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.
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:
- 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
- Some physical changes, such as blood pressure.
How are depression and anxiety related to 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.
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.