My client sat weeping softly into her hands. “I am so tired. I am just exhausted,” she began. “I find myself so cry-y and I don’t want to do anything. I think the pain is just getting to me.”

As she continued to talk, I began to wonder if it was more than just dealing with the pain in her joints.

“I wonder if you are also depressed,” I offered.

“Depressed? Who can be depressed in the summer?” she responded.

I thought again of the tenacious way that the symptoms of depression and the symptoms of chronic pain and inflammatory disease are wrapped together, making it difficult to tell what was what. The main symptom, extreme fatigue, goes with all three. As do sad and sometimes hopeless thoughts, and difficulty sleeping, or sleeping all the time, and irritability, and pulling away from people and enjoyable activities.

One thing is clear is — you can be depressed even in the summer.

My client and I began to talk about what was going on in her life. She told me she didn’t want complain, but… I urged her to complain away, and talk through all that she had been holding back. She was doing an amazing job doing demanding work, taking care of her family, planning a creative project that was important to her, and, by the way, living with RA that was unpredictably debilitating. Yet she gave herself no credit for all that she accomplished, looking mainly at what was undone, or not done to her standards.

She is similar to many of my clients, and maybe you resonate with this pattern. My client was pushing and achieving, tired and in pain, and saw no way to get to the next place. She was isolated from people to talk to about how she really felt, and didn’t even allow herself to know what she was feeling.

She was depressed.

It can be hard to remember when you are in that place that depression is not a moral failing, or a lack of effort to “just get it together.”

Depression is part of a biochemical reaction in the brain and nervous system that goes hand in hand with any inflammatory disease, and is especially prevalent in RA and other arthritis conditions.

And it is treatable. And when it is treated, and you start to feel better, it makes all the other things that need to be managed more manageable.

How do you know if you’re depressed?

Get yourself checked out.

Talk with someone — start with your physician, go to a professional you work with and trust and see what they think. Check in with family members — what do they see? Trust your own intuition if something just doesn’t feel right.

How can you feel better?

There are lots of things that help depression. One of the most important is someone warm and empathetic to talk with. Someone who can hold what you say, and remind you to talk about how you feel, and allow you to find your way with it. The person matters more than the initials after their name, and it mostly matters if you trust them and feel better after you have talked with them. “Talk therapy” continues to be one of the most successful treatments in research studies.

One of the most important parts of talk therapy, or conversations with the person you trust, is the validation of your feelings, and the belief in your strengths as you deal with the array of issues in your life.

Medication is also a successful intervention for many (not all) people. It works best in conjunction with some kind of talking.

Groups are also helpful — they help mitigate the isolation that comes from the chronic pain and from depression. There are even some therapists who offer online groups. But almost any group that you are interested in helps — it doesn’t have to be therapy. A class in the community center, a religious group, hanging out with the parents’ group in your neighborhood — all help. Yes, you may have to force yourself to go, but there is something healing in that.

The most important thing is to get your fatigue, your sadness, your irritability checked out. It is too easy to write it off as just from the “pain,” as my client was doing.

You deserve to feel better.