By definition, pain hurts. But it doesn’t just make you feel bad physically; trying to carry on in the face of unrelenting discomfort can drain your emotional resources, too.

A study of 130,880 people from the Canadian Community Health Survey found that those with arthritis experienced twice the rate of major depression and suicidal thoughts as those who didn’t have the disease. Researchers also revealed that people who reported chronic pain, limitations in daily activities and multiple health problems were more likely to be depressed.

In part, the connection is chemical. “Pain and depression share common pathways in the brain, and they’re controlled by the same two neurotransmitters, or chemical messengers: serotonin and norepinephrine,” explains psychiatrist Joseph Garbely, DO, chief medical officer at Friends Hospital in Philadelphia. “Depression can actually intensify pain, which is reason alone to seek treatment for mood disturbances that linger for more than two weeks.” 

Garbely recommends the following to achieve emotional well-being:

Take control. The life changes that often come with chronic pain can play a significant role in depression. “Ask yourself: Am I feeling bad because I’ve lost some of my independence? Because I can no longer contribute as much to my household income?” advises Dr. Garbely. Mourn your losses, and then brainstorm ways to get some control back. If you can no longer drive, for instance, don’t give up your weekly card game; have someone drive you.

Be open with your doctor. “People are afraid to use the ‘D’ word because of the stigma that comes with depression – but they’ll open up about symptoms that are often the result of depression, like lethargy and insomnia,” notes Dr. Garbely. It’s important to tell your doctor that you’re feeling blue, so he or she can help treat the condition, not just the symptoms.

Consider a double-duty drug. While standard antidepressants, including selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and sertraline (Zoloft) improve mood, Dr. Garbely encourages people with both chronic pain and depression to consider amore recent class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs), including venlafaxine (Effexor) and duloxetine (Cymbalta).

“These drugs target both serotonin and norepinephrine," Dr. Garbely says, "so they ease pain as well as depression.”

Talk it out. Many health insurance plans cover talk therapy, and studies show that people get more relief from a therapy-plus-antidepressant approach than from medication alone.