Source: http://www.arthritisselfmanagement.com/health/resources/resources-for-managing-depression/?page=all

by David W. Golann

Depression gets less attention than many of the other conditions that frequently accompany arthritis. But it can be just as serious, exacerbating the symptoms of arthritis and making them more difficult to treat. The good news is that depression does not need to be weathered silently and alone; it can be effectively treated. This article lists Web sites and books that can help you or someone you know take the first steps to managing depression.

It has long been known that having arthritis can make some people more susceptible to depression. The pain of arthritis and the functional limitations it imposes can turn people inward, keeping them from working, socializing, and participating in activities they once enjoyed, all of which can increase the likelihood of depression. Researchers also believe that depression and pain are intimately linked and may share some chemical pathways in the brain. It is estimated that almost a third of people with a chronic pain condition have depression related to their condition.

What is depression? Someone who is feeling sad may say that he or she is “depressed.” But feeling “down” or “blue” — as we all do sometimes — does not equal depression. People who have major depression, the most common type of depression, experience some of the following symptoms for extended periods: sad, anxious, or “empty” feelings; feelings of hopelessness, helplessness, pessimism, guilt, worthlessness; loss of interest in once-pleasurable activities; fatigue, difficulty concentrating, irritability; getting too little or too much sleep; eating too little or too much; and thoughts of death or suicide.

Contrary to what some think, people with depression cannot simply snap out of it. Asking people with clinical depression to just “buck up” or “not think about it” makes as much sense as asking people with arthritis to just make their joints stop hurting. Like arthritis, depression is a medical condition that requires focused management. Treatments for depression include conservative approaches such as psychotherapy as well as a wide variety of medicines. Unfortunately, many people, especially older people, do not get the help they need to deal with their depression. For some seniors, there is a stigma surrounding depression that prevents them from coming forward and seeking treatment.

There are many books and Web sites offering information about depression’s causes, symptoms, and treatments. We list some of them here. Resources such as these can also help people who have a friend or family member who is dealing with depression.

Web sites

Depression and Bipolar Support Alliance
The Depression and Bipolar Support Alliance Web site has a great deal of information on depression and its treatment as well as practical advice for people dealing with depression. Under“Empower Yourself” on the left-hand column of the page, you will find many resources targeted to help you tackle depression. Click on “Find Support” to locate a depression support group in your area and access the Alliance’s online support group and online discussion boards.

Families for Depression Awareness
Families for Depression Awareness seeks to help the whole family deal with the depression of one of its members. From the main Web page, click on “Family Stories & Interviews” in the left-hand column for stories of people who have dealt with depression. Or click on “Support” to search for many different kinds of treatment professionals and learn about depression support groups.

Freedom From Fear
On the left-hand column of Freedom From Fear’s main Web page, click on “About Anxiety and Depression” for information on depression, anxiety, and the treatment of these conditions. Under“Links & Resources,” you can screen yourself for depression and read about health insurance for people with depression.

Geriatric Mental Health Foundation
The Geriatric Mental Health Foundation promotes mental health treatment for seniors. From the main Web page, click on “Consumer/Patient Information” and then scroll down to find information on depression. Articles include “A Guide to Mental Wellness in Older Age” and “Coping with Depression and the Holidays.”

Mental Health America 
Look under “Health Info” on Mental Health America’s Web page for fact sheets on depression and its treatment. Under “Get Help,” you can find advice on screening and treatment and paying for care as well as contact information for your local Mental Health America affiliate, which can help you locate a mental health professional in your area. (You can also find a therapist near you at the Psychology Today Therapy Directory or at the American Psychological Association Psychologist Locator, or by calling the American Psychological Association at 800-964-2000.)

National Institute Of Mental Health
On this site, you’ll find an article on women and depression and one on men and depression, as well as many other fact sheets.

Psych Central
The Psych Central Web site provides a thorough introduction to the diagnosis and treatment of depression and includes discussions of depression in different populations (teens, women, seniors). Scroll to the bottom of the page to find “Personal Stories of Depression.”

Books

You Are Not Alone: Words of Experience and Hope for the Journey Through Depression
by Julia Thorne
Harper Perennial, New York, 1993
The author, who dealt with depression for many years, shares others’ first-hand accounts of their battles with the condition. The main message of the book is that those with depression can take solace and support from a community of people who have had similar experiences.

Beating the Senior Blues: How to Feel Better and Enjoy Life Again
by Leslie Eckford and Amanda Lambert
New Harbinger Publications, Oakland, California, 2002
The subject of this book is clinical depression, more than the “blues” referred to in the title. It is an easy-to-read primer on depression in seniors that leads people through small steps that can help them manage depression. There are chapters on social connections, exercise, medicines, and dealing with grief. The book also includes many stories of seniors who have overcome depression.

On the Edge of Darkness
by Kathy Cronkite
Delta, New York, 1994
This book offers first-hand accounts of depression by some of America’s most well-known people.

Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You
by Richard O’Connor, PhD
Berkley Trade, New York, 1999
Dr. O’Connor takes readers through an explanation of depression and, while acknowledging that there is no simple solution to the condition, presents behaviors and ways of thinking that can help put people on the road to dealing with, or “undoing,” their depression. The book includes chapters on work, family, and marriage.

