Rheumatoid Arthritis and Depression

RA is a chronic condition affecting all aspects of your life, often leading to depression.

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As many as 40% of people with RA experience significant symptoms of depression, which can lead to more physical function problems, higher disease activity, poorer health overall and an increased need for medical care.

Depression Can Make Your RA Worse

“People with mental health conditions definitely tend to have more functional limitations,” says Louise Murphy, PhD, director of the arthritis program at the Centers for Disease Control and Prevention (CDC) in Atlanta. Gary Kennedy, MD, director of geriatric psychiatry at Montefiore Medical Center in New York City agrees, “Not only does depression increase the odds of developing other health problems, such as heart attack, it may also worsen arthritis-related pain.”

It could also mean you are less likely to seek help for your condition. According to the National Alliance on Mental Illness, someone who has depression and a chronic illness may be less likely to adhere to treatment, and more likely to smoke, drink alcohol, eat poorly and neglect physical activity. All of these behaviors can lead to poorer outcomes.

Could the Link Between RA and Mental Health Be Inflammation?

We know that pain and disability are linked to depression in RA, but a developing theory is that inflammation also plays a role. “There is a body of literature recognizing depression as an inflammatory state. There is a well-documented event called cytokine-induced depression, where cytokines are increased and depression occurs,” explains Patricia Katz, PhD, professor of medicine at University of California San Francisco who studies the relationship between functional and psychological status among adults with chronic health conditions. Cytokines are communication molecules involved in the immune response. Specific proinflammatory cytokines, such as interleukin-1, interleukin-6, and tumor necrosis factor-α, are involved in the pain and inflammation process.

Dr. Katz and and her colleague Mary Margaretten co-authored a 2011 report in the International Journal of Clinical Rheumatology that reviewed what is currently known about the link between RA and depression and what role inflammation might play. Dr. Katz says continuing to focus on which inflammatory chemicals play a role in depression could make a difference in treatment. “If increased inflammation is leading to depression and you find out that the primary driver of that inflammation is TNF, then that might suggest treatment with a TNF inhibitor would make a difference,” she explains. But she adds, “There is more work needed.”

Don’t Hide From the Problem

Mental health issues in people with RA are under-reported and underdiagnosed. This is not surprising to Michael Clark, MD, director of the chronic pain treatment program at Johns Hopkins University in Baltimore. “We’ve known for a long time that psychological disorders of all types are increased in patients with chronic pain,” he says. However, a stigma persists about psychological issues that may keep patients from talking about it with their doctors at all. If you think you may be depressed, talk to your doctor and work together to develop an assessment and treatment plan.

Because mental health and disability are strongly linked, not diagnosing or treating one can impact the other greatly. For example, having depression may mean you don’t have the energy to exercise, and similarly, having a lot of pain and inflammation may cause you to be depressed. Eventually, this influences sleep, activity, social interactions, adherence to treatment, and self-care. Dr. Murphy recommends, “Treating mental health conditions should be regarded as a fundamental part of managing arthritis symptoms.”

Treating the Person

There are many treatment options available to you, from medications to psychotherapy to deep relaxation and acupuncture. Having a collaborative health care team is vital to success. Your rheumatologist and mental health specialist need to be on the same page to coordinate treatment and reduce potential drug interactions.

Medications used to treat anxiety and depression include selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs). Dr. Murphy recommends self-management classes for anxiety and depression, pointing out that a CDC study found that these classes were “associated with a considerable and sustained decrease in mental distress.” Cognitive behavioral therapy, a type of psychotherapy that focuses on changing negative thought patterns and behaviors, might be prescribed for you. Alternative therapies such as acupuncture, massage and yoga are also effective in alleviating symptoms of depression and arthritis.

Physical activity is another good option. Almost any kind of activity can help reduce pain and depression – and it’s essential for managing other arthritis symptoms, too. You can use Your Exercise Solution to help you choose and modify activities that are right for you.

Enjoying life is an achievable goal. Dr. Kennedy recommends, “That’s why you must give as much attention to your mental well-being as you do to your physical health.”

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