Rheumatoid arthritis is a chronic autoimmune disease. The immune system becomes confused and can no longer identify what belongs in the body and what doesn't. In rheumatoid arthritis, the immune system begins attacking the joints. This process causes pain, swelling and stiffness of the joints, as well as inflammation. Fatigue is another common symptom that interferes with functioning. The symptoms of rheumatoid arthritis worsen over time. Daily activities become increasingly difficult as the joints lose flexibility. As their lives become more and more restricted, many people withdraw and become depressed. Roughly twenty to twenty-five percent of rheumatoid arthritis patients struggle with clinical depression, rates far above the nine-point-five percent in the general population.
Clinical depression, also known as unipolar major depression, is a serious psychiatric disorder. People who suffer with depression feel sad, hopeless, guilty, and isolated. They cannot take pleasure in activities that they used to enjoy. Most also have troubled sleeping and eating patterns, doing either too much or too little of each. Many also have pain symptoms. It seems that depression is a fundamental deregulation of the brain's normal activities.
Why are Depression Rates Higher among Rheumatoid Arthritis Patients?
Many people with rheumatoid arthritis feel hemmed in by their condition. Activities that before were automatic now require advance planning. Basic actions such as tooth-brushing must be carefully considered and executed so as not to cause any additional strain on the joints. A lot of things take longer to do than they used to, and are much more taxing. Some things are no longer possible to do at all. Furthermore, many struggle with the ignorance of family, friends, and co-workers, who do not know the full extent of the disease and may trivialize its impact. Low energy and pain make it difficult to engage in social activities. Dealing with rheumatoid arthritis can be very isolating. Social isolation is one of the main risk factors for depression. In addition to the new boundaries on their abilities, rheumatoid arthritis patients must also deal with a lot of pain for a long time. The link between chronic pain and depression is well established. Pain puts an inevitable damper on mood and interferes with everyday activities. Pain taxes the system, and things that before could be easily dealt with now become huge obstacles. Small wonder, then, that so many people struggling with this condition become depressed.
The Vicious Cycle of Pain and Depression
While pain can lead to depression, depression can also lead to pain. Depression increases the body's sensitivity to pain. The higher the pain, the greater the associated disability. The greater the disability, the more passive the person is likely to become, accepting the course of the disease as inevitable, instead of seeking ways to deal with the condition. Depression makes a person more likely to focus on the negative. People who suffer from depression in addition to their rheumatoid arthritis are more likely to suffer complications due to lack of self-care. They also withdraw from human contact, thus depriving themselves of the help and comfort that friends and family can supply. Depression interacts with the rheumatoid arthritis to make the disease more painful, more disabling, and more socially limiting than it already is.
Treating Depression in Rheumatoid Arthritis Patients
In many ways, the worst part about dealing with depression and rheumatoid arthritis is the way it cuts you off from doing the things you love and spending time with the people around you. Often, making an effort to be more active socially can make a big difference. Interpersonal therapy can teach you how to better interact with people. Once you explain your difficulties you can replace their indifference with compassion and a willingness to help. Rheumatoid arthritis is a difficult enough condition to deal with as it is, you shouldn't have to do it alone. For more severe cases, antidepressant medications can help. Selective serotonin and norepinephrin reuptake inhibitors (SNRIs) may prove especially helpful, since they work to block both the psychological symptoms and the pain. More than ten percent of depressed rheumatoid arthritis patients have had suicidal thoughts. Talk to your physician if you're experiencing symptoms of depression. You're not alone, and there is help, and hope, to be had.