Antidepressants: OK for RA?
What you should know if your doctor recommends antidepressants in addition to your prescribed RA treatments.
If your doctor diagnoses you with either depression or anxiety, you may be prescribed one of the many drugs on the market designed to block or regulate brain chemicals that may be at the root of these mood disorders. Commonly prescribed antidepressants include:
- Selective serotonin reuptake inhibitors (SSRIs): Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), escitalopram (Lexapro)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs): Duloxetine (Cymbalta), venlafaxine (Effexor), milnacipran (Ixel), desvenlafaxine (Pristiq)
- Tricyclic antidepressants: Amitriptyline (Elavil, Endep)
- Norepinephrine-dopamine reuptake inhibitors: Bupropion (Wellbutrin, Zyban)
Antidepressants are used to treat not only depression, but anxiety, chronic pain and sleep issues. In fact, doctors may prescribe antidepressants for treating chronic pain caused by RA, or even sleep problems, rather than for depression or anxiety. The drugs’ use for these symptoms in people with RA remains controversial, as they may not be that effective in reducing RA pain. Some studies suggest that antidepressants may even treat inflammation itself, but this has not yet been determined.
Your rheumatologist may prescribe an antidepressant for you, or he may refer you to a mental-health professional like a psychiatrist who will prescribe these drugs. For people with RA who are diagnosed with depression, adding an antidepressant may help regulate their mood, make them feel better emotionally, and even help them sleep better. What should you know about adding an antidepressant to the drugs you’re already taking for RA?
SSRI antidepressants, when taken along with a nonsteroidal anti-inflammatory drug like ibuprofen or naproxen, can increase internal bleeding risk. In addition, these antidepressants, if taken over the long term, have been linked to bone loss. People with RA who have taken long-term corticosteroids like prednisone to control inflammation may also be at higher risk for bone loss, so bone density testing and monitoring may be important.
As with any new medication, it’s important to discuss the possible side effects or interactions with your rheumatologist. You’ll also want to track how effective the antidepressant is at reducing your depression or anxiety. To learn more about arthritis drugs and their possible interactions or side effects, check the Arthritis Today Drug Guide.
Antidepressant drugs aren’t the only tool you and your doctor can use to treat your depression or anxiety:
Seek counseling. A mental-health professional like a therapist, psychologist or psychiatrist can discuss how RA increases your stress or causes you frustration or grief, and recommend ways to manage feelings more effectively.
Talk it out. Join an arthritis self-management or support group to learn coping techniques and feel that you’re not alone in living with RA.
Get moving. Exercise is nature’s mood lifter. Regular physical activity, including exercises designed to improve range of motion (ROM), strength and cardiovascular fitness, has been shown to relieve depression symptoms by actually increasing levels of serotonin, dopamine, norepinephrine and other mood-related brain chemicals. Arthritis exercise classes or videos can help improve physical function and help you do your daily tasks more easily, so you may feel less frustrated by your RA.