Last Reviewed on September 29, 2010

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Source: http://www.arthritismd.com/arthritis-and-depression.html

Arthritis and Depression: When Physical Pain Can Have an Effect on Emotional Pain

Introduction:

According to the National Institute for Mental Health in 2005, approximately twenty million Americans or 10 percent of our population suffer from depression each year.  In the elderly population, both arthritis and depression has a high prevalence.  As many as one half to a third of the elderly population has arthritis and approximately 20 percent of the elderly population suffers with depression (Jeste, 2005).  The symptoms and disability commonly associated with arthritis may increase the vulnerability of those individuals with arthritis developing depression by increasing their number of risk factors.  It is important for patients with arthritis and their caregivers to become educated and monitor for warning signs of depression in order to assure patients are treated effectively.

How Arthritis Can Lead to Depression:

Patients diagnosed with either rheumatoid arthritis (RA) or osteoarthritis (OA) have a relatively high incidence of depression.  Rheumatoid arthritis is considered to be the most severe form of arthritis.  Patients with rheumatoid arthritis may experience debilitating symptoms characterized by severe joint deformation, anemia, weight loss, fatigue, and problems involving the heart, lungs, and eyes.  Approximately two million Americans have rheumatoid arthritis.  The disease predominately affects women more than men by 3:1.  Rheumatoid arthritis is caused by an adverse immune response attacking one’s own joint linings called the synovial membrane.

People with osteoarthritis, also known as degenerative arthritis, also may have symptoms leading to decreased mobility and diminishing quality of life.  Approximately 15 million Americans above the age of 45 suffer from osteoarthritis (Arthritis-Symptom.com, 2004).  These individuals live with pain, diminished range of motion and function in the hands, spine, hips, knees, and feet resulting from progressive degeneration of cartilage in these joints.

Seeing how disabling severe arthritic symptoms can be, it is understandable how people who are enduring arthritis can develop symptoms of depression.  These individuals suffer from both physical pain and emotional pain having lost the ability to perform activities they once enjoyed and the level of mobility they once had.  The progressive joint destruction experienced not only limits joint motion but ultimately impacts an individual’s ability to function.  Patients may find it is harder to perform tasks at the workplace, harder to care for their children.  Symptoms can even impair one’s ability to accomplish activities of daily living such as dressing, and bathing.  These factors such as lost mobility, function and independence can all contribute to developing depression.

The Relationship Between Arthritis and Depression: A Self-Consuming Cycle

Depression that is a result of an arthritic condition is a self-consuming cycle. One symptom feeds directly into another. It has been theorized that there is a cognitive component associated with depression for people who have arthritis.  In particular, the patients’ physical symptoms and major life changes, such as being diagnosed with an illness and disability, may affect mood.

For example, consider a person named Robert who has recently been diagnosed with rheumatoid arthritis.  He is enduring many physical symptoms of pain associated with rheumatoid arthritis, such as aching joints.  Robert is somewhat limited in his abilities to enjoy all of the activities that he was once able to partake in (for example, going for frequent runs or playing the piano).  He may feel that he has lost some of his freedom due to arthritis, and this feeling, coupled with his physical pain, may cause him to feel depressed.  Robert might think to himself, “I am hindered by arthritis.  I will never be able to do anything I enjoyed anymore.” These thoughts can lead to emotional symptoms of sadness, hopelessness and despair.  These emotional symptoms, in turn, can cause Robert to intensify his experience of physical symptoms, such as pain, fatigue, and low energy.  His lethargic feelings may accentuate and begin a downward spiral whereby he becomes even less active and more depressed.  Therefore, although depression cannot cause arthritis, it can exacerbate the symptoms.  It is important that Robert and his identify the warning signs of depression to initiate treatment and hopefully stop the cycle.

Symptoms, Warning Signs, and Diagnosis of Depression Associated with Arthritis

According to the American Psychiatric Association Diagnostic and Statistical Manual – IV (American Psychological Association, 2000, 1994), in order to receive a diagnosis for a major depressive episode, a person must have “at least five of the following symptoms during the same two-week period, nearly every day:”

• depressed mood most of the day
• markedly diminished interest or pleasure in almost all activities most of the day
• significant weight loss or weight gain, or decrease or increase in appetite
• insomnia or hypersomnia
• psychomotor agitation or retardation
• fatigue or loss of energy
• Anxiety
• feelings of worthlessness or excessive guilt
• reduced ability to think or concentrate, or indecisiveness” (Quoted in Comer, 2001; Based on APA, 2000, 1994).

In order to be diagnosed with major depressive disorder, one must have the presence of a major depressive episode and no history of a manic or hypomanic episode (APA, 2000, 1994).

