The diagnosis of RA, when established and told to you as a patient, comes as a dreadful shock. It is very difficult for a doctor to be positive and cheerful when breaking any sort of bad news, and as RA continues to be thought of as a chronic and disabling disease the news that you have it can be grim. You go to books in the library or to the Internet and learn about your future or so you think. Much of the material you see contains every possible thing that can go wrong, so it is not surprising that you will fear for the worst. So you will be depressed just by learning what you have.
Then there is the depression that comes with feeling awful. Feeling awful is part of having rheumatoid arthritis. The onset, in many people, is accompanied by a flu-like feeling tired, aching and depressed and this may persist for many months or longer. The pain may be unrelenting, or just as you think things are improving it all returns. When anyone suffers like that they cannot get things together. Everything is an effort. You may not be able to keep up your previous workload, whether it is at home doing the housework or in your job. You are irritable, and realise that others are finding you difficult, so you become miserable. Family life becomes a chore. You may be so stiff in the mornings that you cannot get the children ready for school unless you get up at an unearthly hour. Sex may be painful, or an effort. Others may not understand and still expect the same of you, but you know you simply cannot do it all. You start to feel inadequate and that adds to the depression. Everyone has bad days, and bad things happen, but if you start by feeling terrible every morning before any difficult life events come along, then those events become impossible to cope with.
As a rheumatologist I have often fallen into the trap of saying to one of my patients "Why, you look well today!" and then had a diatribe about how you cannot judge books by their cover. That too is depressing; you may look well, and so people do not realise how awful you feel inside, and what a struggle it is to keep up appearances.
And then you are tired. High fatigue means low quality of life. Night after night of disturbed sleep can be depressing. Many patients cannot understand why they continue to feel tired and unwell even if the disease itself seems to be fairly quiet, and I am often asked why this happens. The simple answer is we are not sure, but there are a number of things that may contribute. Some are physical and some are psychological, and there is an intimate relationship between fatigue and depression..
Many people with RA get depressed by the unrelenting aching and everything else, and depression also results in disturbed sleep. Conversely people with depression who develop RA may have higher fatigue levels.
I agree actually. I started this writing about fatigue 8-)
there is There is also another factor the effect of some interesting chemicals on the brain. In RA research has shown that there are lots of chemicals that are important in the chain that runs from white blood cells to joint inflammation. TNF- has been in the news, but others may be important, and the groups called free radicals, interleukins and interferons are among them. We know that the levels of these chemicals may be disturbed in RA, but other research has shown that high levels of them may make you feel really ill. Thus people with multiple sclerosis who are given -interferon often feel absolutely awful for a day or two, just like having flu, and it has recently been found that high levels of interleukin-6 have the same effect. One of the hormones produced by the adrenal glands, dehydroepiandrosterone, is low in RA and chronic fatigue. We don't know if these or other hormones contribute to the depressiom found in RA depression but it seems likely.
Lastly chronic pain causes depression by a direct effect on the brain. Pain is felt in a specific area of the brain and if this area is constantly active because pain messages keep coming in, it won't switch off a bit like the ghost image on a TV. The chemicals in this pain centre in the brain are the same ones as those that control mood, so overactivity in the pain centre causes depression.
So now you know why you might be depressed. How do you recover from it? Here are a few tips.
wanttobe, there are many "letter to normals" for fibromyalgia floating about the internet, like these: