Does rheumatoid arthritis lead to depression?

Does rheumatoid arthritis lead to depression?

Rheumatoid arthritis is a chronic illness that affects 1.3 million adults in the USA, it is a systemic inflammatory disease that affects people both physically and mentally. Major depressive disorder is common in patients with RA. It is being suggested that depression in rheumatoid arthritis is nearly three times that of the general population, yet if often goes undiagnosed. One of the reason for this is that some of the symptoms of RA, such as fatigue and poor sleep could easily be attributed to the disease, when they could also be an indicator of poor mood and or anxiety. However, though people with RA are more susceptible to depression than the general population, many RA will not experience this symptom and it is thought it may only affect around 13-20% of RA patients. The coexistence of immune-mediated inflammatory diseases with depression has long been recognized. Data that illustrate the intimidate associations between peripheral and brain immune responses raise the possibility of shared pathophysiological mechanisms. These associations include the negative effects of proinflammatory cytokines on monoaminergic neurotransmission, neurotropic factors, measures of synaptic plasticity. Levels of C reactive protein of the ways researches measure inflammation, are often higher in people with depression. The evidence supporting this association is accumulating and includes findings from clinical trials of immunomodulatory therapy, indicating that these interventions can provide benefits to mental health independent of improvements of physical disease scores.  

In many cases depression has been underdiagnosed. The study in the British journal practice noted that people may think of their depression and anxiety normal. They may also think doctors place more importance on treating the physical symptoms of RA rather than potentially related mental health conditions. Living with untreated Ra and mental illness can make both the diseases worse. According to the mayo clinic, untreated depression can make it harder to treat RA. That’s supported by recent research. 

A 2017 study in the journal Psychosmatic Medicine, found the link between depression and RA goes both ways. Pain from RA can make depression worse, which in turns makes it harder to manage RA symptoms. That is in part because pain causes stress, and the stress causes release of chemicals that changes moods. When mood changes, there is a domino effect. It’s harder to sleep and stress levels may rise. Simply put, anxiety and depression appear to worsen pain or make it more difficult to manage pain. 

Doctors may not do formal evaluations of a patient’s mood state when they are attending clinic, perhaps due to lack of time, resources, training, or a belief that someone else, such as the General Practitioner should take responsibility for these assessments. Unfortunately, undiagnosed depression can mean that patient may find coping with the demands of suggested treatments, and efforts required for effective self-management too hard to make, and a patient may not avail themselves potentially useful medications and interventions. Furthermore, if the symptoms being experienced are actually more to do with the depression than the RA, patients can become disenchanted with the treatments that apparently do not work, as they do not feel better. 

People may not realize that they are depressed, and so do not talk to their doctor about how they feel. Some people also still worry about perceived stigma of admitting to feeling low, and being diagnosed with a mental health condition. The people mentioned at the beginning of this factsheet have spoken out because of this, and are trying to raise the profile of mental health issues both here and internationally. 

Focusing only on RA, without addressing mental health conditions like anxiety depression, can lead to lower quality of life. The mayo clinic states that people may see a decline in various aspects of daily living. They may have higher pain levels and greater risk of heart disease. Personal relationships and productivity of work may also be affected.