context: Many studies link fibromyalgia and depression. In fact, people with fibromyalgia are up to three times more likely to have depression at the time of their diagnosis than someone without fibromyalgia. Some researchers study the effects of depression on brain chemistry. Others look at abnormalities of the sympathetic nervous system -- the part of the nervous system that determines how you handle stress and emergencies. These abnormalities, they contend, may lead to the release of substances that cause more sensitivity to pain. The result is fibromyalgia with its chronic pain and feelings of depression. Learning more about the connection between fibromyalgia and depression can help you seek appropriate medical treatment from your doctor. That includes asking your doctor about antidepressants. By following an appropriate fibromyalgia treatment plan and getting the support of family and friends, you can take control of your fibromyalgia. You can also get control over your symptoms of depression and improve your quality of life. Sadness is a normal reaction to loss, life's struggles, or an injured self-esteem. Depression surpasses sadness and becomes a problem that affects your whole life. People who are depressed commonly experience: loss of pleasure in enjoyable activities weight loss or gain low energy feelings of guilt a sense of worthlessness thoughts about death These thoughts, physical changes, and feelings interfere with daily life. Depression that lasts for weeks at a time may be characterized as major or clinical depression. There are other types of depression. Common types include chronic depression -- known as dysthymia, bipolar depression, and seasonal depression or seasonal affective disorder ( SAD). The stress from fibromyalgia's pain and fatigue can cause anxiety and social isolation. The chronic deep muscle and tender point pain can result in less activity. That causes you to become more withdrawn and can also lead to depression. It is also possible that anxiety and depression are part of fibromyalgia, just like the pain. Depression and fibromyalgia can greatly interfere with the way you manage your activities at home or at work. So it is important to openly discuss any symptoms of depression you have with your doctors. Some people with fibromyalgia and chronic pain may be aware they are depressed. Others may not be sure they are depressed. Nevertheless, they know something is wrong. The signs of depression with chronic pain may include: decreased energy difficulty concentrating or making decisions feelings of hopelessness, guilt, or irritability loss of interest in nearly all activities persistent sad or anxious mood uncontrollable tearfulness In severe cases, depression with chronic pain can lead to thoughts of death or suicide. The stress of living with chronic pain and relentless fatigue can put a person into "overload." That can result in overwhelming feelings of nervousness and anxiety. What isn't clear is whether a stressful life brings about the fibromyalgia or if having fibromyalgia leads to stress. No matter which comes first, stress adds to problems of anger, distractibility, and irritability. Most patients feel worsening of pain and fatigue when they have more stress. Sometimes, severe stress occurs just before the disease starts. Feelings of depression are common with all types of chronic pain, including headache, back and neck pain, hip pain, shoulder pain, and the pain of fibromyalgia. For example, the prevalence of major depression in people with chronic low back pain is about three times greater than in the general population. By the same token, having a depressive disorder also increases the risk of developing chronic pain. Patients who are depressed have greater pain. They describe greater hindrance from pain and display more pain behaviors than pain patients who are not depressed. People with chronic pain such as fibromyalgia often become depressed and isolated. As a result, they spend more time away from other people, even people they love, such as family and friends. Instead of focusing on their personal lives or the lives of their loved ones, they become increasingly focused on their pain and suffering, which is very real. Adding to the frustration are the repeated appointments with health care providers to try to find relief and the resulting costs. If you avoid treating fibromyalgia, you may descend into a spiral. The chronic pain and fatigue limits your physical activities and exercise. That, in turn, weakens your body. You may begin to feel isolated, fearful, suspicious, lonely, and afraid, which can strain relationships. As time goes on and your symptoms continue, you may have trouble keeping your job. Doing so can be especially difficult if you have many absences or errors because of your symptoms such as fatigue, concentration problems, and pain. If your income is lost, you will have more stress. The longer your chronic pain and other symptoms continue without relief, the more likely you will be to experience stress-related symptoms. It's important to understand that fibromyalgia is more than the deep muscle pain and tender points you feel. It encompasses everything about you -- your feelings, emotions, and attitude; the way you respond to stress; and the way you communicate with others. The good news is, though, that while there is no cure, the fibromyalgia pain and symptoms of depression can be successfully treated.