Whom to Turn to When a Patient has Arthritis and Depression

There are many sources of medical help and emotional support for patients who have both arthritis and depression.  While all of these are good sources, if you suspect that you or someone you know may have depression, a physician or other qualified health-care professional should be part of the treatment team.  Among the resources are:

• Primary Care Physician – for preliminary screening or diagnosis of arthritis, depression, and overall medical care.  Primary care physicians can also prescribe antidepressants, which will allow, for some patients, the treatment of depression without having to visit a psychiatrist.
• Rheumatologist – to treat symptoms of arthritis
• Physical Medicine and Rehabilitation physician – to treat symptoms of arthritis and design an exercise program for you to follow with a physical and/or occupational therapist
• Physical Therapist – to ameliorate the physical pain of arthritis by strengthening muscles and facilitating movement of the bones and joints
• Psychiatrist – to treat depression, usually by prescribing medication
• Clinical psychologist – to treat depression using psychotherapy, cognitive-behavioral therapy
• Caregiver – can be a family member, friend, or hired caregiver to help with daily treatments as prescribed by doctors while the patient is at home
• Family and friends – to provide emotional support and other needs of the patient

Treatments of Depression Related to Arthritis

Cognitive Therapy for Depression

Because there is a possible cognitive component to comorbid arthritis and depression, one mode of treatment that can be beneficial is a form of psychological therapy called cognitive therapy.  In recent years, and after much research, cognitive therapy has been regarded as being one of the most effective treatments for depression because there is usually a component of cognition that causes depression (i.e. negative feelings or thoughts, whether induced by a physical or emotional response to pain or a change in way of life due to arthritis).

In cognitive therapy, a psychologist works with a patient to analyze his own thoughts and what are termed “faulty” cognitions, which tend to be negative or pessimistic thoughts that are either exaggerated or untrue.  Consider the case of Robert.  Upon being diagnosed with rheumatoid arthritis, he made unrealistic assumptions:  “I will never be able to do anything I enjoyed anymore.”  Robert, like many people with depression, thinks in extremes and his belief that he will never be able to enjoy his life again is exaggerated to the point where his belief is untrue.  The psychologist would teach Robert how to identify these faulty cognitions and also how to evaluate his thoughts more realistically, so that his mood will improve.

The psychologist would also teach Robert a more positive and rational way to deal with his anxieties and cognitions, to reduce his depressive symptoms.  For example, the psychologist would reason out with Robert, “Is it true that you will never be able to do anything you enjoyed anymore?”  She would then point out that in fact, there are many things Robert can do, and would work with Robert to consider activities that he enjoys and is fully able of doing even though he has rheumatoid arthritis. For example, if Robert likes to run marathons, he could try similar activities like bicycling, going for brisk walks, or doing other lower impact activities.  Robert also likes to play the piano.  Although he may be limited in being able to play the piano, he can still pursue his love for music by teaching others how to play.  The psychologist could also point out that Robert’s physical pain does not prevent him from other pleasurable activities such as socializing with friends, going to the movies, or being active in a neighborhood club.  By teaching Robert how to reason out his negative cognitions, the psychologist shows Robert that there are still many ways he can enjoy his life.

Biological Causes and Treatments for Depression

Medical Treatments for Both Arthritis and Depression

Although cognitive therapy is a highly effective method for treating depression, not all depression is caused by negative cognitions.  For some people, there is a significant biological component to depression, which can be inherited genetically.  Depression is frequently caused by a chemical imbalance in the brain, often with the neurotransmitters serotonin or norepinephrine.  Psychiatrists and other medical doctors frequently prescribe antidepressant medications to patients with depression, according to what neurotransmitters are suspected to cause the depression in each particular patient.  One of the most commonly prescribed antidepressant medications are selective serotonin reuptake inhibitors (SSRIs).  SSRIs are prescribed when decreased serotonin is thought to be responsible for causing depression.  This class of medication works by blocking the reuptake of serotonin and thereby increases serotonin activity in the brain (Comer, 2001).     Antidepressant drugs can also improve sleep for patients.

Older forms of antidepressants, namely tricyclics, are effective in treating depression, but also have an analgesic effect.  Analgesic medications are effective at treating the pain that arises from arthritis.  Analgesics work by blocking the pain pathways to the brain. A common analgesic is acetaminophen.  Analgesics are beneficial because they do not induce stomach problems or aggravate ulcers, and they allow a patient to retain consciousness.  Although they have a beneficial analgesic effect, tricyclics are presently not prescribed with high frequency because of the negative side effects associated with them, such as dizziness, decreased blood pressure, and dry mouth.

Medical Treatments for Arthritis Only

Medications which may also be effective for reducing pain, swelling, and stiffness are nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen.  These drugs work by reducing the production of prostaglandins in the body.  Prostaglandins are responsible for sending messages of pain to the brain (Arthritis Foundation, 2005).  Another class of medications is disease-modifying antirheumatic drugs (DMARDs).  These drugs reduce inflammation in rheumatoid arthritis, and also suppress the immune system.  One important factor to be aware of is that one of the adverse side effects of these arthritis medications, such as chronic use of steroids like prednisone, may trigger depression (Arthritis Foundation, 2005).

