Fibromyalgia, depression and stress – how are they connected?

Connection between fibromyalgia stress and depression
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Quick Look

Why is it that fibromyalgia often begins or worsens at times of stress?

Science: Stress leads to an increase in IL-8, a pro-inflammatory cytokine (PIC) associated with increased pain, greater risk of disease, and depression.

Conclusion: Stress can trigger or worsen fibromyalgia and depression because it elevates PIC levels.

Increased IL-8 production in response to stress increases the risk of disease

My theory of fibromyalgia proposes that an elevation in pro-inflammatory cytokines, especially IL-8, is critical to the onset and progression fibromyalgia and the various symptoms of fibromyalgia.

The study briefly summarized below is of interest because:

  • They identify a problem in the “innate inflammatory pathway” (aka the “inflammatory response system”) as the most likely explanation for the association between stress and a higher incidence of disease.
  • They specifically observe that an increase in IL-8 with the onset of stress increases the risk of disease.
    • But with social support, IL-8 did not increase with stress (shows the importance of support from others.)
  • The relationship between stress, risk of disease and cytokine elevation was only observed for IL-8 (suggesting this pro-inflammatory cytokine may be of particular importance.)
  • IL-8 elevation was also linked to depression.

The following observations provide support for our theory of fibromyalgia:

  • Shows a connection between stress and fibromyalgia (the connection is the increase in pro-inflammatory cytokines, especially IL-8.)
  • Shows how fibromyalgia might result in frequent depression.
  • Suggests a mechanism by which fibromyalgia (with its pro-inflammatory cytokine elevation) could increase the risk of developing an inflammatory condition.
  • Shows one possible pathway by which inflammatory disease might increase your odds for developing fibromyalgia.



February, 2007

Stimulated production of interleukin-8 covaries with psychosocial risk factors for inflammatory disease among middle-aged community volunteers.

Summary of the Abstract

Psychosocial factors such as chronic stress are increasingly associated with greater vulnerability to inflammatory disease, but the mechanism of this effect remains unclear.

One possibility is that these psychosocial characteristics are associated with activation of innate inflammatory pathways.

The relationship between psychosocial risk factors and the pro-inflammatory cytokines IL-1, IL-6, TNF, and IL-8 was explored.

A positive relationship was observed between the level of IL-8 production, symptoms of depression and perceived stress. However, with perceived social support, IL-8 levels decreased, or did not increase as much.

No significant associations between psychosocial factors and IL-1, IL-6 or TNF were observed.

These findings suggest that those at greatest risk for developing inflammatory disease are those whose IL-8 production increases most substantially in response to psychosocial factors such as stress.

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