@merpreb For me the depression first manifested in high school. Mine is caused by a brain chemical imbalance that will require me to be on my medication for the rest of my life. The RA started right after high school. Depression creates it's own pain: physical, mental and emotional. I can see chronic pain that presents initially without depression can lead to serious depression when the pain doesn't respond to treatment. What makes it worse (no matter which came first) is the lack of understanding and support from medical personnel, family and friends. Then when strangers start attacking you or telling you what you should do, like you're just too stupid or lazy to fix yourself you just want to scream or go to sleep. Or scream then go to sleep. I'm sorry if I sound harsh today. This morning I had my second go round for the week with my eye surgeon. It's easy to get tired of trying to find a doctor, etc., who will finally be the right one. Sometimes you have to take a break but knowing that it's only a break. You have to keep going because it could be the next doctor or the next or the next that truly listens and can help. They are also continually making advancements in depression and pain. It wasn't until the 2000's that they started using biologics for rheumatoid arthritis. All we can do until we find the right doctor and the right treatment is to take care of ourselves the best we can, ask for help when we need it and hold on to knowing that at some point in the future there will be significant advances in treating pain and depression. Oh, and keep supporting each other.