Exercise

Exercise is an effective treatment for depression that is not pharmacological, but it works to help depression by physiological changes.  When a person exercises, the endorphin levels in the brain increase.  Endorphins are what is termed the brain’s “feel good” chemical, so as endorphin levels increase, mood improves.  Exercise is also beneficial for treating arthritis by maintaining range of motion of joints, overall cardiovascular fitness and most importantly preserving function and mobility.  Specific exercise regimens can be prescribed by a general physician or specialist such as a physiatrist (rehabilitation medicine doctor) or when working with a physical therapist or occupational therapist.  “New research [has shown] that exercise and diet together significantly improve physical function and reduce knee pain from osteoarthritis of the knee in people over age 60 who are overweight or obese compared with either therapy alone (Chicago Caregiver, 2005).”

Does Treating Depression also Treat Arthritis?

In 2003, the Journal of the American Medical Association (JAMA) published a study led by Elizabeth Lin which examined whether treating depression was also able to treat the pain and suffering associated with arthritis.  Termed the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) study, 1,001 participants in 18 clinics in the United States were divided into an intervention group and a control group.  The participants in the intervention group could choose to be treated by either 6-8 psychotherapy sessions or by antidepressant medications. There was also a control group who was not treated for depression.

The findings of the study were that after a year, the participants who were treated for depression, whether it was by medication or psychotherapy, were significantly improved in terms of their symptoms of not only depression but also arthritis.  Patients were surveyed on their amount of pain experienced and the amount of interference in their everyday activities.  The scale for pain was from 0-10, with 10 being the maximum amount of pain (Peterson, 2003).

“The researchers found that after one year, regardless of the type of treatment, the patients who received treatment for depression (the intervention group) not only had fewer symptoms of depression, but also experienced less pain (5.62 vs. 6.15), less interference with their daily activities due to arthritis (4.40 vs. 4.99), less interference with daily activities due to pain (2.92 vs. 3.17).”  The participants treated for depression were able to participate in their daily activities more fully and felt that their quality of life and health was significantly better (Peterson, 2003).  Researchers believe that the success of the treatment was due to both the use of antidepressant medications including SSRIs and a method of counseling called Problem-Solving Treatment in Primary Care which teaches patients how to solve problems that exist in their daily life (DeClaire, 2005).

The Importance of Seeking Help

Depression can be treated successfully a majority of the time.  However, patients who have both arthritis and depression may not be treated for depression because its symptoms are, at times, neither recognized nor acknowledged.  Many resources are available to treat patients with arthritis and depression, such as health care professionals, who are willing and fully able to help.  Family and friends are also an invaluable resource because they can assist the patient with help in getting to appointments, caring for the patient while at home, and perhaps most importantly, lending emotional support.  There are many barriers to treatment that can occur, and it is important to be aware of these barriers so that a patient and his caregiver can overcome them.

One major barrier is that people do not recognize depression because its symptoms, such as inattention, somatic pain, and insomnia, are also symptoms of arthritis.  Therefore, a patient and his caregiver may not be aware of the patient’s symptoms reflecting an underlying mood disorder rather than the physical manifestation of arthritis.  Even if the symptoms are clear to the patient or the caregiver, some still may not seek help because of the fear and the stigma associated with psychiatric illness.  However, depression is common today, and it is becoming increasingly well understood by both healthcare professionals and the general public.  The main challenge for the caregiver in this situation is finding a way to get the patient into treatment for depression in addition to arthritis.

A Positive Outlook for Patients with Arthritis and Depression

Today, with the advent of new medications and therapies to treat both arthritis and depression, the outlook for successful treatment is good.  As scientists, doctors, and other healthcare professionals discover new treatments, their level of understanding of arthritis and depression increases, and in turn, the public awareness also increases.  This is helpful for people with both arthritis and depression feel more comfortable seeking help rather suffering in silence.  What is important to remember is that, although arthritis can be disabling, by maintaining a positive outlook on life and treating signs and symptoms of depression, the cycle of depression and arthritis can be broken, enabling one to  improve their quality of life and return living.

Authors:  Theresa L. Kowalski, B.A., Princeton University, Princeton, NJ., Victoria Chan Harrison, M.D., New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York City, NY

Resources for Patients with Arthritis and Depression

Arthritis:

ArthritisMD.com: www.ArthritisMD.com

National Institute of Arthritis and Musculoskeletal Skin Diseases:  www.niams.nih/gov

Depression:

National Institute of Mental Health:  www.nimh.nih.gov/publicat/depression.cfm

American Psychological Association:  www.apa.org

American Psychiatric Association: www.psych.org

References:

APA (American Psychiatric Association).  (1994). Diagnostic and Statistical Manual of Mental Disorders, (4th ed.).  Washington, D.C.

Arthritis Foundation (2005).  “Making it Go Away.”  http://www.arthritis.org/resources/arthritistoday/2003_archives/

Arthritis Foundation (2005).  “Take Medicines Wisely.”  http://www.arthritis.org/conditions/pain_center/medications.asp

Arthritis-Symptom.com (2005).  “Arthritis Symptoms.”  http://www.arthritis-symptom.com

AssistPainRelief.com (2005).  “Analgesics.”  http://www.assistpainrelief.com/info/analgesics/

Clark, M. (2005).  “Management:  Chronic Pain, Depression and Antidepressants:  Issues and Relationships.”  Johns Hopkins Arthritis.  http://www.hopkins-arthritis.som.jhmi.edu/mngmnt/depression.html

Comer, R.J. (2001). Abnormal Psychology (4th ed.). New York: Worth Publishers.

