Depression Linked to Poorer Outcomes in Patients with Fibromyalgia

Depression, an important modifiable factor in the management of fibromyalgia, was associated with poorer outcomes. Future guidelines should focus on the importance of both identifying and treating depression when fibromyalgia is diagnosed, according to a study published in Journal of Primary Care & Community Health.¹

“Depression has been a controversial issue in the conceptualization and treatment of fibromyalgia, and the 2 disorders are linked in important ways,” investigators stated. “Fibromyalgia patients have 3 times the rate of depression compared to those without fibromyalgia. Greater than 50% of patients with fibromyalgia have lifetime depression. There is a significant overlap in symptoms resulting in theories that posit fibromyalgia is merely a depressive equivalent or an affective syndrome disorder due to shared symptom presentation.”

A longitudinal treatment outcome study analyzed the prevalence of depression symptoms in patients with fibromyalgia in a tertiary care center. Investigators studied the impact of depression on functional outcomes after patients completed an intensive outpatient multicomponent fibromyalgia treatment program, which consisted of 16 hours (2 days) of cognitive behavioral therapy (CBT) as the intervention strategy. The Fibromyalgia Impact Questionnaire Revised (FIQR) was used to determine functional status and the Center for Epidemiologic Study of Depression (CES-D) measure was used to evaluate depression. These measures were administered at baseline and then 5 months after completing the program, via mailed surveys. Eligible patients had a fibromyalgia diagnosis, as confirmed by physicians using the American College of Rheumatology (ACR) criteria.

The study included 411 adult patients with fibromyalgia. Most (73.2%) patients reported depressive symptoms at admission. The average age was 54.7 years, and most were White (90.5%) and female (90.3%).

Both depression and functional impairment significantly improved following the treatment program (CES-D: Mean 25 vs 21, P < .001; FIQR: Mean 59 vs 46, P < .001). Higher depression scores at baseline predicted poorer outcomes after the multi-component treatment. Patients with depression were more functionally impaired when compared with patients without depression at follow-up. However, patients who were able to effectively treat their depression resulted in improved functioning at the follow-up assessment.

Although the CES-D is a valid screening tool, patients did not participate in a structured clinical diagnostic interview to diagnose depression, which limited the study. Additionally, findings were restricted to a tertiary care center cohort consisting of only patients with fibromyalgia, which may hinder generalizability. Several variables, including sleep disorders, fatigue, cognitive issues, and illegal substance use, were not accounted for in statistical analyses and may have affected the accuracy of the results. Further, investigators did not account for changes in antidepressant status from baseline to follow-up. However, the study included a large population sample of patients with physician-confirmed fibromyalgia, which improved the validity of diagnosis.

“Proactive identification with validated screening tools and treatment of depression as a part of comprehensive fibromyalgia programs may improve outcomes,” investigators concluded. “Further study with a large cohort of fibromyalgia patients in a randomized controlled trial, to study the impact of depression and its treatment on fibromyalgia outcomes is essential to confirm the differences in outcomes noted in our study… Given the impact of both fibromyalgia and depression on individuals’ quality of life, diagnosing and effectively treating depression is likely to improve individual response to non-pharmacologic management of fibromyalgia.”

Reference:

Munipalli B, Allman ME, Chauhan M, et al. Depression: A Modifiable Risk Factor for Poor Outcomes in Fibromyalgia. J Prim Care Community Health. 2022;13:21501319221120738. doi:10.1177/21501319221120738