People living with arthritis are far more likely to have depression and anxiety than the general population. There are many reasons for this connection: physical pain causes depression and inflammation plays an underlying role in both conditions. And having pain and fatigue can negatively affect social relationships and cause loneliness.

The relationship between different kinds of arthritis and mental health issues like depression and anxiety is increasingly researched and recognized by doctors. But that doesn’t necessarily mean that critical conversations about mental health are happening between people living with arthritis and the doctors who treat them.

In fact, in our latest ArthritisPower Community Poll, we asked people if their rheumatologist or primary care doctor asks about their mental health. Of the 971 people who responded, 59 percent said no.

In a 2016 survey of rheumatologists published in the Journal of Clinical Rheumatology, authors concluded that while rheumatologists were aware that many of their patients were dealing with mental health issues, they “may lack the confidence, time, and/or referral networks to provide consistently effective care for depressed patients.”

Talking About Mental Health with Your Doctor

First, know that rheumatologists and primary care doctors are actively talking among themselves about how to provide better screening, diagnosis, referrals, and treatment for mental health issues among people living with arthritis.

“I think number one is normalizing it,” rheumatologist Alexis Ogdie, MD, director of the Penn Psoriatic Arthritis Clinic, told CreakyJoints during a recent interview. “Having physicians just ask the question [about mental health] is remarkable in what that will do for you.”

She says that many patients think this conversation belongs in a primary care realm or that they should seek out a therapist or a psychiatrist or something on their own. And they’re not going to necessarily do that. “When I open the door and say, ‘This is really common in your disease,’ I think that makes it okay to talk about it. I think people are more comfortable.”

A recent article in The Rheumatologist, a publication for doctors, acknowledged that it’s not necessarily your rheumatologist’s job to treat depression, but your rheum should acknowledge the problem and help make a plan for more evaluation and management with either a primary care doctor or refer you to a specialist.

Starting the Conversation

If your doctor doesn’t ask about your mental health — and you’re concerned that you might be experiencing signs of depression or anxiety — bring it up yourself.

“Sometimes it doesn’t seem like there’s time and attention to these things in a medical encounter,” Adena Batterman, MSW, LCSW, senior manager of inflammatory arthritis support and education programs at the Hospital for Special Surgery in New York City, shared in a recent interview. She regularly coaches patients to broach their feelings with their doctor.

“Your provider needs to know [how you feel] to properly treat you, and to discern if this is a normal type of sadness and grief and anger, or is it something that really should be treated?” she says. “They need to have a full picture of who you are, not just your joint counts, your sed rate, and range of motion.”

The Importance of Treating Depression and Anxiety

Having untreated depression and anxiety isn’t just bad for your overall quality of life; it can also derail your arthritis treatment, which can in turn make your mental health issues worse — leading to a vicious cycle. Depression and anxiety are associated with increased disability and a worse response to treatment.

There is no formula that can predict which arthritis patients will develop depression or anxiety, according to an article on SimpleTasks, a site from the American College of Rheumatology. Many factors — including biology, coping mechanisms, and a patient’s level of distress — affect whether or not someone with a rheumatic disease will also develop depression, according to Karen Smarr, PhD, clinical assistant professor of medicine at the University of Missouri, in the article.

Only a fraction of people with depression and anxiety get treatment, however. A big part of that may be due to patients’ reluctance to take medication or to add therapy to a schedule that’s already challenging to maintain along with arthritis symptoms like pain and fatigue.

All of that is very understandable, but what’s most critical is that you don’t try to make these decisions on your own. People with depression and anxiety may experience brain changes that make them less aware of just how much they’re debilitated by their symptoms, which makes outside perspective and advice all the more important. And remember that just because you start medication or therapy for a mental health condition doesn’t mean you’ll need to stay with it indefinitely.

Bottom line: If you think you are experiencing depression or anxiety along with arthritis or another rheumatologic disease, tell your rheumatologist or primary care doctor.

“They might not bring it up because they’re really focused on controlling your illness,” says Batterman. “But I think that everybody, patients and providers alike, need to broaden their field of vision and see that [treating mental health] is part of treating inflammatory arthritis.”

Learn More About ArthritisPower

This question was one of our monthly ArthritisPower Community Questions, which offers ArthritisPower participants an opportunity to learn from each other and provide our research team insights.

If you’re diagnosed with RA or a musculoskeletal condition, you can participate in future polls like this, as well as research studies, by joining CreakyJoints’ patient research registry, ArthritisPower. As a patient-led, patient-centered initiative, our research team is committed to investigating research topics that matter most to you.