DeClaire, J. (2005).  “Better Depression Care for Older Adults also Improves Arthritis Problems, Study Finds.”  Group Health Cooperative.

DeClaire, J. (2005).  “Key Findings and Q&A on the Arthritis and Depression Study (Project IMPACT).”  Group Health Cooperative.

Gilles, G., ed. (2005).  “Top 10 Research Advances and Self-Care Tips for Arthritis.”  Chicago Caregiver, May/June 2005.

Jeste, D.V.  (2005). “Depression in Older Persons.”  National Alliance for the Mentally Ill http://www.nami.org/Template.cfm?Section=By-Illness&template=/ContentMangagement . . .

National Institute of Mental Health (2005).  “Depression.”  Bethesda (MD):  National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services.

Peterson, E.A. (2005).  “Can Treating Depression Help Reduce Arthritis Pain and Suffering?”  EBSCO Publishing.

Pfizer Australia (2004).  “Silent Epidemic of Depression Associated with Arthritis.”  Pfizer Australia Health Report.  http://www.pfizer.com.au/Media/Arthritis1.aspx

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Rheumatoid arthritis and depression - research studies

Winter 2009: NRAS

Taken from NRAS magazine, Winter 2009

Two studies recently published in the journal Arthritis Care and Research have looked at depression. In one study, Canadian researchers have suggested that people with arthritis and other rheumatic diseases should be screened for depression. Researchers at the University of Toronto found that one in ten suffered from major depression and after adjusting for age and sex, the likelihood of people with arthritis being depressed and even suicidal was twice that of people without any rheumatic diseases. Few with major depression had consulted a mental health professional.

In the other study, researchers and the National Data Bank for Rheumatic Diseases in the US have tried to identify the leading causes of depression in people with RA.

They studied the medical records of more than 22,000 people with RA and analysed data on demographics, clinical features of the disease, treatments, employment and work status, pain, fatigue and disability.

The results showed that 15 per cent had reported symptoms of depression at the beginning of the study and the figure rose to 38 per cent after nine years. The leading causes for depression were found to be pain and fatigue.

Psychological aspects of rheumatoid arthritis should be considered, so talk to your healthcare team about this if you feel you need help. Don’t feel as if it’s your fault if you are having difficulty coping.

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• Arthritis Depression | Arthritis Anxiety | Arthritis Today Magazine (earlsview.com)
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• Cancer screening rates comparable for those with and without rheumatoid arthritis (eurekalert.org)
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Arthritis and Depression

What is depression and how does it relate to arthritis?

Depression is a mental disorder generally expressed as inability to concentrate, disturbance in sleep pattern, loss of appetite, inability to experience pleasure, feelings of extreme sadness, guilt, helplessness and hopelessness, and thoughts of death.

Pain, fatigue, functional limitation and social isolation are major risk factors for the development of depression and are often experienced by persons with arthritis. Therefore, people with arthritis and their health care providers should be aware of the risk for developing depression and patients should seek help if needed.

How common is depression among people with arthritis?

Major depressive disorders affect 13 percent to 17 percent of patients with rheumatoid arthritis (RA). Major depressive disorder is two to three times as common in patients with RA as in the general population.

What are the symptoms of depression that people with arthritis should watch for?

If people with arthritis experience any of the following symptoms for more than two weeks, they should contact a mental health professional or a provider immediately –

• Depressed mood
• Loss of interest and enjoyment
• Reduced energy
• Being easily fatigued
• Diminished activity
• Marked tiredness on slight effort
• Reduced concentration and attention on a task
• Reduced confidence and self-esteem
• Feeling of guilt and unworthiness
• Bleak and pessimistic views of the future
• Ideas or acts of self-destruction or suicide
• Disturbed sleep
• Diminished appetite and interest in sexual activity
• Unexplained physical symptoms

(Source: International Classification of Disease, World Health Organization – 1992)

How is depression diagnosed in people with arthritis?

Diagnosis of depression is made through a medical and psychological evaluation, conducted by a specialist trained to recognize and diagnose depression. The specialist will contact a mental health professional or the primary care physician, who can address to both arthritis and depression.

Who is at risk of depression?

There are several risk factors for developing depression, and they can be either biological (including genetic factors and chemical imbalances in the body), psychosocial (including chronic stressors like life events involving personal loss – death in the family, chronic pain like chronic arthritis pain and daily hassles due to restricted mobility) or both.

How can people with arthritis manage depression?

Appropriate management can help people with arthritis live healthy and independent lives, thus decreasing functional limitation. However, in order to manage health, one will have to control both arthritis and depression.

Arthritis pain and disability can be controlled by self-management. It is important for patients to learn about their disease and to take part in their own care. Research has shown that patients who take part in their own care report less pain, make fewer visits to their doctor and enjoy a better quality of life.

The following are important self-management skills:

Exercise is important for maintaining healthy and strong muscles, for preserving joint mobility and for maintaining flexibility and good life style.

