People living with rheumatoid arthritis (RA) are twice as likely as the rest of the population to feel depressed. An important thing to understand is that it is NOT your fault you are depressed, therefore, YOU are not making your RA worse. It is natural to feel anxious or sad as a result of the diagnosis and to be depressed as a symptom of the disease. Instead, realise that it just demonstrates that rheumatoid arthritis is a complex condition that may require multiple levels of treatment; and, that an important strategy for reducing the pain of arthritis is treating your depression. Two approaches can be used, non-pharmacological and pharmacological, together or individually.
Separate from improving mood, antidepressants have been shown to reduce pain in many different chronic conditions, including arthritis, and they work even when depression is not a factor. How these drugs work to reduce pain is not fully understood, but may have to do with improving sleep, relaxing muscles, or increasing neurotransmitters in the spinal cord that are responsible for lessening pain signals.
Please consult your doctor to discuss your treatment options.
There are many strategies you can try, which you may find useful for helping you to avoid or alleviate depression without using drugs. No matter what suggestions you decide will work best for you, we recommend you speak with your doctor or therapist before getting started:
- Try to find a way to express your emotions, including thoughts or feelings such as anger, in a safe environment. If you do not feel comfortable speaking with a spouse or friends, then you may want to consider seeing a therapist. If nothing else, keeping a diary might prove useful and it could help you understand your thought patterns and the cycle of depression. Realize, however, that a diary does not provide an exchange of ideas and you run the risk of entrenching your negative emotions. Write your rant, but include a few sentences at the end that begin with: "I appreciate my spouse/doctor/child for . . ." or "Even though I had a hard time getting out of bed this morning, I watched a really funny show/read a good book/had a chance to quietly think alone about . . . " Also you can read through what you just wrote and think about ways you could have turned a bad situation into a good one or acted differently in response to a negative event. Alternatively, if you can, read your diary to a supportive friend or a therapist.
- Consider taking time to examine your support network. How do you feel about the type of social support you get? Is it sufficient? Are you in a relationship in which you have positive support? You may have support from a spouse, but is it problematic support, that is, support that reinforces negative feelings? When you talk about your pain with a partner or friend, do they change the topic, encourage you to stop dwelling, tell you that you worry too much, avoid discussing the problem, are overly helpful, or provide unsolicited or impractical advice (and get annoyed if you don't follow it)? Do their actions contribute to your positive or negative emotions? If you feel your support network is not helping, consider speaking to a therapist.
- Try to train your brain to think more positively (focus on positive events no matter how small or rare they may seem), but try to feel less guilty about your emotions no matter how negative. A positive attitude helps to improve functioning of the immune and cardiovascular systems, increases the likelihood that you will participate in healthy activities, and can help improve the chances of getting support from friends, family, and the community.
- Try to find things to laugh about. Laughter can boost your immune system, but it also just plain feels good. Some people take laughter so seriously, they attend laughing classes at yoga clubs.
- Try to stay grounded in reality by not personalizing, or feeling responsible for, negative occurrences, and try not to expect the worst.
- If your partner is depressed, that may be affecting how well you cope with arthritis and therefore contributing to your own depression. Consider talking to your partner about also getting treatment and working together to overcome depression.
- When you feel safe to, take control by learning everything you can about your disease without overthinking your symptoms. It is important to understand your disease and how it affects your body, but concentrating on your pain too closely can make it take up too much space in your life.
- Look for ways to find purpose in your life. If there are activities in your life you can no longer participate in because of your illness, find ones you can do. Fatigue and disability can feel limiting, but people have amazing adaptive abilities. Try not to forget there is always something you can do, something that may never have occurred to you, or you had once thought of doing but were too busy for. You may find, in a strange way, your arthritis has expanded your horizons.
- Try to practice mindfulness. Essentially, it means paying close attention to events as they occur in a dispassionate, or non-emotional way. This is a Buddhist concept that is rapidly being taken seriously in the scientific community, particulary in the area of neuroplasticity. Neuroplasticity is the brain's ability to reorganize itself by forming new neural pathways, which means that our thoughts can change the structure and function of the brain no matter what age we are. For more information on this fascinating topic, read The Brain that Changes Itself by Norman Doidge.
- Think about joining a support group, for arthritis and/or depression. Some resources you may find useful in your search include:
- As much as you can, attempt to exercise and eat healthfully. Please refer to the May/June 2009 issue of JointHealth™ monthly titled, "Keeping Active with Arthritis." If you would like a copy please contact us at firstname.lastname@example.org or call 1-866-974-1366. You may also find this and other JointHealth™ monthlies online at www.jointhealth.org. To learn about the role of nutrition in your health, you will find information in the About Arthritis section of the JointHealth™ website, under "Diet and Nutrition."
- Try to do what you can to manage your pain. For tips and to learn more about pain, please refer to the April 2009 issue of JointHealth™ monthly, "The pain of arthritis."