What is The Link Between Depression and Arthritis?

Diseases and depression have always been linked with each other. This is especially true in the case of chronic health conditions.

People who suffer from arthritis, may it be osteoarthritis or rheumatoid arthritis or any other type, are likely to become depressed at some point in their lives.

There are a number of reasons so as to why this happens. The feeling of helplessness, chronic pain and disability can be some of them.
Being depressed for long periods of time may intervene in the treatment of arthritis.

The depression, in this case, may range from mild to severe. Even slight signs of depression need immediate medical attention.

What Is Arthritis?

A collection of diseases involving the inflammation, tissue damage or infection of various joints of the body is known as arthritis. This disorder is generally observed among people belonging to the older age groups. Women are more likely to develop arthritis than men.

What are the types of arthritis?

Arthritis can be of various types based on the factor which caused the disease and the joint affected.

The most common types of arthritis are:

Osteoarthritis – The bones making up the joint degenerate and cause inflammation and pain.

Rheumatoid arthritis – The immune system attacks the tissues present between the joint and degrade them, causing inflammation and pain.
Some other types include psoriatic arthritis, gouty arthritis, and fibromyalgia.

What are the symptoms of arthritis?

The symptoms of arthritis mainly include pain, tenderness, stiffness, redness, and swelling in the affected joint.

A permanent cure for arthritis has not been discovered yet, but the symptoms can be controlled and prevented through medication, therapy and in extreme cases, surgery.

What Is Depression?

Depression, also known as major depressive disorder, is a serious mental illness. It is very common among people nowadays.

Depression can have a major impact on the daily activities of a person. It affects the mood in a negative way and the person remains sad all the time and does not feel like doing anything.

Along with the mental health, it interferes with the physical aspects of health as well.

What are the symptoms of depression?

It is identified with the help of the following symptoms:

  • Feeling low and sad
  • Hopelessness
  • Fatigue or weakness
  • Difficulty in sleeping, insomnia or sleeping too much
  • Suicidal thoughts
  • Not being able to concentrate
  • Difficulty in making decisions
  • Restlessness
  • Feeling worthless
  • Not being able to remember details
  • Significant change in weight

However, not everybody suffering from depression may experience all the symptoms together.

What can cause depression?

Depression can occur due to many factors such as –

  • Genetics
  • Trauma
  • Accident
  • Social rejection
  • Physical abuse
  • Stress

It can happen to any person and at any age.

What is The Link Between Depression and Arthritis

How And Why Does Arthritis Lead To Depression?

Depression is connected to several health conditions such as heart diseases, cancer, diabetes, and arthritis.

Since arthritis is a chronic disease, there are high chances of the disease leading to anxiety and depression.

Studies reported that the symptoms of depression were clearly visible through some tests. They also show that people suffering from rheumatoid arthritis may be more depressed than those suffering from osteoarthritis.

Rheumatoid arthritis patients are more prone to depression as well as anxiety than those without the disease.

Both arthritis and depression are dependent on each other. Arthritis can cause depression and chronic depression may further lead to worsening of the symptoms of the disease.

Arthritis patients may feel depressed due to one or more of the following reasons:

Chronic pain

A study found that rheumatoid arthritis leads to depression due to many factors, one of them being the chronic pain.

Another study done on older adults reported that pain along with other chronic symptoms of arthritis induces symptoms of depression among them.

There is a need for reducing the passive pain coping strategies in order to refrain from depression. Passive coping involves the feeling of helplessness in order to deal with the pain.

Disease activity

Depression is directly linked with the disease activity. When the disease activity increases, the level of depression becomes high as well. There is a need to control and manage the comorbid depression in this case.

A study reported that people with rheumatoid arthritis were more prone to depression if the disease activity was more. This included the increase in the tenderness of their joints.

Another study found that more than half of the people with arthritis were suffering from depression. The severity of depression was directly proportional to their disease activity.

Disability

Because of the pain and disability of rheumatoid arthritis, people may go through psychological suffering or anxiety. This may be accompanied by depression.

A person who feels depressed may not respond to the treatment being given to him. This causes the disease to persist for a longer duration than normal.