Rest or a short nap that does not interfere with nighttime sleep may be useful in controlling pain, tiredness and muscle weakness associated with arthritis.

Assistive devices can be used to reduce stress on certain joints. For example, braces or canes may help reduce stress on the knees. Jar grippers or similar gadgets may help reduce stress on small joints.

Family members and others in close contact with the person with depression can offer support, by early recognition of onset of depression; by helping the patient to start treatment at an appropriate facility and by helping them continue with the treatment; by providing adequate supervision and support to minimize the risk of suicide; by helping the patient to resume their activities and role in life on recovery; and by getting all the necessary guidance and information to prevent further recurrence.

People with depression should see their health care provider as soon as symptoms begin.

The Arthritis Foundation Self Help Program and Arthritis Foundation Exercise Program are known to decrease depression and improve the mood of people with arthritis.

Resources:

Substance Abuse and Mental Health Services Administration (SAMHSA)
www.samhsa.gov

National Institute of Mental Health
www.nimh.nih.gov

The U.S. Administration on Aging
www.aoa.gov

National Institute of Arthritis and Musculoskeletal and Skin Diseases
301-495-4484
www.nih.gov/niams

Information for this fact sheet was compiled from the following sources –

• The American Psychosomatic Society
• The Journal of the American Medical Association
• World Health Organization
• Arthritis Foundation

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Source: Arthritis Today http://www.arthritis.org/depression-pain.php

Pain in the arms, legs and back. Fatigue and sleep­lessness. Problems associated with arthritis and related conditions, right? Yes, but they’re also the physical signs associated with depression, so figuring out the root cause means you can get proper treatment.

Arthritis-like physical symptoms among others [see below] may im­p­rove if the depression is treated with medication, according to research published in the Journal of General Internal Medicine.

Why patients with depression may experience joint and muscle pain is not yet fully understood, says Matthew Bunyard, MD, senior staff physician in The Cleve­land Clinic’s department of rheumatic and im­mu­nologic diseases.

“One theory is that the pain path­­ways going through the spinal cord and brain somehow get de­ranged, and patients with depression experience musculoskeletal pain even though they don’t have arthritis,” says Dr. Bunyard.

Whatever the theory, doctors may not realize that a patient’s physical symptoms are linked with depression, according to another study published in the Journal of General Internal Medicine. Consequently, patients may not receive appropriate treatment, such as antidepressants or psychotherapy.

To ensure good care, doctors need to complete a thorough health history and physical examination to distinguish whether depression or another ailment is the cause of the physical symptoms, says Dr. Bunyard. Rheumatologists need to consider that some patients may be suffering from both depression and arthritis. The chronic arthritis may be contributing to the patient’s depression, or the depression could be aggravating the pain from arthritis – a chicken-and-egg predicament.

Whether the chicken or the egg comes first, communication between the doctor and patient is key to ensuring the best possible care, says Dr. Bunyard, who suggests that patients keep a written account of what their pain feels like, writing down a description of whether the pain is numb, sharp or dull; where it’s located; what makes it better or worse; and how long it lasts. Bringing the journal to the doctor’s office will help the doctor prescribe any necessary treatment. In the case of musculoskeletal pain, a visit should occur if symptoms are persistent or interfere with daily activities.

– Heather Lindsey

Physical Symptoms of Depression

• Bowel problems
• Chest pain
• Dizziness
• Fatigue
• Headaches
• Heart palpitations
• Joint pain
• Muscle pain
• Nausea
• Shortness of breath
• Sleep problems
• Stomach pain

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Conquering Depression Associated With Arthritis - Psychological Toll of Arthritis Linked to Depression

By Carol Eustice, About.com Guide

Updated June 07, 2011

Physical damage caused by chronic arthritis is mostly visible, but the psychological toll may not be as apparent. Chronic arthritis affects both mind and body. To some degree, the psychological impact of arthritis can be influenced by your coping skills and attitude.

Reacting to Loss

Arthritis is a disease which exemplifies the full impact of chronic illness, both physically and psychologically. Arthritis is a progressive disease which can lead to increased physical limitation and eventual loss of ability. How fast loss occurs depends on the severity of your disease. As you become more disabled, all aspects of your life become involved — and there may be emotional upheaval.

Arthritis pain can be draining — it can drain your energy and cause fatigue and exhaustion. Normal daily activities can become burdensome and leisure activities can turn into unenjoyable encounters. The impact of arthritis on your lifestyle may surprise you.

Athletes may be forced to become spectators, career-oriented people may become unable to work, sociable people may retreat into isolation, and independent people may be forced to become more dependent on others.

How you react to change and transition may determine if you will become depressed and how long depression will last. A certain amount of feeling down or blue is a normal reaction to loss. When depression lasts for long periods and interferes with normal life, professional help should be considered.

Fearing the Future

There will be ups and downs with arthritis, good days and bad days. The course the disease will be uncertain. The uncertainty and unpredictability can lead to fear. Fearing the future and the unknown are part of this emotional cycle.

From the time of the initial diagnosis, questions will pop into your mind: What will the future hold? Will I need a wheelchair? Will I become crippled?

