Shingles, stress and depression – how are they linked?

Shingles is a viral infection that causes large red rashes commonly on the face or torso. Some people only experience a mild itch, others suffer from severe pain. But what causes shingles? Research has found that there may be a link between shingles and mental health problems such as chronic stress and depression. You may be wondering what an infectious virus has to do with mental health. There’s no straightforward answer. In this article, we are going to look at how shingles is affected by stress and depression.

What is shingles?

Shingles is a viral infection that causes a painful skin rash. Symptoms can vary from mild itching to intense pain. In some cases, there can be long-lasting complications. Shingles is caused by the varicella-zoster virus. This is the same virus that causes chickenpox, and it belongs to the family of viruses that cause cold sores and genital herpes.

Anyone who has had chicken pox could potentially develop shingles later in life. After you have recovered from chicken pox, the virus can enter your nervous system where it may lie dormant for years. Shingles is caused when the virus reactivates. It travels along nerve pathways to the skin, where it causes painful symptoms in the skin and nervous system.

The US Center for Disease Control and Prevention found that almost 1 in 3 people in the USA will develop shingles at some point in their lives. (1)

People with symptoms can pass the virus on to others who are not immune, either because they haven’t had chicken pox or the chicken pox vaccine. However, the infected person will develop chicken pox, not shingles.

Shingles has been linked to mental health problems such as chronic stress and depression – which we will discuss below.

What are the symptoms of shingles?

Firstly, shingles can cause tingling, numbness and a burning, intense pain in an area of skin. This may be accompanied by a headache and a general feeling of being unwell.

A few days later, a red, blotchy rash will appear across one side of the body, often on the torso, or sometimes on one side of the neck or face.

If the shingles rash appears around the eye, it’s vital to see a doctor as soon as possible. If left untreated, shingles close to the eye can cause an infection which can lead to permanent damage to vision.

Over the course of a few days, the rash turns into itchy blisters that leak fluid. The blisters later dry out and scab over. Some people also experience fever, headache, sensitivity and fatigue.

If you suspect you may have shingles, keep the rash clean and dry. Take paracetamol and use a cold compress to ease the pain. See your doctor as soon as possible.

It can take around 4 weeks for the rash to heal. However, some people continue to suffer from persistent pain that lasts months or years. This is called postherpetic neuralgia.

What is postherpetic neuralgia?

Around 1 to 4% of shingles sufferers require hospitalisation, and 10 to 18% of shingles patients will go on to develop a serious complication called postherpetic neuralgia (PHN). (2) 

Postherpetic neuralgia affects nerve fibers and skin, and causes a burning or stabbing pain that persists even after the rash and blisters associated with shingles have healed. Shingles can lead to nerve damage which causes nerves to send inaccurate signals, such as pain signals, to the brain. The result is chronic neuropathic pain. (3)

PHN can be treated using medications such as painkillers, anticonvulsants which calm nerve impulses and stabilise electrical activity in the nervous system, or steroids which may be injected around the spinal cord.

Alternatively, doctors may prescribe antidepressants, which affect serotonin levels and can influence the perception of pain.

Can stress cause shingles?

Your state of mind can have a major impact on your physical health. Stress and depression can put you at a higher risk of developing physical illnesses, prolong recovery time, and worsen existing problems. But is there a connection between stress and shingles?

Stress alone does not cause shingles. However, it does have an important role to play in the reactivation of the virus. In fact, studies show that a recent trauma or significant life distress can increase the chance of developing shingles. (4)

Chronic or extreme stress weakens the immune system. A weakened immune system provides an opportunity for the shingles virus to reawaken.

A sudden shock like the death of a loved one or traumatic event can trigger extreme stress, which in turn weakens the immune system. This may be compounded for people who are already at high risk because of other factors.

Other risk factors that can trigger an outbreak of shingles include:

• Being over 50. The risk of developing shingles increases with age.
• Having a diseases that affects the immune system, such as HIV, AIDs or cancer
• Undergoing cancer treatments such as radiation or chemotherapy

Taking certain medications, such as those used to prevent the rejection of transplanted organs and steroids like Prednisone

Shingles and depression

Depression is a serious and mental disorder that has various causes and symptoms. Depression can be inherited, but it can also be caused by environmental factors such as high levels of stress.

