Clinical depression is often linked to aches and pains, including back pain. Having chronic back pain is also associated with worsening depression symptoms in some people.

Research indicates there’s a bidirectional relationship between back pain and depression.

People with clinical depression often experience bodily aches and pains, which may include back pain, headaches, gastrointestinal pain, and generalized aches. And those living with chronic pain frequently develop symptoms of mental health disorders, including depression.

Back pain is not a formal symptom of depression, but it is frequently reported in research and clinical settings as a co-occurrence of depressive disorders. In other words, many people who have depression also complain of physical pain in their back.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) also indicates that depression across different cultural contexts may manifest in ways beyond the formal diagnostic criteria, including physical pain.

Not everyone with back pain develops symptoms of depression, but depression is common among people living with chronic pain, including back pain.

Experts have long theorized that the link between depression and back pain could be mediated by:

  • lack of sleep caused by pain
  • inability or limitation to do things you enjoy due to pain
  • social isolation due to the above
  • preoccupation (including anxiety) with the underlying cause of the pain

Lack of sleep, isolation, anxiety, and not being able to experience the things you enjoy may be associated factors of depression.

A 2021 cross-sectional study found that 36% of participants who lived with chronic pain also developed depression symptoms. People with higher levels of pain usually reported more severe symptoms of depression, likely mediated by lower sleep quality. The authors noted that these results align with those of previous research.

Research from 2023 also found that symptoms of clinical depression in U.S. adults were associated with back pain and that, in turn, back pain often meant worsening of depression symptoms. The study also indicated that depression was significantly more prevalent among people with back pain (37.4%) than those without back pain (8.5%).

Back pain may be associated with both physical and mental health conditions. A healthcare professional may want to explore possible physical causes of back pain before moving to a mental health diagnosis. They may complete a physical exam, gather information about your medical and family history, and run some tests.

Once they’ve ruled out a possible physical cause, they may want to explore symptoms of burnout, anxiety, and depression, among others.

The formal symptoms of depression, according to the DSM-5-TR, include:

  • low mood (sadness, emptiness, hopelessness)
  • loss of interest in activities you used to enjoy and in most other things
  • low energy and fatigue
  • changes in appetite (eating more or less than usual)
  • changes in sleep patterns (sleeping more or fewer hours than usual)
  • changes in movement (moving faster or slower than usual)
  • feelings of guilt and shame
  • difficulty focusing or making decisions
  • thoughts of self-harm, death, or suicide (including suicide attempts)

A healthcare professional may diagnose clinical depression if you’ve had at least five of these nine symptoms for most of the day, for 2 weeks or longer. At least one of those five symptoms should be low mood or loss of interest.

It’s also possible that back pain has an underlying physical cause, even if you have depression.

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The exact mechanisms behind the link between back pain and depression haven’t been fully established. As mentioned before, sleep deprivation, social isolation, and anxiety may mediate the development of both conditions.

Certain brain chemicals (neurotransmitters) and inflammatory markers may also play a role in both chronic pain and depression.

For example, chronic pain may impact dopamine receptors in the brain, lowering dopamine levels. Dopamine is a neurotransmitter that regulates motivation and pleasure, and lower levels of dopamine have been associated with depression symptoms.

Research also shows that depression and chronic pain may be linked to disruptions in the level of inflammatory molecules (cytokines, C-reactive protein, and prostaglandins) and the neurotransmitter glutamate. This suggests that someone could develop chronic pain and depression due to these disruptions.

More research into the biological overlaps and connections between depression and pain is needed to better understand the shared mechanisms.

Depression and back pain often coexist. The exact mechanisms underlying this link aren’t fully understood but experts theorize lack of sleep, social isolation, neurotransmitter imbalances, and inflammation may play a role. If you have depression, you may have physical symptoms, including back pain.