As time goes on some questions get answered, while other questions develop. The fear of increased pain, fear of increased disability, fear of new treatments, fear of how family and friends will react, and fear of financial loss are all legitimate concerns. How you confront your fear can influence your emotional response to illness.

Managing Depression

One way of managing depressive feelings can involve altering negative thoughts and demonstrating positive actions.

Gather the Facts

Becoming knowledgeable about arthritis can help you control your fear of the unknown. Dealing with reality, rather than distorted thoughts, and accepting accurate perceptions and objective opinions should help thwart feelings of depression. Don’t make things worse by imagining the worst. Face reality as it occurs.

Avoid Isolation

Arthritis and depression, together, may lead to feelings of worthlessness and a lack of confidence. Low stamina and strength, in combination with lacking confidence, might make you want to avoid family and friends, choosing isolation instead. It is important to maintain contact with other people and draw energy from their support and understanding. Approachability is key to developing and maintaining friendships and family bonds. Remain open to people who accept you along with your limitations.

Pursue Enjoyment

Despite your physical limitations, there are still activities you find enjoyable. It is imperative for your psychological and physical health that you continue to pursue activities which bring satisfaction and happiness to you. Though your life has been altered because of chronic illness, your life can still be delightful. Enjoyment can be a diversion from depression. If your mind is occupied with pleasure there is less room for negativity.

Focus on Today

Focusing on what needs to be done on a particular day and what is happening around you channels your thoughts into the present. Taking control of chores you can do, finishing tasks you are able to perform, caring for yourself, and concentrating on a goal for a particular day keeps your mind engaged with healthy thoughts and activity.

Improve Self-Esteem

Depressed feelings often result from low self-esteem. Make it your intention to do things that make you feel good about yourself. Dress in clothes that make you feel attractive. Wear make-up or get a haircut to improve your feelings about your appearance. Set realistic goals and achieve them. Helping others is a powerful way of developing feelings of worthiness. Make it a point to recognize the positive aspects about yourself.

Get Help

Everyone can experience periods of depresses mood in their lives. It is a medical problem, however, if it impacts your life day after day and impacts your ability to function.

Symptoms of a major depressive disorder may include:

• Feeling extremely sad, anxious, or empty
• Feeling hopeless
• Feeling worthless
• Having thoughts of suicide or death
• An increase or decrease in the need for sleep
• Loss of enjoyment from things that were once pleasurable
• Loss of energy
• Difficulty concentrating, thinking, or making decisions
• Changes in appetite leading to weight loss or gain

If you have a number of these symptoms for most of the day, nearly every day for two or more weeks, you may have a major depressive disorder and should seek professional help.

Sources:

Depression. The Cleveland Clinic Health Information.

http://my.clevelandclinic.org/disorders/depression/hic_depression.aspx

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Millions of arthritis sufferers ‘are battling depression’

By JENNY HOPE

UPDATED: 12:35 GMT, 24 January 2011

A leading charity says the emotional impact of living with long-term pain is being neglected by doctors

Millions of arthritis sufferers are battling depression because of the pain of their condition, says a new survey.

It shows three out of five people with arthritis are brought low by chronic pain, with women worst affected.

Half of young people in their 20s and 30s report that arthritis-related pain stops them going out socially and leading a normal life.

The survey by leading charity Arthritis Care shows the emotional impact of living with long-term pain is being neglected by doctors, with patients getting no advice on how they can help themselves.

This leads to a rising burden on the NHS, it says, as 10 million Britons live with some form of arthritis, mainly rheumatoid arthritis and osteoarthritis.

The condition accounts for one-third of visits to the GP, and the economic burden to the UK is £7 billion each year.

The survey found 68 per cent of 2,263 sufferers feel depressed when their pain is at its worst.  Four out of five feel tired and half feel weak and helpless.

More women than men said when their arthritis pain was bad they felt depressed – two-thirds compared with half of men – and women were more likely to feel alone or scared.

Women and young people aged 34 and under were most likely to be forced into staying at home rather than having a social life, with up to two-thirds leading reclusive lives.

Three out of four people with arthritis say the pain prevents them sleeping through the night, and one-third say it stops them having an intimate relationship.

But even people close to sufferers don’t understand the level of pain, say eight out of ten surveyed.

Information on how to deal with the pain was best provided by specialist doctors, according to almost half of sufferers, and by GPs for two in five.

Yet medication coupled with self-management programmes can ‘substantially lessen’ the severity of depression and improve pain and disability, says Arthritis Care.

Neil Betteridge, chief executive of Arthritis Care, said ‘This report starkly highlights the devastating and far-reaching effect arthritis pain has on people’s lives.

‘Depression is an overlooked effect of arthritis pain and people must be supported to cope with the emotional impact of living with arthritis.

‘Arthritis is a painful and debilitating condition which can also leave people feeling anxious, tired and vulnerable.

‘While it is clear that more research is needed to further establish a link between the different types of arthritis – of which there are more than 200 – and depression, early treatment is key.

‘Arthritis Care is calling on health professionals to recognise the emotional impact arthritis can have on people and to recommend self-management so that they can start to take control of their lives.’