Inflammation

C – Reactive protein is a marker of inflammation detected during a blood test. The level of this protein in the blood regulates the inflammation or swelling in the body. Due to an increase in the production of this protein in the body because of the disease and inflammation, people experience depression as a result of the chronic pain.

Treatment with a drug known as quetiapine has been found to have anti-inflammatory effects. This helps in eliminating the pain and depression.

Medication

The drugs being used for the treatment of arthritis have a major impact on depression.

Studies report that taking in disease modifying anti-rheumatic drugs (DMARDs) play an important role in inducing depression among people. Apart from depression, these drugs also increase the risk of anxiety and suicidal ideation.

Fatigue

Apart from the pain, other factors which cause depression may be disability and fatigue. Disability means not being able to work or move the affected part of the body. This leads to frustration and then depression. Fatigue is the weakening of the body which again hampers the daily routine.

This is a very frequent symptom of arthritis. This affects the physical and mental health of patients suffering from arthritis, mainly rheumatoid arthritis.

The disease activity also affects the level of tiredness a person may feel, along with other symptoms of arthritis.

A cause of this fatigue may be due to the loss of sleep. People with arthritis find it difficult to sleep properly due to the inflammation and pain. This disturbs the sleep routine and people may feel tired which may further depress them.

Isolation

Social interaction is a very important part of life. Those who suffer from arthritis may find it difficult to engage in social activities because of their disability. This is another reason for the development of their depressive symptoms.

Stress

When a person suffers from a chronic disease such as arthritis, he or she is bound to be stressed. Stress leads to them believing that they are helpless and would not be able to cope with the pain. It is important to reduce the stress so that they may not feel depressed.

According to studies, people may even need to undergo stress management training.

Hereditary

The genetic makeup of a person’s body is also responsible for causing depression along with the depressed or sad mood. This means that depression can be hereditary involving biomarkers such as cytokines, neurotransmitters or genetic mutation.

A better understanding of the genetic history of a person helps to determine more information on the physical and psychological conditions. This would make the treatment easier and more effective.

Age

Another study found out the relationship between depression and age. According to the findings, young people with rheumatoid arthritis were more likely to suffer from depression than their older counterparts.

The reason for this may be that older people adjust to the disease activity better than the younger ones.

How Does Depression Affect The Person?

Just like arthritis may lead to depression, depression can lead to an increase in the disease activity as well. To add to this, it negatively affects the person in various other ways.

Risk of other diseases

When someone suffers from multiple disorders simultaneously, the chances of depression may be even higher. This can be seen in the case of people with rheumatoid arthritis and cardiovascular diseases.

Depression can cause several other previously nonexisting disorders in healthy people. A study reported that depression in those with rheumatoid arthritis may increase the risk of myocardial infarction (heart attack) by a significant percentage.

After the onset of depression, the health of a person is bound to deteriorate.

Response to Treatment

People with depression find it difficult to respond to the treatment given to them. This was observed by a study conducted on rheumatoid arthritis patients.

The anti-tumor necrosis factor-alpha therapy had less effect on them. Proper management of depression may help to improve the treatment efficacy.

Habit of Smoking

A habit of smoking may develop in people who are depressed due to the chronic pain in joints. According to a study, smoking and depression are comorbid in such cases.

Smoking tobacco and opioids interfere with the drugs taken for the treatment of arthritis and may worsen the symptoms.

Alcohol consumption

It is a common observation that people who feel low or are depressed may engage themselves in drinking. Alcohol has negative effects on arthritis. The results of some studies indicate that higher alcohol consumption leads to an increase in the severity of the symptoms.

Drinking also interferes with the treatment of arthritis. Alcohol should be consumed in a low or moderate amount.

Sleep Disorders

The severe pain causes depression among patients with arthritis. People may find it difficult to sleep because of this. Not getting sufficient sleep every day affects the health and functioning of the body.

Physical activity may decrease

Not being able to move the affected body part tends to make people avoid physical activities. They may not involve themselves in any kind of social activity or even their daily routine can be affected due to the depression.

Doing any form of exercise is very healthy and it even helps to lower the disease activity and treat arthritis.

Quality of life may deteriorate

Various studies have found that the quality of life deteriorates in almost every type of arthritis. It could be osteoarthritis, rheumatoid arthritis or fibromyalgia syndrome. The primary reason for this is depression and anxiety.

