As anyone with arthritis understands, it’s not just a “joints” condition — the pain affects your whole life, including your mental health.
About 30 percent of people with rheumatoid arthritis develop depression within five years of their diagnosis, according to a British study; a separate review found that 20 percent of people with osteoarthritis experience depression or anxiety.
The link between arthritis and depression is complex. For starters, there’s the inflammation that goes along with autoimmune disorders like rheumatoid or psoriatic arthritis. That inflammation is what makes your joints achy, painful, and swollen, but a growing body of research suggests inflammation from arthritis can also raise the risk of depression. When the brain cells in charge of immune responses start acting up, the brain can’t like it usually does, which can contribute to mood disorders like depression, says Davis Lans, DO, FACP, a rheumatologist in New Rochelle, New York.
The pain of any form of arthritis can also alter your mindset, says Robert Kerns, PhD, professor of psychiatry, neurology, and psychology at Yale University. Some people are prone to what he calls “pain catastrophizing,” or dwelling on how much your body hurts and how helpless you feel against the pain. When those feelings become overwhelming, people with arthritis can fall into depression.
On top of all that, arthritis pain can make everyday activities like going to work or visiting friends taxing, says John Davis III, MD, a rheumatologist with Mayo Clinic. “They tend to withdraw from work and social activities, which leads to social deprivation and loss of relationships and positive roles,” he says.
That isolation could take a toll on mental health. A six-year study of 2,100 adults over age 50 found that lonely people are at higher risk of depression. Even at home, that lack of activity can have an effect; when someone with arthritis has to pause their day to rest, family relationships can become strained and intensify the stress, says Dr. Lans.
With all those mental health risk factors at play, it’s important to be able to recognize the signs of depression among people living with arthritis. Despite what you might expect, the main depressive symptom in people with chronic disease isn’t an overwhelming sadness, says Dr. Kerns.
“What is most salient is decline in interest in activities,” he says. “They just don’t find activities that were previously enjoyable or rewarding to be so enjoyable, partially because they’re associated with pain.” Other signs of depression include:
- Sleep problems (sleeping more or less than usual)
- Appetite changes (eating more or less than usual)
- Feeling hopeless
- Feeling helpless, worthless, or guilty
- Difficulty concentrating or focusing
- Physical symptoms, such as headaches or digestive distress (cramps or upset stomach)
If these symptoms occur most of the day for most days over a couple of weeks, it’s important to let your doctor know. You don’t want to let depression go untreated. (If you are experiencing any thoughts about death or suicide, call the National Suicide Prevention hotline [1-800-273-8255] or 911 right away.)
An arthritis diagnosis doesn’t mean you’re destined to develop depression. Taking these steps can help improve your mental health:
1. Stay active
“It’s intuitive and totally understandable that people who experience pain … would naturally cut back on their activities,” says Dr. Kerns. “But we learned that that’s exactly the wrong thing to do.” A 2015 review found that regular exercise reduces pain and fatigue associated with rheumatoid arthritis. Keeping as active as you can will help improve your mood and make you feel better, physically and emotionally, in the long run.
2. Don’t force happiness on yourself
If dwelling on your pain or other arthritis symptoms drives you to depression, trying to convince yourself that things aren’t that bad sounds like a good idea. But it could backfire, says Cheryl Crow, a rheumatoid arthritis patient who has dealt with anxiety and postpartum depression. Instead, learning to accept what life is like with arthritis could improve your mindset.
“Acceptance is different from resignation,” she says. “You don’t say, ‘I’m resigned to my fate and it’s never going to get better,’ you just accept that that’s where you are [right now].”
3. Educate yourself and your family
Teaching yourself and your family what to expect with arthritis can reduce the stress of the disease, says Dr. Lans. He recommends doing your own research and reaching out to support groups, plus bringing your spouse to doctor visits. “I think that really helps for emotional support,” he says. Becoming a patient advocate in our 50-State Network could help you feel more proactive and empowered. Tracking your symptoms with our ArthritisPower app can help you better understand your mood and pain symptoms so you can discuss them with your doctor.
4. Get adequate sleep
While depression is linked with sleep problems, the opposite is true too: Chronic lack of sleep can be a risk factor for depression, possibly because restful sleep helps the brain form new connections. Aim for at least seven hours of sleep every night, recommends Dr. Lans.
5. Seek professional help
Sometimes, though, preventive measures won’t be enough, so don’t hesitate to seek professional help if you suspect or know you have depression. You might benefit from medication, and talk therapy can help you from getting bogged down with negative thoughts, says Dr. Kerns.
Crow says she didn’t see a therapist until she felt it was “legitimate” when she had postpartum symptoms, but she wishes she’d gone for counseling sooner.
“At first I didn’t think therapy would help because the things I was worried about were all true,” she says. “I have a lifelong, incurable disease and talking to a therapist is not going to fix the disease, so I thought, ‘What’s the point of going?’”
“Now I know that the point is learning how to cope with the reality of my health situation, not changing it,” she adds.
Pain relief might not be the point of treating depression, but it could be a positive side effect. One study in Arthritis Care & Research found that when depressed moods persisted, knee pain would get more severe.
“When you’re depressed, your pain threshold is much lower,” says Dr. Lans.