Lupus and Clinical Depression
Life with lupus—with symptoms that come and go, disease flares and remissions, and the uncertainty of what each day will bring—can be difficult and challenging. It is normal to experience feelings of unhappiness, frustration, anger, or sadness when you live with a chronic illness such as lupus. And it is normal to grieve for the loss of the life you had before lupus. As you learn more about lupus, and how to adjust and adapt to necessary life changes, these sorts of negative feelings will lessen.
Sometimes, though, negative feelings can become overwhelming and long-lasting. How do you know if and when to seek professional help for these feelings? In this fact sheet, we will try to help you understand the difference between temporary mood swings and long-lasting feelings that signal a more serious illness, called clinical depression.
Symptoms
People are considered to be clinically depressed when they have a depressed or irritable mood, decreased energy, and other symptoms in the list below that last for more than a few weeks and are severe enough to disrupt daily life. Probably the best single marker for clinical depression is loss of interest in activities and responsibilities that used to be important. For example, if you find yourself saying, “I used to enjoy gardening, cooking, and going to church. I don’t feel like doing any of those things anymore.”
Clinical depression may be brought about by lupus, by the various medications used to treat lupus, and/or by any of the factors and forces in a person’s life that are not related to lupus. For reasons that are not entirely understood, this type of depression is often experienced by people with chronic disease. There is good news, however. If recognized and properly treated, symptoms of clinical depression can improve.
Psychological and Physical Symptoms of Clinical Depression
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Diagnosis
Clinical depression may not be recognized in people with lupus because its symptoms and the symptoms of active lupus can be so similar. For example, lack of energy, trouble sleeping, and diminished sexual interest can be attributed to the lupus itself. However, these are also symptoms of clinical depression.
Causes
A variety of factors can contribute to clinical depression in people with chronic illnesses. The most common cause is the emotional drain from the stress of coping with the complications of physical illness. Add to that economic, social, and workplace concerns. Various medications used to treat lupus—especially corticosteroids—may cause clinical depression. When certain organs or organ systems are affected by lupus (such as the brain, heart, or kidneys), clinical depression may occur. A flare of lupus also can trigger clinical depression, both because you feel ill, and because it may seem as though you are never going to be free of lupus.
Facts About Clinical Depression and Lupus
- Between 15 and 60 percent of people with a chronic illness will experience clinical depression.
- Clinical depression may be a result of the ways in which lupus physically affects your body.
- Some of the medicines to treat lupus—especially corticosteroids such as prednisone (and at higher doses of 20 mg or more)—play a role in causing clinical depression.
- Clinical depression may be a result of the continuous series of emotional and psychological stressors associated with living with a chronic illness.
- Clinical depression may be a result of neurologic problems or experiences unrelated to lupus.
- Clinical depression also produces anxiety, which may aggravate physical symptoms (headache, stomach pain, etc.).
- Two common feelings associated with clinical depression are hopelessness and helplessness. People who feel hopeless believe that their distressing symptoms may never improve. People who feel helpless believe they are beyond help—that no one cares enough to help them or could succeed in helping, even if they tried.
What Can You Do?
Clinical depression generally improves with a combination of psychotherapy and medication.
Seek psychotherapy. You should not feel embarrassed or hesitant about asking your doctor for a referral to a psychiatrist, psychologist, or therapist. Psychotherapy, under the guidance of a trained professional, can help you learn to understand your feelings, your illness, and your relationships, and to cope more effectively with stress. Cognitive behavioral therapy—a special type of psychotherapy—can be very helpful when you are living with chronic illness. Support groups led by a therapist or trained counselor, such as those organized by the LFA national network of chapters and affiliates, also can be instrumental in helping you deal with symptoms of clinical depression. To find a group in your area, go to lupus.org/chapters or call toll-free (800) 558-0121.
Take antidepressant medications. Several types of prescribed drugs can help ease the effects of clinical depression. Anti-anxiety medicines are also available to reduce worry and fearful feelings. These improvements can occur in a matter of weeks in some people once medication is started.
Find ways to reduce pain. Chronic pain can be a factor in the development of clinical depression. Besides medication (which can also play a role in clinical depression), experts often recommend non-medication ways to conquer—or at least reduce—chronic pain, such as yoga, tai chi, Pilates, acupuncture, biofeedback, meditation, behavioral changes, play therapy, and chiropractic care.
You may be considering over-the-counter treatments for your depression and/or pain. It is important to remember that all herbs and supplements should be discussed with your rheumatologist or primary care provider before you try them, as certain ingredients can cause reactions with your prescribed medications.
Get more exercise. If you are physically able, take part in some sort of physical activity every day. This can be as simple as walking the dog, yard work or gardening, or window shopping at the mall.
Improve your sleep habits. Not getting enough restful sleep can cause many health problems, including symptoms of clinical depression. To improve your sleep, and, in turn, your mental well-being, try to:
- Get seven to eight hours of sleep in a 24-hour period.
- Do aerobic exercise every day, such as brisk walking—or whatever you can manage.
- Avoid caffeine, nicotine, and alcohol several hours before bedtime.
- Know which medications keep you from sleeping and take those early in the day.
- Have a good mattress, comfortable bed linens, the right room temperature, and the right amount of darkness.
- Include rest periods throughout your day when needed.
