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Fibromyalgia, mood disorders share common link.

SAN DIEGO -- New data support the possibility that a common heritable factor puts people at risk for both major mood disorder and fibromyalgia, Dr. Lesley M. Arnold said at a psychopharmacology congress sponsored by the Neuroscience Education Institute.

She and her associates recently replicated a 1985 study of 45 patients with fibromyalgia or rheumatoid arthritis--both chronic, painful conditions that are more prevalent in women than in men.

The 1985 study found higher rates of major affective symptoms in the fibromyalgia group than in the rheumatoid arthritis group. Patients in the fibromyalgia group reported more family members with major depressive disorders, compared with patients in the rheumatoid arthritis group.

In the current study, interviews with 118 patients with fibromyalgia or rheumatoid arthritis again revealed higher lifetime rates of mood and anxiety disorders in the fibromyalgia group than in the rheumatoid arthritis group.

The investigators went a step further, however, by directly interviewing 805 first-degree relatives of the patients. The interviewers were blinded to whether the patient had a history of fibromyalgia or rheumatoid arthritis.

Results showed significantly higher rates of major depressive disorder and bipolar disorder among relatives of patients with fibromyalgia, compared with relatives of patients with rheumatoid arthritis, said Dr. Arnold, who serves as director of women's health research at the University of Cincinnati.

Further analysis showed that fibromyalgia and major mood disorders coaggregate in families, which means that even if a patient with fibromyalgia has never had a major depressive disorder, family members are still much more likely to have major mood disorders, compared with families of patients with rheumatoid arthritis.

"This suggests that perhaps either there's shared environmental factor that contributes to both disorders, or there's a common heritable factor. Given that the coaggregation was so strong, we think that there is a common heritable factor that puts patients at risk for both fibromyalgia and major mood disorder," Dr. Arnold said.

Interviews with patients showed that 48 of 78 with fibromyalgia had a history of major depression and 10 had a history of bipolar disorder, compared with reports of a history of depression from 11 of 40 patients with rheumatoid arthritis and no reports of bipolar disorder.

In the fibromyalgia group, 23 patients reported a history of panic disorder or agoraphobia, 18 reported posttraumatic stress disorder (PTSD), 16 reported social phobia, and 5 reported obsessive-compulsive disorder. In the rheumatoid arthritis group, three patients reported panic disorder or agoraphobia, two each reported PTSD and social phobia, and none reported obsessive-compulsive disorder.

Dr. Arnold is a consultant for, or has received honoraria or research funding from, Eli Lilly and Co., Pfizer Inc., and Wyeth Ayerst, all of which make antidepressant medications.

RELATED ARTICLE: Quiz Yourself on Pain-Depression Link

Think that you understand how physical symptoms overlap with major mood disorders? Test yourself with the following quiz. The answers are below.

1. Approximately what percentage of patients who have major depressive disorder or panic disorder present to primary care physicians with exclusively physical symptoms?

A) 0% B) 10% C) 30%

D) 50% E) 80%

2. Approximately what percentage of patients with major depressive disorders also have a chronic, painful physical condition?

A) 0% B) 8% C) 28%

D) 43% E) 84%

3. Which physical symptoms are not associated with major depressive disorder?

A) Headache

B) Chest pain

C) Abdominal pain

D) Joint pain

E) None of the above

4. American College of Rheumatology criteria for fibromyalgia include which of the following?

A) Morning stiffness

B) Fatigue

C) Insomnia

D) Widespread pain for longer than 3 months

E) Eleven of 18 positive tender points

5. Overlapping features of fibromyalgia and major depressive disorder include all of the following features except.

A) Female predominance

B) Body aches

C) Fatigue

D) Insomnia

E) Tender points

Answers: 1: E. 2: D. 3: E. 4: E. 5: E.

Source: Dr. Lesley M. Arnold


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Article Details
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Title Annotation:Pain Medicine
Author:Boschert, Sherry
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Jul 1, 2004
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