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Arthritis and Mood Disorders:
Understanding the Link

arthritis

By Isaac Christiansen

What is Rheumatoid Arthritis?

Classified as an autoimmune disease, rheumatoid arthritis is a serious, chronic condition. People who suffer from this illness deal with many challenges, because the body is attacking its own connective tissues. Although the hallmark sign of rheumatoid arthritis is swollen, red and painful joints, there are many other life altering symptoms, such as:

  • Extreme fatigue
  • Unexplained fever
  • Weight loss
  • Skin lumps
  • Mobility-limiting stiffness
  • Dry mouth and eyes

If the body-wide inflammatory process of RA is left unchecked, permanent and disfiguring joint damage may occur. RA is a disease that affects every part of a person's life, including mental and emotional health.

Rheumatoid Arthritis and Mental Health

arthritis

The typical RA patient is a female, generally aged 30-60 years old. Therefore, this truly is a disease that can strike a young, ambitious and active person in their prime years. Experiencing any illness, be it chronic or acute, can be a risk factor for developing anxiety or depression. However, since RA is a chronic and lifelong condition, rheumatologists and other treating physicians have learned to pay close attention to their patient's mental health.

A European study conducted in 2009 suggests that up to 63 percent of RA patients also struggle with mental health. Most of the disorders that these patients suffer from were indicated on the depressive or anxiety spectrum.

Why do RA patients suffer from higher rates of mental health concerns? One clear reason is the loss of energy and physical ability that is the major diagnostic symptom of RA. Other reasons include:

  • Dealing with high levels of pain - Pain and depression are likely bedfellows. People with RA deal with pain as a fact of their everyday lives. This takes a toll, mentally and physically. Unfortunately, depression and anxiety can intensify a patient's perception of pain.
  • Fear of unpredictable symptom flares - As a chronic illness, RA is always lurking in a person's body. However, people with this condition suffer periods of high disease activity, called flares. Flares can be triggered by stress, illness or lack of sleep. Sometimes though, flares happen for no discernible reason. This life-disrupting uncertainty can be a large source of anxiety and depression.
  • Fear of RA symptoms becoming worse over time - Unfortunately, RA is quite often a disabling illness. Since this is a disease that is most commonly diagnosed in women who are in the midst of their best working and family lives, the thought of losing physical capacity can be an enormous cause of grief and depression.

Assessing the Risk of Mood Disorders

arthritis

Arthritis clinicians understand that their patients have a higher chance of developing depression and anxiety during the first years following their diagnosis. Therefore, the role of medical professionals in an RA patient's care isn't only to help control and mitigate pain and joint damage - they must also continually screen for signs of a developing mental disorder.

Mental health, just like physical well-being, is a state of wellness that must be maintained. If an RA patient is experiencing challenges with depression, they have a much better future outlook if their clinician is able to identify early symptoms and advise treatment. RA is a disease that requires care from a multi-disciplinary team that can include:

  1. Primary care doctors
  2. Rheumatologists
  3. Immunologists
  4. Orthopedists
  5. Physical therapists
  6. Psychologists

Mood disorders, such as major depression and anxiety, can worsen over time if a patient is not treated appropriately. It's very important that an RA patient receive on-going care not only from their specialists, but also in the form of psychotherapy and mood-stabilizing medication when appropriate. Dealing with the pain and fatigue of RA is a lot to handle, and most specialized arthritis professionals recommend talk therapy as a treatment for associated depression and anxiety.

Stabilizing Mental Health

arthritis

Psychotherapy, perhaps more commonly known as talk therapy, is an empowering treatment for people who are facing feelings of depression and anxiety. The psychotherapist's role in an RA patient's life is of tantamount importance in successful treatment. Benefits of therapy can include:

  1. Increased feelings of personal empowerment
  2. Development of healthier coping mechanisms
  3. Examination of negative thinking or behavioral patterns
  4. Learning relaxation techniques
  5. Improved interpersonal relations

Medication for mood disorders is also a possibility that many RA patients may consider as a part of their mental health treatment. These medications should always be discussed with all of the patient's healthcare providers and be used in tandem with psychotherapy. Some common medications used to help people who are struggling with depression and anxiety may include:

  1. Tricyclics
  2. SSRIs
  3. Benzodiazepines

One of the most important services that a treating medical professional can offer to an RA patient is a tolerant and compassionate attitude. Many people are fearful of discussing feelings of depression and don't receive the help they need to live a full life. Improved screening and patient education can help RA patients get the help they deserve.

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