Read more: http://www.dailymail.co.uk/health/article-1350073/Millions-arthritis-sufferers-battling-depression.html#ixzz25HuWJCIW

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Another very insightful post – says it extremely well

Dwelling in depression

BY COLOURTHEDAY ON JUNE 25, 2012

I don’t know whom to blame, but there must be someone! Everywhere I turn, somebody is depressed. I talk to the girls, about their friends or acquaintances, they are depressed, their friends, that is. I think I must know at least ten people telling me they take anti-depressives; I imagine I have twice that number of friends who are too ashamed to tell me about anti-depressives.

Depression inflation…

I have all respect in the world for the despair and hopelessness that comes with this illness.

But I have nothing but disrespect for all the GPs who use this as the best excuse ever not to get to the bottom of things. So easy to just hand out a prescription and “see you next month” when someone comes in to complain about lack of sleep, lousy feelings or lack of drive.

Since when are all those feelings not part of life?

Since when, has the cure for all, been a pill?

I know many people have serious depressions, and I don’t mean to offend anyone. I have so much respect for those who fight this disease, and have the courage to seek professional help. It is those who sit at the other side of the table, I am aiming at.

So many people starting on anti-depressives use them for years and years.

So many don’t get ANY other help.

If reading about side effects were obligatory, would so many use these pills?

If your GP told you, that this drug might help, but we won’t really know before at least six months, would you use them?

This creates patients, who stay patients for many more years than necessary. If listened to, if treated with more care and less pills, the situation would be so much different.

I can’t help thinking that depression is a “fashion” thing. And feel so sorry for those who suffer with severe depressions, though more awareness of this illness can help!

I can’t help thinking; nobody has mouse arms anymore. After serious research into neck injuries, it became clear that those large whiplash neck supports worsens the condition, whiplash also went out of fashion. (Though I have it, a real whiplash!)

I hope depression gets out of fashion too. Someone makes loads of money because people are wrongly treated with expensive pills.

Sorry about the rather cross language and strong meanings in this post. I was angry.

There is probably a pill for that too!

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10 Signs & Symptoms of Depression in Men

By Jerry Kennard, Health ProWednesday, August 04, 2010

When men first become depressed they may not recognize the symptoms for what they are. Anxiety may be one of the first real sensations men are aware of. There may be a sense of feeling edgy and finding difficulty in meeting people or going places are all signs. Physically the man might feel panicky and have symptoms of sweating, shaking, diarrhea, palpitations and sweating.

Although depression in men does share many of the same symptoms experienced by women, men tend to be prone to sudden outbursts of anger and irritation. Risk taking behavior may increase and there may be a increased loss of control and aggression.

The way men cope with depression may largely relate to the way they were socialized. Men occupying traditionally male roles are more attuned to attitudes of power relationships, competitiveness and independence. It isn’t uncommon for men to bury their feelings in alcohol or to use other forms of self-medication. Rather than confront depression by acknowledging their feelings they will often seek distractions.

All men are susceptible to depression. There is some evidence to suggest that more introvert males are more likely to become depressed, but this has to be tempered by the fact that other male personalities may be able to mask depression more effectively.

Men often seem to come off worse after relationship breakdowns. Depression is far more common in men who are divorced. This may relate in part to the breakdown of the relationship but there are often spin-offs to a divorce, such as lack of access to children, less money, loss of a house, that affect men and may contribute to their depression.

Men are three times more likely to commit suicide, particularly if they are separated, divorced or widowed. Men who drink alcohol are more likely to commit suicide.

Major events in people’s lives can have a negative effect on mood. The same is true for men. One of the most significant changes in a relationship is the arrival of a baby.

Depression in mothers is well documented but we now know that as many as 1 in 10 fathers experience depression too.

Changes in the structure of relationships, possible income reduction and fatigue may all contribute.

Unemployment is a well known contributor to depression in men. Around 1 in 7 unemployed men will develop a depressive illness within 6 months of losing their job or being made redundant. The saying ‘you are what you do’ is very true for many men. Take away the work role and a domino effect takes place which may affect their role of breadwinner, head of house, independence, choice, self-esteem and self-worth.

Retirement can affect men in a roughly similar way to job loss. The possible lack of authority, socialization will colleagues, a structure and purpose to the day, can all have a negative effect on mood. Preparing for retirement can be extremely beneficial. Some men find they are able to reduce their working hours and set up other hobbies or activities to help the transition.

Sexual relations frequently suffer during depression or may contribute to depression. The scenarios are many and varied and sexual difficulties can arise for a number of reasons. For example, the relationship may have soured and loss of sexual contact is a consequence and constant reminder. Then again, some men continue to have sex during depression but describe it as functional and less satisfying. Yet other depressed men seek out sex as a form of solace and distraction. In others, depression may lead to reduced sexual activity or impotence. A side effect of medication for depression can be reduced sex-drive. Erectile dysfunction may be due to a physical cause but one of the effects may be depression.

Sources:

Royal College of Psychiatrists. http://www.rcpsych.ac.uk/mentalhealthinformation/

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