Too many of us have stories about struggling to access the care we need. Often, health care obstacles are directly tied to medicine's gender bias, as well as stigmas relating to our race, ethnicity, sexuality, gender identity, age, size, income, and condition. In our series Pain Today, we are highlighting these stories through personal and reported essays, hoping to empower each other to advocate for our health in a way that much of the medical community does not.
We usually imagine the doctor's office as a place where our physical problems will be fixed by experts. But what happens when doctors can't pinpoint the true cause of our symptoms? Or worse-when they decide that our symptoms are all in our heads?
Being believed at the doctor's office is not only expected, but it's also a vital step in securing a diagnosis and treatment plan. But women, in particular, who present unusual physical symptoms of pain often find that they are ignored during their consultations. Their pleas for help are dismissed and, instead of receiving a plan for uncovering the physical cause of their pain, they are prescribed antidepressants.
While antidepressants can be a key element in treating a wide range of conditions, they aren't the answer to everything. In the U.S., antidepressant use has been steadily rising amongst the female population- especially between 2009 and 2010 and between 2017 and 2018-but not for men. According to a 2020 NCHS study, 17.7% of women used antidepressants frequently, compared to 8.4% of men around these times.
Studies have shown that women are diagnosed with depression more than men, which may explain this gender gap in antidepressant use. However, a study in the 1990s found that between 30-50% of women were misdiagnosed with depression.
An explanation for this worrying trend may be that some doctors, consciously or unconsciously, assume that women's unexplained complaints of pain must stem from a mental issue as opposed to a physical one.
For instance, Robyn Atcheson began experiencing debilitating pelvic pain with her first period at the age of 12. When she visited her doctor, her symptoms were dismissed as the normal side effects of the menstrual cycle.
"I was frequently told by my doctors and consultants that the pelvic pain I was experiencing couldn't be as bad as I said," Atcheson recalls. "It was suggested that I was exaggerating for attention and I got the infamous line of 'It's all in your head' on a regular basis."
When she was 21, Atcheson finally got an MRI scan, which revealed multiple cysts on her ovaries. "I was put on injections that trigger an artificial menopause," Atcheson says. The pain got worse, and she was hospitalized.
After an ultrasound and an x-ray, a consultant came to give her her results. Atcheson says, "He sat down on my bed and, without examining me or listening to me at all, told me that the only thing I needed was a psychiatrist because the pain was not real."
"When I started crying, he took that as confirmation that the problem was mental rather than physical and told me I'd need therapy and antidepressants," she goes on.
Antidepressants had been mentioned previously as a way to treat depression as a side effect of her pain; however, she says, "This was the first time someone suggested that the pain would cease if I took antidepressants because clearly, there was nothing physically wrong with me."
Atcheson refused the medication, knowing that her condition was not a mental one. She eventually received a diagnosis from another doctor with stage 4 endometriosis and ended up needing seven surgeries related to the condition.
Holly Smith, a Money Saving Blogger and Author, is another woman who found that her symptoms of pain were overlooked and dismissed by professionals. She began to experience severe stomach pain when she was 17. Over the course of 10 years, various doctors claimed that there was "nothing wrong." As Smith explains, she was given antidepressants on several occasions "because they were sure I had 'mental health issues,'" as she puts it. She eventually referred herself to a specialist after 15 years of misdiagnoses and misunderstandings. Six weeks later, she was diagnosed with a rare autoimmune condition called MAST Cell Activation Disorder.
It's hard to imagine a healthcare system with such archaic biases against women. Do doctors really jump to such swift conclusions about whether our physical symptoms are "real?"
Over the course of the 17th, 18th, and 19th centuries, the term "hysteria" was adopted by medical professionals across the western world. As one historian noted, it became a catchall medical term to describe "everything that men found mysterious or unmanageable in women." The term is still conversationally used today to describe erratic or overly emotional behavior, usually in women.
Of course, hysteria is no longer seen as a valid medical diagnosis-but based on the accounts of Atcheson and Smith, it would seem that the concept still lingers and, in many ways, is built into our healthcare practices, with women's pain frequently being dismissed as the side effect of a mental condition.
While it's clear that some women with pain symptoms are receiving an incorrect diagnosis of depression, it's not always quite so straightforward. In some cases, women find themselves dealing with a physical condition that can actually be treated with antidepressants.
