LUPUS AND DEPRESSION

Jamie Trachtenberg, LMSWDirector of Social Services

February 27, 2008

What does “depression” mean?

Just as we feel happy or fearful or jealous or angry, we are all “depressed” from

time to time.

There is a big difference between clinical depression

and mild mood swings that everybody

experiences from time to time.

Clinical depression is an extremely disabling,

unpleasant and prolonged condition.

It is the most common psychiatric

condition, affecting 20% of women and 10% of men in the general population.

Clinical depression may bring on a variety of physical and

psychological symptoms.

Some symptoms of clinical depression

»

• Sadness and gloom• Crying spells• Uneasiness or anxiety• Irritability• Feelings of guilt or remorse• Decreased memory and recall• Indecisiveness• Loss of interest in things you once enjoyed• Loss of appetite (or eating too much)• Insomnia, restless sleep or sleeping too much• Inability to concentrate• Low energy or fatigue• Low self-esteem• Feelings of helplessness or hopelessness• Or physical symptoms such as headache, heart

palpitations, lack of sexual interest and/or performance problems, and other body aches and pains, indigestion, constipation or diarrhea

How to identify symptoms of clinical depression in lupus

What can be confusing for those living with lupus is that many of these symptoms can otherwise be explained by the symptoms of lupus as well (e.g., fatigue or lack of concentration). It can be difficult to tell between the emotional and physical reasons that may be contributing to feelings of depression.

Not all people who suffer from clinical depression have all of the symptoms. To be considered clinically depressed you will have a depressed mood, difficulty in sleep and appetite, and at least one or two of the symptoms mentioned which last for several weeks and are severe enough to disrupt daily life.

Professional help should be considered if symptoms of depression disrupt your daily life.

How common is depression in a person living with lupus?

Some studies state that approximately 15% of those living with chronic illness suffer from clinical depression; others put the figure as high as 60%. Although clinical depression is certainly more common in people with a chronic medical illness (such as lupus) than in the general population, not every person with a chronic illness suffers from clinical depression.

Bouts of clinical depression usually last for only a few months with a chronic illness. Depression often goes unnoticed in those who have other medical illnesses because it presents symptoms similar to those of the original medical condition.

In persons living with lupus, symptoms of depression such as exhaustion, loss of energy and interest, insomnia, intensified pain, decreased sexual interest, etc. can quite naturally be attributed to lupus.

Even in those individuals without chronic medical conditions, most cases of depression go unrecognized until the later stages of the illness when the severity of the depression becomes unbearable, and the family or doctor can no longer ignore it. In fact, several studies indicate that between 30 – 50% of cases of major depressive illness go undiagnosed.

How common is depression in a person living with lupus?

What is more troubling is that many studies indicate that major depressive disorders in those medically ill are under and poorly treated, even when depression is recognized. Many patients refuse to acknowledge that they are depressed and will actually deny that they are feeling unhappy, discouraged or depressed. These people often experience what doctors call “masked” depression – a refusal to accept the idea of emotional distress, replacing physical complaints instead.

Doctors who are familiar with their patients’ usual mood and personality are more likely to recognize changes related to depression. Patients are more likely to open up about their feelings when they are encouraged to do so by a doctor with whom they are comfortable and trust.

Unfortunately, there is an all too common distorted impression that those with chronic illnesses have “reason” to feel depressed. This view has interfered with earlier identification, earlier treatment and earlier relief for those suffering from clinical depression.

What is the cause of depression in lupus?

There is no one cause of clinical depression in lupus, rather there are various and different contributing factors.

– The most common cause is the emotional drain from the continuous series of stresses and strains associated with coping with a chronic illness and medical condition.

– A recent study (2004) has shown that those with major depression had more severe lupus disease activity than did those without a major depression, This finding implied that lupus disease activity is an important risk factor for the worsening of depression.

– Other causes may be the many sacrifices and losses required by the continuous life adjustments that a person living with lupus must make.

– Various medications used to treat lupus, such as Prednisone (steroids) may produce depression.

– Lupus involvement of certain organs (the brain, heart, or kidneys) can lead to clinical depression.

– There are also many unrecognized or unknown factors (which may or may not be related to lupus) which may cause depressive illness.

Of course, there are those living with lupus who would develop clinical depression whether or not they had lupus. And those who may never develop clinical depression but are living with lupus.

What is the treatment and prospects for depression in lupus?

Effective treatment for depression requires early diagnosis and early intervention. Fortunately, most episodes of depression in people with lupus are short- lived and lessen on their own within a few months. Just as some lupus patients can tolerate a lot of pain, some seem to accept and tolerate major symptoms of depression without complaint.

However, depression is very stressful and anxiety-producing, which may aggravate lupus activity. Depression should be treated with the same aggressiveness and persistence you use to treat a lupus flare or any other medical complaint. Naturally, any underlying medical condition that could contribute to the depression must be identified and controlled.

There are several treatment options for depression. Both psychotherapy and anti-depressant medications can be quite effective. Those suffering symptoms of depression should ask their doctor or social worker for the name of a licensed mental health professional experienced in treating people with chronic medical illnesses such as lupus. Working with a mental health professional can be useful in identifying additional ways of coping with the stresses of chronic medical illness. Joining support groups such as those offered by the S.L.E. Lupus Foundation may provide additional support.

Psychotherapy can be very helpful to work through and understand your feelings, your illness and your relationships. The new coping skills will aid you in dealing more effectively with stress and your life situation.

It is important to keep communication open between yourself, your rheumatologist, and primary care doctors regarding feelings of depression so they can all work together effectively. This shared relationship makes the most of the quality of care you receive and provides the most powerful approach to managing your depression.

ANTI-DEPRESSANT MEDICATIONS

Anti-depressant medications are often used to help people who have depression. With the help of these medications, most people can achieve significant recovery from depression.

It’s important to be aware that anti-depressants are not “happy pills” and they are not a panacea. They are prescription-only drugs that come with risks as well as benefits, and should only be taken under a doctor’s supervision. They are, however, one treatment option for depression.

For adults with severe depression there is strong evidence that anti-depressants are more effective than any other treatment. Most people do best with a combination of medication and psychotherapy. If depression is mild or moderate, psychotherapy alone may be sufficient, though even in this case, short-term anti-depressant drug treatment can help individuals get to the point where they can engage in therapy.

Anti-anxiety medications, when used in combination with anti-depressants offer significant and rapid mood stabilization and anxiety reduction.

Patients who take newer classes of anti-depressants known as SSRIs (selective serotonin reuptake inhibitors) begin to feel the effects in 2 – 12 weeks, and sometimes different medications and dosages need to be tried to find what works best.

HOW CAN I HELP MYSELF?

Changes in behavior may help in fighting a serious depressive episode as well as combating the “blues”:

Exercise regularlyTake medication consistentlyPace yourself and get enough

restAssert yourself – ask for help

when neededFind effective ways to

communicate with family membersJoin a support groupEat healthfully

It is natural for someone to grieve the loss of their old self. It’s important to learn to come to terms with your lupus – embrace it, don’t deny it. Give yourself permission to be depressed from time to time and develop a sense of humor and maintain a positive attitude. Get on with the business of living!