People with rheumatoid arthritis (RA) are about twice as likely to be depressed as people without this inflammatory autoimmune disease.
That's no shocker: It makes sense that living with chronic pain, and potential disability, can make you feel helpless and hopeless. However, the relationship may be more complex than that; the inflammation itself may play a role in causing or contributing to depression.
The good news is that treating the depression can improve your quality of life, and maybe even ease joint pain and inflammation associated with RA.
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Depression doubles mortality risk
Depression is more than just a bad mood; it can be dangerous.
One study from researchers at the Indiana University School of Medicine found that people with RA who had "persistent or recurrent" depression were at least twice as likely to die during the study period as their counterparts who were not depressed.
"Treating the underlying depression can be as important as treating your RA," says Martin J. Bergman, MD, the chief of the division of rheumatology at Taylor Hospital, in Ridley Park, Penn.
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Sighing can be a sign of depression
Are you depressed? Well, a small study suggests that frequent sighing can be one sign in people with RA.
In a 2011 study of 13 people with RA, University of Arizona researchers found that frequent sighing was linked to depression, but not connected to pain or the number of flare-up days. (The study subjects wore recording devices around the clock on two separate weekends.)
While the study is preliminary, sighing could be a marker for depression in RA patients, the authors conclude.
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Inflammation may play a role
High levels of tumor necrosis factor-alpha (TNF-a) in the blood have been associated with a greater risk of depression in RA patients, Dr. Bergman says. "So it is possible that the inflammation causing the RA also causes depression."
TNF blockers are widely used to treat RA, and it's possible they may also mitigate some symptoms of depression, says Dr. Bergman, who receives speaking and consultation fees from the makers of TNF blockers. "This can be a bonus."
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Both pain and depression need attention
Manu Mathews, MD, a pain expert at the Cleveland Clinic, in Ohio, says "if pain is not addressed, depression is more likely to be resistant to treatment, and vice versa is true."
Both problems need to be taken seriously.
"People who have severe depression don't exercise, sit around all day, and just feel lousy all the time, and this makes their pain and their perception of pain even worse," says Dr. Bergman.
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Tell your doctor
Hopefully your doctor will ask about feelings of depression, but if she doesn't, don't hesitate to bring it up. Too often, visits focus on physical symptoms at the expense of emotional ones.
Only one in five people with RA and depression discuss their depression with their doctors, according to research at the University of North Carolina at Chapel Hill.
"We can't treat it if we don't know about it, so we need to do a better job of asking about symptoms of depression," Dr. Bergman says. This works both ways: Tell your doctor if you have been feeling sad or hopeless, he says.
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Treating pain may relieve depression
The worse your pain, the greater your risk of depression, says Dr. Mathews.
"We are not sure if depression precedes pain or pain precedes depression, but the data are in favor of feeling depressed as a result of pain," Dr. Mathews says.
A 2011 study suggests that clinical remission was associated with a reduction in depression symptoms.
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Depression can affect ability to manage RA
Today's RA treatments are effective, but they don't work if you don't take them, Dr. Bergman says.
"We know that people who are depressed are less likely to adhere to their treatment regimen," he says. This can lead to a vicious cycle of worsening pain and depression.
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There's evidence that cognitive behavioral therapy, which focuses on coping skills, relaxation training, and the management of flare-ups, can relieve depression in people with rheumatoid arthritis.
In a 2001 study in the journal Pain, people newly diagnosed with RA who were randomly assigned to cognitive behavioral therapy sessions with a psychologist were less depressed and had less joint inflammation six months later than similar patients who did not receive therapy.
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Antidepressants can help
People who have RA can safely take antidepressants in addition to other medications, and studies suggest antidepressants improve depression, anxiety, and feelings of helplessness.
In addition to helping with depression, some antidepressants may have an analgesic effect , says Dr. Bergman.
"The first thing I would do for an RA patient would be to put them on RA treatment, but if they are also depressed I might put them on an antidepressant...and I wouldn't be totally surprised if they got pain relief from that," he says.
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Exercise may ease pain, boost mood
Many people with RA find it difficult to exercise because of the pain.
But aerobic exercise such as walking and swimmingor if those are impossible, gentle stretching such as tai chimay actually improve function and reduce pain, Dr. Mathews says.
Exercise can boost your body's natural feel-good chemicals or endorphins. It's worth finding a type of exercise you can do (and enjoy!) in an effort to improve your mood and RA symptoms.
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Prioritizing sleep can help
Recent studies have found that many people with RA suffer from poor and fragmented sleep, due to pain and other reasons.
You should make an extra effort to get quality sleep. "Better sleep improves pain and depression," Dr. Mathews says.
It's important to maintain healthy sleep hygiene: Go to bed at the same time each night, avoid caffeine and cigarettes three or four hours before bed, keep the TV out of your bedroom, and use the bedroom only for intimacy and sleeping, says Dr. Mathews.
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