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Patients with arthritis are more likely to develop depression. This article outlines the connection between the two diseases and how to treat it.

Arthritis is an inflammatory disease that characteristically affects the joints of the body, leading to joint inflammation, pain, and swelling. However, sometimes, arthritis goes beyond physical symptoms and can cause psychiatric issues, such as depression and anxiety. Unfortunately, while the physical symptoms of arthritis can be treated with a combination of medication, physical activity and, in some cases, surgery, the psychiatric manifestations of the disease are a little harder to treat.

Additionally, while arthritis can cause depression or anxiety, both of these conditions in turn can worsen your arthritis. It can be a vicious cycle that needs to be broken.

Unfortunately, there is no one subtype of arthritis that is spared from depression and anxiety. In fact, having any type of arthritis, such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, lupus, gout, and fibromyalgia can lead to the development of depression and anxiety.

What are depression and anxiety?

Depression is a disease in which patients feel:

  • Sadness
  • A lack of interest in daily activities
  • Weight loss or gain
  • Insomnia or excessive sleeping
  • Fatigue/Lack of energy
  • Inability to concentrate
  • Feelings of worthlessness or excessive guilt
  • Recurrent thoughts of death or suicide

Anxiety is characterized by:

  • Feelings of stress or tension
  • Worry
  • Irritability
  • Some physical changes, such as blood pressure.

How are depression and anxiety related to arthritis?

Studies show that patients with arthritis are two to 10 times more likely to develop depression and anxiety than the general population, though the rates differ depending on the subtype of arthritis.

Chronic or long-term pain, as is present in patients with arthritis, can aggravate your mental health issues, particularly depression and anxiety. Depression and anxiety, in turn, make your arthritis worse because it is a well-documented phenomenon that anxiety and depression lower your threshold for pain.

People who have both arthritis and depression have increased problems including:

  • More functional limitations (inability to carry out everyday activities)
  • Less likely to adhere to treatment regimen
  • Increased risk of developing other health issues

Therefore, patients can find themselves in a never-ending cycle of pain, poor health and bad mental health.

So why does this happen?

First of all, we need to understand the connection between arthritis and depression. Studies have shown that those arthritis patients who are in most pain are are most likely to have anxiety or depression. However, the reason why the higher pain severity is associated with depression is not yet known. Nevertheless, there are some theories as to why this occurs.

Experiencing pain consistently, day in and day out, can be extremely stressful, both mentally, emotionally and physically. Neuroscience studies have consistently found that chronic stress actually changes the levels of certain chemicals in the brain and nervous system such as cortisol, serotonin and norepinephrine.

These hormones and chemicals have a strong effect on your mood, behavior, and the way you think. As these hormones become imbalanced, patients develop depression and anxiety. Thus, patients with high pain levels, across all sorts of diseases, are at a higher risk for developing depression and anxiety.

With depression and anxiety, the pain worsens. This is because having depression reduces a person’s mental abilities to deal with pain. Essentially, people who have depression and anxiety feel their pain more intensely compared to people who are not depressed. Pain, often times, is very mental and in patients with depression, its effect is amplified. Additionally, symptoms associated with depression (such as stress, poor sleep, anxiety) all increase pain levels.

Other than the profound connection between pain and depression, another connection between arthritis and depression is the presence of inflammation. One study found that a marker of inflammation, known as C-reactive protein, is associated with depression. In fact, people with depression have CRP levels that were significantly higher compared to the rest of the population that did not demonstrate depressive symptoms. More and more studies are starting to recognize depression as a byproduct of chronic inflammation.

Finally, another connection between arthritis and depression is the change in lifestyle that accompanies patients that develop arthritis. As arthritis is painful in the joints and exhausting in general, you are less likely to get out and participate in activities that you previously enjoyed, such as going out for dinner with friends, going for a hike, and participating in sports. Thus, arthritis can lead to a sense of social isolation, which leads to the development of depression. Additionally, people with arthritis have trouble with physical activity, and one of the major tenets of having good mental health is to exercise and be physically active. Thus, a lack of physical activity can trigger depression.

Conclusion

While scientists are not entirely sure exactly what causes high rates of depression in patients with arthritis, they postulate that pain levels, inflammation, and lifestyle changes likely play an important role. It is vital to monitor yourself for signs of depression and anxiety as they can be treated with medication, just like any disease with physical symptoms. If you find yourself feeling depressed or anxious, seek help from a medical practitioner.

  • Frank, ROBERT G., et al. "Depression in rheumatoid arthritis." J Rheumatol 15.6 (1988): 920-5.
  • Dickens, Chris, et al. "Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis." Psychosomatic medicine 64.1 (2002): 52-60.
  • Brown, Gregory K., Perry M. Nicassio, and Kenneth A. Wallston. "Pain coping strategies and depression in rheumatoid arthritis." Journal of consulting and clinical psychology 57.5 (1989): 652.
  • Photo courtesy of SteadyHealth

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