Rheumatoid arthritis is a degenerative autoimmune disorder characterized by inflammation and stiffness of the joint, and in extreme cases disfiguration and joint destruction. One of the main symptoms is chronic pain.

Chronic pain is a key risk factor for depression, which affects more than 19 million Americans. Mental Health America (MHA) states that depression is a common mental illness that causes people to lose pleasure in daily life. It complicates other medical conditions and can lead to suicide. Like arthritis, depression affects people of different ages, gender, race and ethnic group.

In the UNC study, 200 RA patients and eight doctors were interviewed by researchers and given questionnaires to assess their depressive symptoms. Eleven percent of the patients experienced moderately severe to severe symptoms of depression. Patients who were more restricted in their normal daily activities were more likely to be depressed. Additionally, researchers discovered that RA patients are unlikely to discuss depression with their physicians.

Symptoms of Depression
According to the MHA, if you have five or more of the following symptoms for two weeks or longer you could have clinical depression and should see your doctor immediately.
• Fatigue
• Reduced energy
• Depressed mood
• Loss of interest and enjoyment
• Inability to concentrate
• Lowered confidence and self-esteem
• Feeling of guilt and unworthiness
• Pessimistic views of the future
• Suicidal thoughts
• Sleep problems
• Unexplained physical symptoms

Risk Factors for Depression
Limitations on normal daily activities and ongoing pain can lead to frustration, anxiety, fear and even anger. Many arthritis sufferers cope with these emotions in a healthy way, but others spiral into depression. These factors increase your risk:
• A family history of depression
• An inadequate social support system
• A previous bout of depression, especially before 40 years old
• Stressful live event, such as financial problems or death of a relative
• Recently giving birth
• Alcohol or drug abuse

Ways to Cope and Reduce Your Risk

Don’t ignore your symptoms. Early intervention is critical for effective treatment. More than 80 percent of people who suffer from clinical depression improve with treatment. Don’t assume you can handle it by yourself.

Talk to your rheumatologist. The lead UNC researcher Dr. Betsy Sleath says that people with RA visit their rheumatologists more than they visit their family physicians. Yet, most rheumatologists don’t ask patients about depressive symptoms. You should take the lead. Some rheumatologists may not be comfortable treating depression, but they can refer patients to an appropriate health professional.

Control pain effectively. Controlling arthritis pain lowers your risk of depression. Some pain medications your doctor will prescribe include analgesics (acetaminophen), NSAIDs (ibuprofen), corticosteroids (prednisolone), or disease-modifying antirheumatic drugs (DMARDs) such as methotrexate. Take them as prescribed and closely monitor how successfully they control your symptoms. If a drug isn’t effective, speak to your doctor right away to get a better alternative.

Stay active. According to the American Academy of Pain Medicine, physical conditioning has short-term and long-term benefits for people with chronic pain. Exercise also stimulates the release of mood-enhancing hormones in the brain known as endorphins, whose effects can last for several hours after a workout. Finally, exercise alleviates inflammation and stiffness which improves your mobility, which can lower feelings of frustration, anger and depression.

Consider antidepressants. These medications help restore the balance of chemicals in your brain that play a role in depression. The most popularly prescribed are selective serotonin reuptake inhibitors or SSRIs, such as Prozac™. Several studies have shown that antidepressants are far superior in treating depression than placebos. Also, a study conducted at the University of California, San Diego Department of Psychiatry showed that one antidepressant, nortriptyline, can actually reduce pain as well.

Try holistic treatments. Several holistic practices such as tai chi, yoga, meditation and aromatherapy which improve arthritis symptoms — including pain and stiffness — also relieve depression. In a study conducted at the Boston University School of Medicine, before-and-after brain scans revealed that levels of the neurotransmitter gamma-aminobutyric (GABA) increased by a whopping 27 percent in participants who had practiced yoga for a 60-minute session. Low GABA levels are associated with anxiety disorders and depression.