WebMD Health - Rheumatoid Arthritis

Jan 31, 2011 10:03 PM

RA, Depression, and Menopause

If rheumatoid arthritis is making you depressed, Patricia Doyle's experience may sound familiar.

Doyle used to love to take long walks near her home in San Francisco and went dancing three nights a week. But four years ago, she was diagnosed with rheumatoid arthritis at the age of 58. As the pain got worse, she reluctantly gave up those activities. And when she was laid off from her job about two years later, depression hit her hard.

"I didn't want to get out of bed," Doyle says. "Nothing mattered to me. It was a horrible feeling." Thinking that she should be able to fix it on her own, she tried walking every day. That helped, but not enough. So recently she "gave in" to the idea that she needed professional help. "I finally told my doctor how depressed I really was, and he started me on an antidepressant," Doyle says.

Doyle's story may ring a bell with you. Depression can develop from living with chronic pain or from the feeling that RA has limited your independence, social activities, and mobility. It often leads to a downward spiral: Giving up an activity you enjoy because it becomes too painful makes you depressed, the depression makes you focus more on your pain, and then you become more depressed. You may start to lose sleep, feel more fatigue, and become isolated.

But experts say that treating depression can set you on an upward spiral. It can help reduce anxiety, stress, and even some of the physical pain of RA.

RA and Depression: The Psychology of Pain

"Depression and pain go hand in hand," says Elizabeth Lin, MD, a family practice doctor and scientific investigator for the Group Health Research Institute in Seattle. Not only can pain bring on depression, but depression can make pain worse, Lin says. "It has been found to lower the threshold of how we tolerate pain -- how easily pain registers in our brain."

No one should feel embarrassed or stigmatized by depression. "Pain is depressing; there's no doubt about it," says Alex Zautra, PhD, a professor of psychology at Arizona State University in Tempe who has conducted several studies on arthritis and well-being. "It's really a mind-body problem. What happens in the body affects the mind, but the mind affects how much energy people have to be resilient in the face of pain."

How Treating Depression Can Ease RA Pain

The upside of the link between pain and depression: Studies show that alleviating depression can also help relieve arthritis pain.

In a 12-month study of 1,001 people with arthritis, people who received psychotherapy or took antidepressants had fewer symptoms of depression and reported less pain, and were able to take part in daily activities more than those who did not.

Another study in 2007 found that counseling and coping skills, such as relaxation techniques and pacing activities, not only lowered anxiety and depression but also reduced joint swelling and increased physical abilities. Two-thirds of the people in the study were women.

When to Seek Help

So how do you know when it's time to talk to your doctor about depression? You should talk to your doctor if:

  • Pain or fatigue is limiting your daily activities, such as cooking, dressing, or going out with friends
  • You can't sleep at night
  • You feel worthless or hopeless about life
  • You're starting to isolate yourself from people
  • You have trouble concentrating

Zautra also suggests thinking about your life beyond RA. How are your relationships with your spouse, friends, and coworkers? Do you wake in the morning thinking you can't get out of bed because of pain or because of the way you feel about yourself?

Once you can get a handle on what's contributing to your depression, you can figure out what to do. "Think about what has helped you be resilient in the past and how you can apply that to this situation, and perhaps try new things as well," he says.

8 Ways to Deal with Depression

It's important to deal with depression and RA together, experts say. Along with getting effective medical treatment for your RA, these activities -- alone or together -- may help:

Counseling. Psychological therapy or counseling can help you find new methods for coping with pain and stress. Too often, Zautra says, people with RA let pain run their lives. "Chronic pain can narrow your focus, so you're always thinking about the pain, when it's there and even when it's not," he says. "But you can learn to focus your attention on other aspects of life that are or can be sources of pleasure, value, and purpose. It doesn't mean the pain goes away, but it becomes less primary in your life." Ask your doctor for a referral to a psychologist who specializes in pain coping skills.

Support. Having a good support network is important for people with RA. Even if you have a spouse or friends to lean on, support groups can provide tips to make the day go easier and offer camaraderie with other people dealing with the same issues. Check with your local Arthritis Foundation chapter for a group near you.

Meditation. In a 2007 study, researchers at the University of Maryland looked at how a type of meditation called Mindfulness-Based Stress Reduction (MBSR) affected 63 people with RA during a six-month period. They found that it reduced psychological distress by about one-third. Other studies also have shown the benefits of meditation for conditions marked by chronic pain. And meditation seems to help people with RA deal with stress, an advantage because stress may cause RA to flare.

Activity. Exercise may be one of the last things you feel like doing, but it's one of the most important. "Get some type of physical activity each day, even if it's just getting outside to get the mail," says Lin. Substitute new activities for ones you may not be able to do with RA -- like swimming instead of running. Exercise not only helps keep your joints flexible and your heart healthy; it releases endorphins -- the brain's "feel good" chemicals -- that may ease depression.

Antidepressants. Relieving anxiety, fatigue, depression, or insomnia with mood-stabilizing medications also eases pain. Some antidepressants also have direct pain-killing properties. Your doctor can help you figure out the best type of antidepressant for you.

Sleep. If pain disturbs your sleep, try taking a painkiller right before you go to bed. Some antidepressants also may help reduce sleep problems.

Pleasure. Do something that makes you feel good. Lin advocates scheduling a pleasant or social activity -- reading, music, a long shower, a visit with a friend -- into each day's activities. It helps keep you from falling into a cycle of pain, isolation, and less activity.

Manage. Depression can make everything seem overwhelming, so break things down into doable chunks. If your house is a mess, start with one small area to clean. Take a short walk instead of pushing yourself to go far. If you feel you can't deal with both depression and RA, take it one step at a time.

"Once you start that positive, invigorating cycle upward, it's synergistic," says Lin. "You may need to push yourself a little, but you'll feel so much better after."

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