Bursitis with Major Depression

Dear Ask The Doctor: Hi Our daughter is ill with bursitis in her hips and has mostly been in bed now for 3 weeks. She has had cortizone injections but this has only given her a few weeks free from pain and then it returns. She is,obviously, on presribed medication from her Doctor. However, we don't think that this is the main problem. She is a single mum with 3 children,10 year old twins and a 15 year old boy. She is in deep financial trouble and has recently been told that she has lost her job at the Bank 25 years with them, and is also in an on off relationship. She does not eat proper meals at mealtimes and is almost constantly depressed. On Sunday evening she collapsed in fits of crying at home and we have been down trying to look after them all ever since. Her doctor came and said that she had an infection and a migraine for which he presribed antibiotics. However, we are not sure if this is all down to the Bursitis or if she actually had some sort of breakdown. We are all obviously very concerned as she has been told that she could end up in a wheelchair. One consultant has said he can operate on the Bursa but only gives a 70 30 chance of success. We realise that this would be very hard to diagnose by e-mail, but we would welcome your opinion form what I have desribed above. Obviously we do not expect you to commit to any firm diagnosis but another view would be very much appreciated. Many thanks for reading this request

Dear Malcolm: As a parent it is difficult to see your children go through pain. I do understand that you daughter is going through a lot in her life. Your daughter's bursitis may only be a part of the problem she is facing. According to what you have mentioned, there is a strong indication of an underlying depressive disorder. Financial strain, experiencing major life changes, chronic pain and social isolation, presence of all these indicated screening for depression.

Bursitis is self-limiting and is usually treated conservatively with application of heat, non-steroidal anti-inflammatory drugs and corticosteroid injections in the bursa. Significant number of patients are able to keep their symptoms under control with lifestyle changes and physical therapy and more than 2/3 of patients on injections will find relief. The presence of major depression will further aggravate the symptoms of pain. Your daughter may have to consult her physician for screening depression and treatment modalities like psychotherapy, antidepressant medication or a combination of both. I do feel that her symptoms of pain will improve once treatment is started.