Depression occurs frequently in the general population and even more frequently in individuals with chronic diseases such as RA. The pain and disability associated with RA has a detrimental effect on the person's lifestyle and ability to cope with daily life. RA is frequently associated with depression or anxiety; in fact, depression occurs in 20% to 25% of all patients with RA.
Depression is a disorder that is easily missed by physicians because of its nonspecific symptoms. Thus it should be brought to the physician's attention by either the patient or his or her family or friends. Common symptoms of depression include the following:
- Changes in appetite
- Sudden loss (or gain) in weight
- Changes in sleep patterns (either sleeplessness or waking too early)
- Feelings of guilt, hopelessness, and despair
- Mental and physical fatigue
- Inability to make decisions
- Withdrawal from others
- Lack of pleasure in once-pleasurable activities
- Thoughts of death and suicide (These thoughts occur in 10% of all patients with RA.)
If depression is identified, it can be treated and the quality of the patient's life improved. Treatment of depression is the same for the people with and without RA. Treatment strategies include counseling, education, frequent patient monitoring, and medications. These therapies have a high success rate.
Regular exercise also has a modest antidepressant effect and can be a very useful adjuvant treatment for depression.
Depression occurs frequently in the general population and even more frequently in individuals with chronic diseases such as RA. If depression is identified, it can be treated and the quality of the patient's life improved.
Antidepressant medication can be a particularly useful therapeutic choice. Choosing the right antidepressant is important, and the decision should be based on your specific symptoms and tolerance for side effects. All antidepressants should elevate mood, albeit not to the same extent in all patients. If you do not obtain any relief after four to six weeks of taking a particular medication, ask your doctor to change to another option. Some antidepressants can improve chronic pain by influencing the perception of pain. Other antidepressants have a side effect of drowsiness, which can help with insomnia.