Stress and Depression in Rheumatoid Arthritis
People suffering from rheumatoid arthritis and other illnesses causing chronic pain often experience stress and are significantly more likely than the general population to experience depression because the painful limitations of RA affects so many parts of our lives - from performing our jobs, to managing our homes and families, to just getting a good night’s sleep. In fact, some statistics show that 20-25% or people with RA experience anxiety and depressive disorders and about 10% have thoughts of suicide.
Past studies have shown that stress causes increased sensitivity to pain. It can cause people to feel helpless and negative. The physical symptoms of both stress and depression also have been shown to cause fatigue, weaken the immune system and cause weight gain- symptoms which in turn cause more us to have even more stress.
It is important for people with RA and other chronic illness causing prolonged periods of pain and disability to be able to cope with stress and to recognize the signs of depression so that it can be managed and treated. People who are having difficulty managing stress, are feeling overwhelmed, or think that they may have symptoms of depression should communicate these feelings and issues to their physician or a mental health professional.
Symptoms of Stress
Life stressors affect us physically, and cause symptoms such as back and neck pain, trouble sleeping, hair loss, fatigue or upset stomach. Stress also causes emotional symptoms such as anxiety, depression, helplessness, overreactions, feeling out of control, or lack of concentration and memory problems.
The following are a few suggestions for reducing stress in our everyday lives:
- Identifying the sources of stress (e.g. work, family, health)
- Management and stress reduction techniques (e.g. listening to music or relaxation tapes, eating healthy and getting enough sleep, managing time and schedules, accepting help from others, organizing and simplifying your life)
- Coping strategies (e.g. focusing on the positive, making time for relaxation, sharing thoughts with family or friends
- Yoga or Tai Chi
- Keeping a journal
- Progressive muscle relaxation
- Cognitive-behavioral therapy (changing the way you think and behave in order to reduce stress or depression)
Symptoms of Depression
There are several types of depression: major depression, dysthymia (chronic depression), atypical depression, and seasonal affective disorder. The following, from the University of Maryland Medical Center, is a list of the symptoms of major or acute depression. For major depression, at least five of the symptoms listed below must occur for a period of at least two weeks, and they must represent a change from previous behavior or mood. Depressed mood or loss of interest must be present:
Depressed mood on most days for most of each day. (Irritability may be prominent in children and adolescents.)
Total or very noticeable loss of pleasure most of the time.
Significant increases or decreases in appetite, weight, or both.
Sleep disorders, either insomnia or excessive sleepiness, nearly every day.
Feelings of agitation or a sense of intense slowness.
Loss of energy and a daily sense of tiredness.
Sense of guilt or worthlessness nearly all the time.
Inability to concentrate occurring nearly every day.
Recurrent thoughts of death or suicide.
In addition, other criteria must be met:
The symptoms listed above do not follow or accompany manic episodes (such as in bipolar disorder or other disorders).
They impair important normal functions (such as work or personal relationships).
They are not caused by drugs, alcohol, or other substances.
They are not caused by normal grief. [For definition see below.]
The symptoms for dysthymia are the same, but are much less intense and last for long periods- two years or more. In atypical depression, people generally overeat, oversleep and react very strongly to rejection. Seasonal affective disorder is associated with annual depressive episodes in the fall or winter characterized by fatigue, overeating, and oversleeping (or undereating and insomnia for some people).
Treatments for Depression
There are several treatment options depending on the degree and severity of depression including medication and psychotherapy or cognitive behavioral therapy. Studies have shown that a combination of medication and therapy is particularly effective for people with chronic or major depression. According to the University of Maryland, some studies show that only 40% of people with chronic depression respond to medication alone while 60% respond to combination therapy. On the other hand, people with minor episodes of depression may respond well to counseling sessions alone.
Other treatments/management techniques that help reduce stress also help depression, such as:
Meditation or deep breathing exercises
Imaginative progressive relaxation techniques (using a combination of deep breathing and self-guided imagery such imagining pain in your body as a liquid that drains through your body and out through your fingers and toes.
Making time for exercise (exercise is known to improve physical function, reduce pain, AND improve mood).
University of Maryland Medical Center Patient Education articles on Stress and Depression
Christine Miller wrote about rheumatoid arthritis as a Patient Expert for HealthCentral. She was diagnosed at 16 months old with polyarticular juvenile rheumatoid arthritis and has gone through the ebbs and flows of disease activity — many medications, much time spent in physical and occupational therapy, surgeries, and periods of relative remission.