The Link Between Depression and Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune, inflammatory disease in which the body's immune system attacks the joints and some organs. These biological factors, as well as RA's effect on quality of life, can lead to depression. People with RA are twice as likely to have depression as the general population. This is due to a complex relationship between the two conditions.

In this article, learn more about the relationship between RA and depression, and why it's so important for depression to be diagnosed and treated alongside it.

Rheumatoid Arthritis and Depression

Scientists don't fully understand the relationship between rheumatoid arthritis and depression, but they do believe it is bidirectional. This means that rheumatoid arthritis can cause depression, and depression can also worsen rheumatoid arthritis.

How Rheumatoid Arthritis Can Lead to Depression

When someone has rheumatoid arthritis, they experience pain, fatigue, joint damage and deformity, and more. They often can't do the activities they're used to doing, like writing, cooking, knitting, and dressing. This all affects quality of life and can lead to a person developing depression.

Additionally, the chronic inflammation and faulty immune response from rheumatoid arthritis may play a biological role in causing depression.

How Depression Worsens Rheumatoid Arthritis

Studies have found that people with rheumatoid arthritis who have depression have worse outcomes than those without depression. This includes:

• Increased pain
• Poorer quality of life
• Reduced rates of remission (when symptoms improve)
• Higher rates of mortality

It's believed that this is partially due to the impact depression symptoms (such as fatigue, apathy, low mood, and difficulty concentrating) can have on coping mechanisms.

People who have depression may have poorer adherence to medication or therapeutic exercise regimens, which can then lead to worse outcomes for rheumatoid arthritis.

One study found that people who had depression at the start of biologic treatments for RA had significantly worse odds of having a good response to treatment and reduced improvement in disease activity by one year.

How to Manage Depression

It's essential to manage depression along with RA in order to have the best outcomes. Some of the treatments for depression and RA overlap.

First, you should speak to your healthcare provider about your depression. They can prescribe antidepressants, if appropriate, or refer you to counseling or psychotherapy.

There are many proven ways to cope with depression, and a therapist can help guide you to the best tools for you.

Some techniques for managing depression include:

• Meditation
• Mindfulness
• Improving quality sleep
• Eating well-balanced and nutritious meals
• Getting regular exercise
• Social interaction or support groups
• Avoiding alcohol, drugs, and nicotine

Interestingly, one 2021 study found that there was no association between rheumatoid arthritis disease activity and depression symptoms, whereas there was a relationship between higher levels of physical disability and depression.

The authors recommended that treatment goals should therefore focus on improving physical and mental functioning and well-being over solely managing medical disease activity.

Occupational therapists often work with people with RA to manage symptoms and adapt to activities of everyday living. Your healthcare provider can provide a referral to occupational therapy if recommended.

How to Prevent Depression

Depression is not entirely preventable, but learning how to identify depression or a depressive episode early is essential to getting a diagnosis and treatment. This is not solely the responsibility of the patient, but it also lies in the hands of healthcare providers to screen people with RA for depression.

Some signs and symptoms of a depressive episode include:

• Loss of interest in previously enjoyed activities
• Fatigue
• Feelings of sadness, apathy, hopelessness, or pessimism
• Difficulty concentrating
• Appetite changes
• Sleep disturbances

A therapist can also work with you to identify your personal triggers and develop an action plan or routine to help prevent these symptoms from worsening.

Summary

Depression in people with rheumatoid arthritis is twice as common as in the general population. This can be due to RA symptoms, like fatigue, affecting overall quality of life. Leaving this depression untreated can worsen RA treatment outcomes.

It's essential that healthcare providers identify depression and provide appropriate treatment alongside any existing treatments for RA in order to achieve the best outcomes.

A Word From Verywell

It's natural to feel low if you are experiencing pain, exhaustion, and lack of mobility. These things can easily lead to a lack of motivation to go about your day. If you have RA and are feeling this way, you may have depression. Depression occurring alongside RA needs to be addressed. Talk to a trusted healthcare provider about seeking treatment for your depression and RA.