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Peeling the mask of facial pain.

At times, depression is masked by pain in regions of the face and mouth which cannot be tracked to any organic cause. Individuals suffering from these symptoms are often viewed as a pain in the neck by physicians, who shuttle them from specialist to specialist and misdiagnose their underlying problem for years, says Stanley Lesse of the Neurological Institute of New York.

Lesse treated and studied 602 patients with troublesome facial pain between 1956 and 1978. In the vast majority of cases, he explains, the pain was a symptom of depression that had been overlooked by neurologists, dentists, otolaryngologists and ophthalmologists. Most of the patients were women between the ages of 36 and 59 who were ill for more than one year before being diagnosed correctly. Facial pain often began following simple dental procedures or minor surgery.

Psychiatric evaluations revealed that the patients usually had insomnia and problems with concentration. They lost interest in their surroundings and were socially isolated. Anorexia was a common problem, adds Lesse. Most had feelings of hopelessness; 18 had made suicide attempts, and 235 had contemplated or become preoccupied with suicide.

In general, these individuals are intelligent, hardworking and very aggressive, says Lesse. They are constantly fighting, however, against imagined feelings of worthlessness and inadequacy that get translated into facial pain.

When treated with psychotherapy and antidepressant drugs, these patients often showed marked improvement if their facial pain had been present for six months or less, reports Lesse. Only one-third to one-half of those who had fial pain for more than one year recovered with this treatment, he says.

Even those patients who responded to pyschotherapy and antidepressants experienced a return of facial pain if they could not tolerate specific pressures in their lives. As with severe depression, "masked" depression is often recurrent.

Early diagnosis, rather than specialist-hopping for several years, is crucial when facial pain masks depression, concludes Lesse.
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Title Annotation:facial pain as symptom of depression
Author:Bower, Bruce
Publication:Science News
Date:Jun 1, 1985
Previous Article:Growing up with depression.
Next Article:Alcohol and the heart.

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