RA & Flares: Tips for Surviving A Flare & Avoiding Depression
The relationship between RA, inflammation and depression has been the subject of more than a few studies. I have been doing some research.
I have read many abstracts of scientific studies and articles written by medical researchers and doctors who treat RA patients. The only thing they can say for certain, at this point, is that there is a connection between inflammation and depression.
But, which comes first? That is the question. Does inflammation cause depression, or does depression lead to inflammation?
I am not a doctor or health care provider of any kind. I am just like you. I am living w/a painful, chronic illness. I have good days and bad days. My goal is to somehow avoid the terrible days I know you all can relate.
We know that life is a contact sport, so to speak. We all have our bumps and bruises from living in a fast-paced world. Sometimes it is just too hard to keep up with the able-bodied around us. We miss our pre-RA selves. We just want RA to go away.
Sometimes we experience a loss so profound that we become depressed. This is perfectly understandable, and normal. For example, the loss of a child, a spouse, or a close friend would naturally lead to feelings of great sadness. The loss of a job could be just as devastating.
Normally we navigate these detours in life with the coping skills we have learned from previous experiences, from our friends, or our families. We are sad for a while, but we eventually regain balance in our lives. We don’t feel helpless or hopeless anymore. We have moved on.
The problem pops up when we cannot move on. Sometimes the sadness stays. Sometimes we lose interest in the things we used to love. That is when it is time to seek help.
Those of us with RA, and other painful, chronic conditions, must deal with all of the normal problems encountered in life in addition to those issues unique to our disease(s). This is no small order.
I have learned a few things since my RA diagnosis. The most important thing I have learned is that no progress can be made in any direction while we are in pain.
When I am in pain, all I want is relief. I want to be able to sleep at night. I want to be able to do the simple things that so many take for granted. I want to shower. I want to cook. I want to feel well enough to read.
I still do not understand why many rheumatologists will not address their patients’ pain. I suppose it has something to do with the DEA’s crackdown on prescription narcotics. The U.S. government, in an attempt to stem the tide of illegal prescription drug abuse, has made it very difficult for chronic pain patients to get the medications they need.
If your rheumatologist won’t address your pain issues, find a doctor who will help you manage your pain. Sometimes Primary Care Providers will help their patients by prescribing pain meds.
Orthopedic doctors may also write scripts for the pain medications you need. If you have a PCP or an orthopedic doctor who will not help, you may need to see a Pain Management doctor. Don’t give up until you find a doctor who will help you control your pain.
Unfortunately, we are all familiar with flares. It is so easy to become depressed when we are flaring. First of all, we hurt! That is bad enough, but we also have to deal with not being able to do the things we were able to do the day before.
You all know what I mean. My last flare was a particularly bad one. My husband had to help me get dressed. Getting into the shower was agony. My body did not want to move, but that hot shower helped me feel better physically. It also helped me feel better mentally.
My husband has been through many a flare with me over the last three years. He knows when I am in a true flare before I do, and he helps get me get through the flare as unscathed as possible.
The first thing he does is make sure my pain is controlled, and that I don’t forget my weekly injections of Orencia or my weekly Methotrexate pills. Lloyd also reminds me that I might need to call my rheumatologist and ask for a burst of prednisone. After that is taken care of, he goes out of his way to get me out of the house and into nature.
I love being outside in the sunshine. Sometimes just a little trip into town for soft serve ice cream, or a brief trip to the lake can lift my spirits, even in a flare.
It is so easy and tempting to just pull the sheets up over our heads and not get out of bed when we are flaring. Of course, we do need to rest, but if we aren’t careful we can confuse our need for rest with the beginning of depression.
I notice that a lot of RA patients take antidepressants to help with nerve pain. Cymbalta and Lyrica are widely prescribed for neuropathy and fibromyalgia pain. There is one drug called Savella that was approved by the FDA specifically for the treatment of Fibro.
Unfortunately, I cannot take any of these meds because of their effect on my blood pressure. Every one of those meds sends my bp soaring.
A few weeks ago, I had an MRI done on my lower back. My orthopedic doc ordered it because I had so much lower back pain that I could barely walk.
The MRI showed a ruptured disc and many bulging discs, as well as DDD. My rheumatologist wanted to prescribe high doses of Celebrex, an NSAID. Unfortunately, all NSAIDs also raise my blood pressure.
Thank goodness for my orthopedic doc’s NP. She started me on 25 mg of Elavil, an old antidepressant. Elavil is not used much at all for depression anymore. It is used, in low doses, to treat nerve pain.
I am now on 50 mg of Elavil once a day. It is taken in the evening because it can make you drowsy. That is great for me, because I was having trouble sleeping.
I also take 10 mg of Lexapro a day. That drug is an antidepressant that was originally prescribed by the second rheumatologist I saw. I was skeptical, but that skepticism turned to joy when Lexapro got rid of the burning pain in my feet.
Not everyone can take the latest and greatest medicine that is out there for nerve pain. That doesn’t mean there are not other meds out there that can help you. You just need a doctor who is willing to think outside the box.
I truly believe that the two antidepressants I take for nerve pain also help me avoid depression. That is a wonderful "side effect".
I am not an expert, but I would like to share the tools I use to keep myself from sinking into depression when I am flaring. They are really simple things, but they are so important.
- Take a shower every day, if you can safely do so
- Don’t isolate yourself. If you cannot get out, pick up the phone and call a friend
- Do something for someone else who is ill or suffering in some way. Send a greeting card, or give them a call to cheer them
- Take all of your meds on schedule.
- Get out of bed, if only for a short time
- Read a good book or write an old fashioned letter
- Take care of your pet. If you don’t have a pet, consider getting one.
- Remind yourself that this too shall pass. It will get better!
- Go online and participate in a support group. No one understands like another RA patient
- If the feeling of sadness seems overwhelming, and doesn’t seem to be getting better, call your doctor. You may need a medicine to help you get your body back in balance. There is no shame in that.
I hope this article helps some of you. Life is meant to be lived. Yes, we have RA, and it can interrupt our plans. Yes, we have to make adjustments to be able to go on. That is okay. The important thing is that we do go on, and that we have fun along the way. It may not be easy, but it is possible, and so worth it!
Vanessa wrote for HealthCentral as a patient expert for Rheumatoid Arthritis (RA).