David McKee of Irvine, California, has had rheumatoid arthritis for most of his life. He has taught self-help classes for people with the disease and has met many individuals who are experiencing depression—something he has dealt with himself.
In fact, estimates put McKee and those in his classes in good company. The rate of depression among people living with rheumatoid arthritis is estimated to be anywhere from 13 to 42 percent. “Depression is a huge part of arthritis,” says McKee.
But why is that?
Dealing with a chronic disease is stressful.
Certainly one part of the answer is that dealing with a chronic illness and the new normal it imposes is no picnic.
Depression can be a result of “the disease and the pain, but also the inability to do the things you once were able to,” says McKee. “You think, ‘I’ve always done these hobbies, and now I can’t!'” he says.
This sense of loss can feel like grief, says Christopher Levon Edwards, PhD, a clinical psychologist at Duke University in Durham, North Carolina, who specializes in chronic pain management and works with people living with RA.
Edwards says it’s also common for people to feel anxious about becoming disabled, or needing too much help from family, and to worry about changes in their body.
With all this change and unpredictability, anxiety and depression are normal — albeit uncomfortable — reactions.
Inflammation plays a role in both diseases.
Inflammation is a buzzword in many medical specialties right now. Scientists speculate that internal inflammation contributes to many disease processes. Among those inflammation has been implicated in: heart disease, cancer, diabetes, and stroke.
Depression is also on the list.
“There is evidence that depression is an inflammatory disease, and there is also evidence that people with high levels of certain inflammatory biomarkers in their system are more likely to develop depression. Some of those markers are the same ones that are elevated in rheumatoid arthritis,” says Patti Katz, PhD, professor of medicine at the University of California in San Francisco, where she studies adults with chronic health conditions.
Further supporting the theory is a study review published in December 2014 in JAMA Psychiatry that found that depressed patients without RA, and whose depression was resistant to a common antidepressant drug, responded when that drug was paired with an anti-inflammatory drug.
But these relationships are hard to tease out in the population of people with RA, says Katz.
“There’s been less concern about the actual inflammatory component of depression in rheumatoid arthritis simply because there’s more focus on reducing symptoms, like pain, that have a more obvious relationship with depression. But if inflammation is, indeed, a component of the depression some patients feel, treating the inflammatory process probably helps,” she says.
Depression may worsen pain perception.
The flip side of pain leading to depression is that depression may worsen perception of pain. In a study published in April 2016 in BMC Musculoskeletal Disorders, researchers approached 56 rheumatoid arthritis patients in doctors’ waiting rooms and asked them to complete a questionnaire designed to assess their depression and anxiety levels.
A year later, when the researchers followed up, they found a strong association between these initial scores and patients’ reports on how many sore joints they had and how they were doing in general. In short: the worse they felt emotionally, the worse they perceived their pain to be.
The authors of that study speculated that perhaps depression and anxiety simply worsened pain sensation. It was also possible, they said, that depression and anxiety lessen the motivation to keep up with medication and healthy behaviors, like exercise and avoiding smoking, known to keep the disease process in check.
The bottom line is that people with RA are more at risk for depression — and that depression, whatever the root cause, inflammation or pain, is treatable.
Support and knowing that there are others contending with the same issues helps, too.
McKee went most of his life without knowing other people with rheumatoid arthritis. Then, in his late thirties, he became involved in programs at his local Arthritis Foundation.
“You build these relationships and bonds that are just incredible,” says McKee. “I was in serious depression and solitude, and didn’t know where to turn, and it provided me an incredible opportunity to help others.”
McKee taught his classes in Indiana, where he used to live. Since his move to California, he’s become a member of Arthritis Introspective, a nonprofit that helps young- and middle-aged adults with rheumatic diseases thrive. Finding a community and helping others, he says “changed my life beyond what words can express.”