Isolation

Depression leads to the feeling of isolation of loneliness. It makes the person abstain from social activities and gatherings. This affects both emotional and physical health of the person.

Isolation is also associated with an increased rate of mortality among both men and women.

Weak Immune system

Depression causes both immune suppression and immune activation. Suppression of the immune system poses as a risk factor for several other medical conditions.

Immune activation leads to the production of cells such as interleukins and tumor necrosis factor which are responsible for inflammation.

Stop taking Self-care

Feeling low about their health condition can lead people to stop taking care of themselves. Self-care is an important factor in improving the symptoms of arthritis.

It also reduces the depression by motivating them to be confident and self-sufficient.

Suicidal thoughts

Extreme cases of depression may even give rise to suicidal thoughts. A study on females with rheumatoid arthritis reported that they are prone to attempting suicide due to depression.

Suicidal ideation has found to be linked with excess alcohol consumption along with depression in arthritis patients.

Mortality

High levels of depression further increase the disease activity of rheumatoid arthritis. The effect may be so severe that it may even lead to mortality or death.

Those who are depressed because of the disease may feel that the severity of it is higher than what was diagnosed.

What Can Be Done To Treat Depression?

Along with the treatment of arthritis, the following measures should be taken to eliminate depression:

Medication

SSRI: Selective serotonin reuptake inhibitors are a type of drug commonly prescribed to treat depression. These should be taken only if prescribed so as to avoid any kind of reaction to the other medicines.

SNRI: Selective norepinephrine reuptake inhibitors are another type of anti-depressants having a similar action on depression as SSRIs.

Psychotherapy

Psychotherapy could help in addressing depression as well as pain.

A study showed that out of all the people with moderate or severe arthritis, only 19% people discussed about their depression with the doctor.

Clinic visits should involve discussion of psychological distress along with physical signs. This would help the patient to identify depression and treat it accordingly.

Acupuncture

Acupuncture is an alternate method of providing pain relief. It involves stimulation of the body parts by insertion of needles into the body. Studies suggest this method as a treatment option for chronic pain, depression, and anxiety.

Physical activity

Exercise should be a very important part of an arthritis patient’s daily routine. Providing continuous movement to the joints reduces swelling, which may decrease the level of pain. Also, it keeps the body weight in check. Increased body weight would cause more pain in the joints.

Physical activity also lifts up the mood and aids in decreasing the feeling of depression.

Out of the 29 studies reviewed, 15 studies reported that exercise was a significant part in the lives of arthritis patients with depression. Also, none of the studies showed negative effects of exercise on depression.

Massage

Therapeutic massage relaxes the body which lowers the level of anxiety and depression. Massaging the affected joints helps in reducing the pain and inflammation.

A study was conducted to see the effect of massage therapy on people with arthritis for three months. The results suggested that this therapy improved the levels of anxiety and depression in people.

However, this cannot be considered as a permanent cure as it does not treat the symptoms of the disorder.

Meditation

Studies have reported that a mindfulness based therapy such as meditation can have significant effects on the health of an arthritis patient. Not only does it decrease the frequency of occurrence of depression, but it has a major positive effect on the pain and tenderness in joints.

A study involving the patients of rheumatoid arthritis reported that most of them with severe or moderate arthritis felt a decrease in their depressive symptoms as a result of the meditation therapy.

To reduce the feeling of pain, the patients should make an effort to increase their self-esteem. According to the results of a study published in 2005, people who accepted their disease were able to adjust to it. They felt better and had an improved quality of life.

Reducing or preventing the disability in those with arthritis can help with the treatment of depression.

A study conducted at the San Francisco General Hospital in 2009 aimed at finding patients of arthritis showing depressive symptoms.

It was observed that 40% of the patients had major depression, while the average result was that of moderate depression.

Conclusion

Both these health conditions are dependent on each other. On one hand, the symptoms of arthritis may lead to depression; while on the other hand, depression may make the person unable to engage in any kind of physical activity.

There is a stigma attached to mental health disorders such as depression. This needs to be ignored and a medical professional such as a doctor, therapist or psychologist should be consulted.

Feeling sad about the disease is normal. Arthritis is a very common health condition which can happen to anybody. There is nothing to worry about as long as the person is undergoing treatment for it.