If you still aren’t getting enough sleep, find a reputable sleep center and talk to your doctor about sleep medications.
Build a support system. Stay in touch with family members, former work buddies, or long-time friends. Make phone calls, join Facebook, try videoconferencing, or consider adding an animal companion to your family.
Stronger Ties With Friends & Family
Treating depression may improve your social life. Depression isolates people. It can sap your self-esteem, making you feel unlikeable. While therapy and medication can help restore some of that lost confidence, you still need to decide to reach out. Reconnecting to old friends when you’re depressed -- not to mention making new ones -- is hard. But it’s a crucial part of getting better.
Getting Help
Some people with depression try to wait it out, hoping it will get better on its own without treatment. That's a mistake. Studies have found that the longer depression lasts, the worse your symptoms may get and the harder it is to treat.
See your doctor. Schedule an appointment with a therapist. The sooner you get help, the better your odds for a healthy future.
Better Love Life
Some antidepressants may dampen the libido. But often, the bigger roadblock to a happy love life is depression itself. One study showed that 70% of people with depression reported a loss of sexual interest while not taking medicine. Treatment may help restore your self-confidence and strengthen your emotional connection with your partner.
Pain Relief
Treatment for your depression can make you feel better emotionally and may reduce pain. That’s because depression can contribute to the discomfort of pain. Studies have found that people who have conditions like arthritis and migraines actually feel more pain -- and are more disabled by it -- if they're depressed. Seeking treatment may help provide relief.
Improved Health
If you are depressed, getting treatment may help prevent some serious diseases down the road. That’s because depression can take a toll on your body. One study found that women who were depressed had double the risk of sudden cardiac death than women who weren’t. Getting treatment may help lessen health risks.
Better Performance at Work
Depression can make it hard to hold a job. If you’re depressed, you might lose focus at work and make more mistakes. If you think depression might be affecting you at work, getting help now could head off serious problems.
Sharper Thinking and Better Memory
Feeling forgetful? Does your thinking seem fuzzy? Experts have found that depression might cause structural changes to the areas of the brain involved in memory and decision-making.
The good news is that depression treatment may prevent or reverse these changes -- clearing away the cobwebs and strengthening your recall.
Happier Home Life
Irritable and angry? Constantly snapping at your kids -- and then feeling bad about it? Getting depression treatment can help boost your mood. And that can help reduce tension around the house and improve your relationship with your family.
Healthier Lifestyle
Why does depression cause some people to gain weight? In part, it’s behavioral -- you may withdraw and become less active, or turn to food for comfort. It’s also physiological -- low levels of certain brain chemicals can trigger a craving for carbs. Getting treatment may change that while giving you the energy to exercise and eat well.
Less Chaos, More Control
When depression zaps your energy, even the most basic tasks -- like vacuuming or paying the bills -- can become impossibly hard. The more chaotic things get, the less capable you feel. Depression treatment can restore the energy you need to take control of your life and get it organized.
Lower Risk of Future Depression
People who have been depressed have a higher risk of becoming depressed again. But ongoing therapy or medication may help prevent depression from coming back. Even if it does return, treatment now will prepare you. You’ll know the early signs. You’ll know some coping skills. And you’ll know where to get help.
Stronger Ties With Friends & Family
Treating depression may improve your social life. Depression isolates people. It can sap your self-esteem, making you feel unlikeable. While therapy and medication can help restore some of that lost confidence, you still need to decide to reach out. Reconnecting to old friends when you’re depressed -- not to mention making new ones -- is hard. But it’s a crucial part of getting better.
Getting Help
Some people with depression try to wait it out, hoping it will get better on its own without treatment. That's a mistake. Studies have found that the longer depression lasts, the worse your symptoms may get and the harder it is to treat.
See your doctor. Schedule an appointment with a therapist. The sooner you get help, the better your odds for a healthy future.
Change your self-talk. Feelings of anger and self-pity can bring on unproductive thoughts; for example, “It’s not fair. I haven’t done anything wrong. Why me?” “I’m too weak even to fight off this illness.” Replace negative, self-defeating inner language with truthful, productive thoughts, such as: “I feel lousy, but I have many blessings.”
You can also list the people and things in your life for which you are grateful: A loving spouse or significant other; your children, and the children of your extended family; caring relatives; good friends; a beloved pet; work or hobbies you enjoy and are able to do; a home you love; volunteer activities; fellowship at school, at a place of worship, or at a community center. Try to add to this list every day!
Discover the values of volunteerism. Volunteerism can provide real emotional benefits. Helping with a charitable cause that is meaningful to you can create social, supportive connections. Helping others can have a positive impact on your sense of well-being.
Strive to accept the new “you.” Pace yourself, and don’t feel badly about delegating some of your responsibilities. Ask for help, and accept help graciously. Finally, focus on what you have, not on what you don’t have, and on what you can do, rather than what you can’t do.
Conclusion
Just as clinical depression develops over time and not overnight, conquering clinical depression is a gradual process. However, most people with lupus find that, in time, their overall attitude and sense of well-being are greatly improved.
You will also find helpful suggestions for living well with lupus in the LFA Patient Education Series fact sheets, Living with Lupus and Coping with Lupus, and on the LFA Web site, lupus.org.
Related Information
Strategies for Restful Sleep
April 2011 15 Questions with Dr. Michael Smith
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