The DSM-5 lists the following as symptoms of depression:

• Feelings of sadness or emptiness
• Loss of interest in fun activities
• Sleeping too much or too little
• Weight loss, weight gain or change in appetite
• Tiredness
• Feelings of worthlessness or guilt
• Difficulty concentrating
• Suicidal thoughts

We know that depression can also provoke physical symptoms such as increased inflammation, insomnia, gastrointestinal problems and chronic pain. (5)

But is there a link between shingles and depression?

A 2013 study concluded that untreated depression can decrease the effectiveness of the shingles vaccine. (6) 

Depressed patients, who had not been treated with antidepressants, were found to have less immunity to the varicella-zoster virus. They did not respond as successfully to the shingles vaccine, which decreases the likelihood and severity of shingles outbreaks.

Another study found that 60.8% of patients with chronic pain such as postherpetic neuralgia may also have depression. (7) Patients who met the criteria for depression were also more likely to be out of work, and reported higher levels of pain and disruption to daily life.

Chronic pain and depression can leave patients trapped in a vicious cycle. Constant pain can cause people to feel depressed and hopeless, which in turn can further weaken the immune system, increasing their awareness and thereby intensifying the pain. This, in turn, can lead patients to slip deeper into depression.

Treating postherpetic neuralgia and depression

A 2016 study by the CDC found that around 20.4% of U.S. adults suffered from chronic pain, like that caused by PHN. (8)

People with chronic shingles pain, depression, stress and/or anxiety may benefit from receiving holistic treatment to address both psychological and physical symptoms.

It is vital to break the cycle of pain, depression and hopelessness. Seeking early treatment is also essential to minimizing the impact that PHN can have on a patient’s life.

Specialists in treating chronic pain often use medication and therapy alongside meditation and relaxation to help people overcome chronic pain.

Some treatment options include:

Medication

Doctors may prescribe steroids, nerve blockers and opioids to help manage this kind of pain. Antidepressants and anticonvulsants may be used to relieve constant pain.

Therapy

Some patients may benefit from therapy with a psychologist, psychiatrist or counselor. Cognitive behavioural therapy can help people deal with the pain, reduce pain triggers, and learn how to be more optimistic and hopeful.

Physical Activity

Exercise helps your body to produce endorphins, chemicals in the brain that boost your mood and can also help to block pain signals.

Conclusion

Taking care of your cognitive health can have many benefits to your overall quality of life.

Minimizing stress and treating depression is worthwhile in its own right, and it can also help reduce your risk of suffering from an outbreak of shingles.

If you have ever had chicken pox, you have a chance of one day developing shingles. If you have an additional risk factor such as a weakened immune system your chances may be increased.

Good mental wellbeing can also help you recover faster from illnesses like shingles and reduce your risk of developing painful complications such as postherpetic neuralgia.

If you are suffering from post-herpetic neuralgia you may find that your symptoms are easier to manage if you also treat underlying mental health complications.

Try these tips to improve your mental health:

• Confide in friends, family or professionals if you are suffering from any of the symptoms of depression or stress
• Make sure you’re getting enough sleep
• Maintain a healthy diet
• Avoid stressful situations whenever possible
• Take regular exercise
• Avoid overuse of substances such as caffeine, alcohol or illegal drugs
• Try mindfulness practices such as meditation or yoga

References

(1) https://www.cdc.gov/shingles/index.html

(2) https://www.cdc.gov/shingles/surveillance.html

(3) https://www.medicalnewstoday.com/articles/160253

(4) Sansone, R. A., & Sansone, L. A. (2014). Herpes zoster and postherpetic neuralgia: an examination of psychological antecedents. Innovations in clinical neuroscience, 11(5-6), 31–34. Retrieved on 23 March 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140624/

(5) https://www.medicalnewstoday.com/articles/322395#symptoms

(6) https://www.sciencedaily.com/releases/2013/02/130214075627.htm

(7) Rayner, L., Hotopf, M., Petkova, H., Matcham, F., Simpson, A., & McCracken, L. M. (2016). Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs. Pain, 157(7), 1472–1479. DOI: https://doi.org/10.1097/j.pain.0000000000000542

(8) Dahlhamer, J., Lucas, J., Zelaya, C. et al. (2018). Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults – United States, 2016. MMWR Morb Mortal Wkly Rep 67(36), 1001–1006. DOI: https://dx.doi.org/10.15585/mmwr.mm6736a2