More Than Pain 
Having a chronic illness such as arthritis can contribute to depression. In addition to causing chronic pain, arthritis may make a person despondent. The added stress a chronic illness places on your body can trigger a depressive episode. A simple task, such as combing your hair, becomes a burden. The memory of what you once were able to do that you now cannot manage douses your spirit. And each night, you face the dread of waking up and wondering how you will manage to get through the day - will it be a good or bad one? All of this is enough to make a usually upbeat person depressed.

Arthritis pain itself is unpleasant. But it also piles on additional stressors, limiting work and fun (like sports), affecting relationships and even self-esteem. "Someone with RA or fibromyalgia may not be able to continue as a breadwinner or fulfill her responsibilities in the house because she's in pain," says Dr. Rutstein. "Those limitations are very frustrating." 

Victoria Schomer, 53, owner of Interior Concerns in San Rafael, Calif., was diagnosed with fibromyalgia two years ago and knows such limitations all too well. "By nature, I'm a positive person," she says. "But when I have long bouts of pain, it's hard to stay positive. I get reclusive and hide." Although she's able to keep working when she's depressed, she sees her life during such bouts as a narrow cycle of "working and hurting."

But depression is not correlated only with pain severity. A study of 69 fibromyalgia patients at the University of Utah Pain Center, Salt Lake City, found that depression was linked to living alone, feeling limited in the ability to perform daily activities and surprisingly to an absence of physical therapy. Negative thinking styles cropped up as well.

But having a positive outlook is not always a surefire way to avoid depression. "Pain itself challenges a person's strength and weakness," says Robert Kerns, PhD, professor of psychiatry, neurology, anesthesiology and psychology at Yale University in New Haven, Conn. "To the extent that the pain is constant, it might challenge someone's ability to distract herself from the pain or to interpret her experience in an adaptive way."

In most, pain precedes the depression. But depression may contribute to the development of pain and disability as well, says Kerns. Researchers at the University of Connecticut School of Medicine, Farmington, examined 203 participants with RA to find if depression that existed before arthritis led to more pain. The study found that those who had experienced depression prior to their arthritis and currently had low mood levels reported more pain and fatigue than those never diagnosed with depression or who had better spirits.

It's the age-old question: Which came first, the chicken or the egg? No matter which comes first, depression is no laughing matter. But it can be overcome.

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