Can Antidepressants Help People With Rheumatoid Arthritis? 

Depression is very common in people with rheumatoid arthritis (RA). Up to 41 percent of people with RA will experience at least some symptoms of depression, compared to about 7 percent of Americans overall. Managing arthritis symptoms and the stress of living with a chronic, painful disease makes people with RA more likely to feel down. Depression can lead to more severe arthritis pain, which can negatively affect quality of life. Antidepressants can help to combat this cycle by relieving both depression and pain. Also, researchers are exploring whether some antidepressants might even work on the overactive immune system to reduce inflammation. 

Antidepressants for depression 
Selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) are the most commonly prescribed antidepressants. They work by altering levels of brain chemicals like serotonin and dopamine, and by changing the way nerve cells communicate. These drugs are very effective against depression, and they can also help with anxiety.  But it’s important to discuss your symptoms with your rheumatologist so you can get a referral for depression screening. A psychiatrist or other mental health professional can help determine whether your mood warrants antidepressants or another treatment. 

“Some patients aren’t depressed. They get demoralized because they’re suffering from rheumatoid arthritis,” explains Glenn Treisman, MD, PhD, Eugene Meyer professor of psychiatry and medicine at Johns Hopkins. “That doesn’t respond to antidepressants. It responds to support and time.”  

Antidepressants for pain and sleep problems 
Although antidepressants weren’t designed to relieve pain, some of them have this effect. Tricyclic antidepressants like amitriptyline and nortriptyline (Pamelor), and selective serotonin reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor XR) treat both depression and chronic pain. They work as neuromodulators, turning down the pain signal by modifying the number of chemical messengers like serotonin and norepinephrine transmitted between nerves. More than half of people with RA say they don’t sleep well—a rate more than double that of the general population. Not getting the appropriate amount of sleep can worsen pain and depression, which can make it even harder to fall asleep. Tricyclic antidepressants like amitriptyline, as well as trazodone (Desyrel) are used to improve sleep.  

Starting on an antidepressant 
Some rheumatologists prescribe antidepressants, while others refer their patients to mental health or pain management specialists. The side effects depend on which drug you take, but typically antidepressants can cause: 

• Drowsiness 
• Nausea 
• Dry mouth 
• Insomnia 
• Dizziness 
• Headache 
• Diarrhea or constipation 
• Sexual problems such as reduced desire or difficulty reaching orgasm 
• Nervousness or agitation 

Tricyclic antidepressants tend to cause more side effects than SSRIs or SNRIs. Before you take any new medication, it’s important to discuss the possible side effects or interactions with your doctor. Keep in mind that you don’t only need to rely  on medications to tackle depression. There are several self-care options that can help your mental health.