants I would then quickly abandon.

I broke this cycle when my daughters were born and I realised that it would be irresponsible to stop treatment because being a good father meant having a stable mood.  

GABAergic model of depression vindicated

Brexanolone, a neurosteroid antidepressant, vindicates the GABAergic deficit hypothesis of depression and may foster resilience – free full-text /PMC6544078/ – May 2019

This is another recent study supporting the theory of GABA’s effect on depression.

The GABAergic deficit hypothesis of depression states that a deficit of GABAergic transmission in defined neural circuits is causal for depression. 

Conversely, an enhancement of GABA transmission, including that triggered by selective serotonin reuptake inhibitors or ketamine, has antidepressant effects.   

Cortical GABAergic Dysfunction in Depression

Cortical GABAergic Dysfunction in Stress and Depression: New Insights for Therapeutic Interventions – free full-text /30914923/ – Front. Cell. Neurosci., March 2019

This is a recent article with many technical details explaining how GABA is involved in stress, depression, and anxiety.

Major depressive disorder (MDD) is a debilitating illness characterized by neuroanatomical and functional alterations in limbic structures, notably the prefrontal cortex (PFC), that can be precipitated by exposure to chronic stress

For decades, the monoaminergic deficit hypothesis of depression provided the conceptual framework to understand the pathophysiology of MDD.  

Pregnenolone for Bipolar Depression

A Randomized, Double-Blind, Placebo-Controlled Trial of Pregnenolone for Bipolar Depression – free full-text /PMC4200497/ – Jul 2014

Depression in bipolar disorder (BPD) is challenging to treat. Therefore, additional medication options are needed. In the current report, the effect of the neurosteroid pregnenolone on depressive symptoms in BPD was examined.

Pregnenolone was well tolerated. The results suggest that pregnenolone may improve depressive symptoms in patients with BPD and can be safely administered.

That’s an unusually positive note with which to end the abstract, and I think there’s some truth to it – at least for me. After finding multiple articles about how neurosteroids are helpful for depression and anxiety, I started experimenting. 

The GABAergic Hypothesis of Depression/Anxiety

The GABAergic Deficit Hypothesis of Major Depressive Disorder – free full-text /PMC3412149/ – Mol Psychiatry. – Apr 2011

This is a very technical article on a newer theory about what “causes” depression and anxiety.

My increasing desperation during bouts of increasing anxiety lately has motivated me to search for alternate routes of treating it (since I cannot have benzodiazepines due to taking opioids). It feels like my depression and anxiety always come together, so any new idea about treating depression gives me hope it could also alleviate my anxiety.

Here we summarize clinical and preclinical evidence supporting a central and causal role of GABAergic deficits in the etiology of depressive disorders. Increasing evidence points to an association between major depressive disorders (MDDs) and diverse types of GABAergic deficits.

Suicidal Thoughts Linked to Musculoskeletal Pain

Suicidal Thoughts Linked to Pain in Those with Rheumatic or Musculoskeletal Disease – By Janice Wood – July 2019

A new survey highlights the significant impact of rheumatic and musculoskeletal diseases (RMDs) on mental health.

The survey of more than 900 RMD patients revealed that pain had caused one in 10 to have suicidal thoughts in the previous four weeks. Pain also caused 58 percent to feel that everything was unmanageable for them.

This is a feeling I know only too well: the sinking sensation every time I think about how I’m going to get through this life, feeling completely overwhelmed by even trivial tasks, running around in mental circles looking for a way out of an unbearable situation… 

SSRIs May Impair Effectiveness of Some Opioids

SSRIs May Impair Effectiveness of Prodrug Opioids For Post-op Pain – Pain Medicine News – Jun, 2019

A multidisciplinary team of researchers from Stanford University and the VA Palo Alto Healthcare System recently published findings that indicate patients taking selective serotonin reuptake inhibitors (ssRIs) and treated with prodrug opioids to manage postsurgical pain may have worse pain outcomes than those prescribed active opioids (PLoS One 2019;14[2]:e0210575).

“An anesthesiologist came to us with information about this relationship that’s showing up in bench labs,” Dr. Hernandez-Boussard told Pain Medicine News, explaining how one of her co-authors was intrigued by an increasing body of research pointing to potentially antagonistic interactions between prodrug opioids and ssRIs affecting the cytochrome enzyme CYP2D6 in the liver (Acad Emerg Med 2014;21[8]:879-885).