Shirley Joy Joffe, a holistic healer and life coach, found herself in this position. She began looking for alternatives to traditional medical science after spending years struggling with fibromyalgia, a condition that causes chronic pain and fatigue and is commonly treated with antidepressants.
When Joffe moved away from home to attend college in 1992, she began to experience extreme exhaustion. "Now and then I noticed that I was suddenly feeling extremely tired, like to the point of exhaustion," she recalls. "And I was quite an athlete, so it was very odd."
Joffe's exhaustion got to the point where she couldn't even get out of bed to make herself food. "I'd get a friend to bring me a loaf of bread or something," she says. Alongside her exhaustion, Joffe was experiencing severe pain. When Joffe went to her doctor, they assumed her exhaustion was a symptom of depression. The pain, as Joffe recalls, was never really questioned or examined. "Oh, that's just muscular pain," the doctor had told her.
Joffe was prescribed medication for depression, despite her insistence that she was not depressed. On antidepressants, her condition got worse. "Not only was I still bedridden and in a lot of pain," Joffe says, "but I was also very, very numb because they caused me to be very woozy."
Eight years later, in 2000, Joffe was finally diagnosed with fibromyalgia, a condition that is thought to increase the levels of certain chemicals that signal pain in the brain. Symptoms include fatigue, widespread pain, and an inability to focus.
While there is no known cure for fibromyalgia, antidepressants are frequently used to treat some of the symptoms that come with the condition. As a 2006 study revealed, depression is a common symptom of the condition, so antidepressants were, at that time, the most common treatment. However, for Joffe, they weren't the answer. She found that a more holistic approach helped her to deal with her symptoms without any of the side effects of an antidepressant drug.
Like fibromyalgia, this condition features symptoms like fatigue and brain fog, which are commonly associated with depression. It can also often come hand in hand with mental health problems.
Sinner saw a doctor in 2007 with these symptoms and was quickly given a depression diagnosis and a prescription of antidepressants. "There weren't any tests or lab work done," Sinner recalls. "The doctor didn't seem to think any other conditions could be causing my symptoms.
Over the next 10 years, Sinner's symptoms continued. She visited multiple doctors who refused to do lab work and maintained that she had depression. Eventually, she received her diagnosis. While Sinner is not against taking antidepressants in theory, she explains that she wishes her lab work had been done after her first appointment to rule out other conditions before her doctor jumped to a diagnosis of depression.
It seems that women are routinely prescribed antidepressants for symptoms that turn out to be linked to conditions other than depression. While antidepressants can sometimes help to alleviate symptoms for these various conditions, they rarely solve the issue.
Plus, the years of frustration in the face of multiple misdiagnoses can further impact a patient's mental health. It takes an average of five years for women to receive a correct diagnosis for autoimmune disease and ten years for female-specific diagnoses for conditions like endometriosis and fibroids.
The women we spoke to all found themselves feeling ignored or dismissed by their doctors. While all were adamant that their initial diagnosis of depression was incorrect, they were all asked to take antidepressants. So, why are our doctors so quick to jump to prescribing antidepressants for female patients with symptoms of physical pain?
Unfortunately, depression can look an awful lot like an autoimmune condition. While the commonly known symptoms of depression include fatigue, energy loss, and brain fog, it can also result in physical pain-studies have shown that depression can actually trigger inflammation in the body resulting in muscle aches.
On that note, it's easy to see why medical professionals might mistake the symptoms of an autoimmune disease with a mental health condition. But surely, doctors must realize that these symptoms might point to something else that requires further investigation? Is it a case of gender bias? Is our healthcare system really inclined to assume that women's symptoms must be linked to their hysterical emotions? It's impossible to say for sure. But one thing is certain-autoimmune conditions, which primarily affect women, and other female-specific conditions are grossly under-researched.
Sadly, many doctors are simply unequipped with the necessary knowledge when it comes to these "female" conditions. As Gabrielle Jackson, author of Pain and Prejudice, wrote in The Guardian, "While we [women] make up 70% of chronic pain patients, 80% of pain medication has been tested only on men. Even in preclinical trials with cell lines and rodents, males have been favored over females."
As she goes on to say, the prolonged suffering of women is down to the fact that "medical science has no answers for them."
For women, this can all seem incredibly bleak. In a healthcare system with such a strong gender bias, many of us may find ourselves coming to an appointment with debilitating pain and leaving with few answers and a largely useless antidepressant prescription-the best we can do is to trust our instincts about our bodies and continue to demand more from an imperfect system.