Anxiety and Depression More Common When Living with RA

  • Living with a chronic illness can lead to depression and anxiety.  Research has indicated that patients diagnosed with RA are more likely to experience depression than healthy individuals.  Similarly, patients diagnosed with depression are more likely to experience anxiety.  

    When you were first diagnosed with RA, did you feel relief to have a diagnosis?  Were you worried about the future?  Did you feel helpless and get depressed?

    My RA symptoms were so dramatic at time of diagnosis that I was very worried about ever being able to use my hands normally again.  After treatment began to work, I was extremely relieved to have found an excellent rheumatologist and receive an accurate diagnosis.  I felt hope for the future.

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    Many years before developing RA, I first experienced depression during graduate school.  It manifested as seasonal affective disorder (SAD).  Eventually my depression developed into a mild but long-term (chronic) form of depression called dysthymia.  Medication and counseling were effective in preventing a cause of severe depression.

    It is completely normal to have a mixture of feelings when diagnosed with a progressive, chronic disease.  We may need to take some time to mourn the person you were before disease and the person you had planned to be in the future.  Our lives were forever changed when the doctor said, “you have rheumatoid arthritis.”  

    We may fear that we won’t be able to take care of ourselves or our families.  Or that our family will continue to care for and love us no matter what happens.  These feelings of fear and doubt, in addition to understandable anger, can lead to depression and anxiety.

    Signs and symptoms of depression include:
        •    persistent sadness, anxiousness, or "empty" feelings
        •    feelings of hopelessness, pessimism, or helplessness
        •    agitation, irritability or restlessness
        •    fatigue, decreased energy, and tiredness
        •    loss of interest in activities or hobbies once pleasurable or decreased sex drive
        •    trouble concentrating, remembering details, or making decisions
        •    insomnia, early-morning wakefulness, or excessive sleep
        •    change in appetite, increased or decreased eating/food cravings, weight gain or weight loss
        •    frequent thoughts of death, dying or suicide, worthlessness or guilt
        •    unprovoked crying spells and/or unexplained physical problems

    There are several types of anxiety including panic disorders, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety disorder, specific phobias, and generalized anxiety disorder.  Many of the symptoms of generalized anxiety disorder overlap with depression.

     

    Generalized anxiety symptoms:
        •    excessive anxiety or worry or irritability
        •    anxiety or worry that is difficult to control
        •    restlessness or feeling on edge
        •    being easily fatigued

  •     •    difficulty concentrating
        •    muscle tension
        •    difficulty falling asleep, staying asleep or unsatisfying sleep
        •    anxiety that is not specific to anything in particular

    In a 2006 study including 82 participants diagnosed with RA and 41 healthy controls, it was found that the total prevalence of anxiety, depression, and mixed anxiety-depressive disorder was 70.8% (n=58) in the RA group and only 7.3% (n=3) in the control group.  Of the RA patients, 41.5% (n=34) was found to have depression, 13.4% (n=11) anxiety, and 15.9% (n=13) mixed anxiety-depressive disorder (Isik, 2007).  Researchers found that anxiety was more common in early stages of RA and depression in later stages.  However, an earlier study had found that anxiety was not related to RA disease duration (Vandyke, 2004).

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    Results from a 2012 study support growing evidence of high rates of symptoms of anxiety amongst people diagnosed with RA.  However, risk factors for anxiety, unlike for depression, have not been systematically examined in relation to RA.  Authors caution that lack of consistent cut-off points in different measurement scales of anxiety and depression make prevalence estimates and meta-analytic studies challenging (Covic, 2012).  

    Anxiety is also common in MS and I have experienced more anxious feelings as my disease has changed and progressed.  It manifests primarily as irritability and impatience with others.  My neurologist prescribed a medication to use as needed when generalized anxiety arises which has been a blessing.  

    What is interesting is that my rheumatologist has not asked me about anxiety or depression.  I recently received a copy of my medical records and notice that my rheumy has made note of my mood and demeanor.  For one visit she listed “cheerful” and another “mood appropriate.”  We have never discussed my depression or anxiety.  

    Have you experienced more depression or anxiety since developing RA?  Please share your stories.  Know that you are not alone.  

    If you have symptoms of depression or anxiety, please tell your doctor and discuss an appropriate treatment approach.  Depending upon the nature of the depression and/or anxiety, treatment can vary greatly.  I like to practice yoga to help alleviate some of the symptoms of anxiety or depression.


    SOURCES:
    Covic T, Cumming SR, et al.  Depression and Anxiety in Patients with Rheumatoid Arthritis: Prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the Hospital, Anxiety and Depression Scale (HADS)BMC Psychiatry 2012; 12:6.

    Isik A, Koca SS, et al.  Anxiety and depression in patients with rheumatoid arthritis.  Clin Rheumatol 2007; 26:872–878. DOI 10.1007/s10067-006-0407-y

    Vandyke MM, Parker JC, et al.  Anxiety in rheumatoid arthritis.  Arthritis & Rheumatism (Arthritis Care & Research)  June 15, 2004; 51(3):408–412.  DOI 10.1002/art.20474

    What are the signs and symptoms of depression? National Institute of Mental Health (NIMH).  Accessed at http://www.nimh.nih.gov/health/publications/depression/what-are-the-signs-and-symptoms-of-depression.shtml


  • Anxiety Disorders: Introduction. National Institute of Mental Health (NIMH).  Accessed at http://www.nimh.nih.gov/health/publications/anxiety-disorders/introduction.shtml

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    Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.

     

Published On: May 16, 2013