A frustrated man holding his head in his hands and also holding a bottle of anti depression medication.

RA, Depression, and Pain Management

Does your rheumatologist routinely ask about your mental health or emotional well-being? Mine doesn’t. Our visits typically cover pain, swelling, infections, any changes in breathing or heart function, laboratory orders, and prescription refills.

Depression & anxiety aren't prioritized

Before each visit, however, while I’m seated in the rheumatologist’s waiting area, I am asked to complete the RAPID3 (Routine Assessment of Patient Index Data 3) questionnaire. It provides a quick and easy assessment of patient-determined disease severity.1

Although there are two questions on the questionnaire that ask how you’ve been able to deal with feelings of anxiety or depression during the past week, the value assigned to those responses is not factored into the final score.

Emotions are rarely discussed during a visit

Beyond these two questions on the RAPID3, I don’t think that emotions have been discussed as part of a normal rheumatologist visit. The only exception I can think of is the visit I had with my rheumatologist just a month after my mother died. I was in the can’t-talk-without-crying stage (which still hits me randomly out of the blue). My distress during that visit elicited a small amount of empathy from my doctor but not much.

Mental health and rheumatoid arthritis symptoms

According to the Arthritis Foundation, having any form of arthritis can have a negative effect on your mental health, most commonly manifested as depression or anxiety.2 Conversely, mental health problems can impact arthritis symptoms.

I thought I was holding up okay

Last year following my mother’s death, I started to be amazed that my body was holding up so well. I expected something to go awry. It didn’t seem I could possibly be under that much stress and emotional turmoil without experiencing a flareup of my RA or MS. Sure I was a little stiffer in the joints, but I chalked that up to a change in eating habits.

After 12 months off sugar and high carbs, I broke down and ate some cake after her memorial serve. That resulted in noticeable swelling and discomfort by the evening. And, then I felt bad physically and emotionally.

Depression as part of the RA experience

As a patient advocate, I am fully aware that depression and anxiety can be associated with many different autoimmune diseases. As someone living with RA and MS, I know that depression and anxiety can be associated with these diseases specifically. But to be honest, there’s much more information available about people living with MS who experience depression and anxiety than those living with RA. It’s more easily accepted and acknowledged as being a part of MS.

I don’t see that same type of understanding or awareness regarding RA and depression or anxiety. What can we do about it? I suggest that we talk more openly about it.

Frustration and anger can simmer into depression

In general, what I observe in the RA community is that people more easily express frustration, anger, and disappointment with their doctors, poor access to quality healthcare, and lack of understanding from those around them.

The pain of RA can be overwhelming, insidious, and hard to treat. People in pain, particularly ones who don’t have access to effective pain management, can understandably become angry and frustrated. Anger and frustration that linger can simmer into long-term depression and anxiety. This is based on personal observation and experience.

However, if you can get the pain under control, you can potentially reduce the anger or frustration, which in turn might limit at least one source of depression.

Antidepressants for chronic pain treatment

Research suggests that some antidepressants have anti-inflammatory properties that help to reduce symptoms of RA.3 Antidepressants can even be prescribed to manage pain in RA.4 But I’ve seen members of the RA community get angry that their rheumatologists suggested a trial of antidepressant medication specifically to reduce pain caused by RA.

“I’m not depressed!! I am in pain!!” would be a common complaint.

The analgesic effect of antidepressants

The stigma of depression can get in the way of treating all aspects of RA. There needs to be greater awareness of the analgesic effect of antidepressant medication. The Johns Hopkins Arthritis Center website explains this very well:5

The effectiveness of antidepressants for the treatment of major depression is well documented; however, the analgesic properties of this class of medication are under-appreciated. It is important for the patient to understand for which of these applications an antidepressant is being prescribed. Likewise, it is important that the physician understand that antidepressants can treat both pain and depression.

Mental and physical health are related

Perhaps since I’ve been on antidepressants for so many years and pain caused by RA is not often a primary complaint I present to my rheumatologist, my doctor doesn’t discuss these issues with me. But she should at least ask on occasion.

Talking to a healthcare professional

Physical health and mental health are so intertwined that it is difficult to address one without affecting the other. This is one reason I have a LCSW (licensed clinical social worker) with whom I discuss all matters related to mental health: death, grief, pain, health, loss of dreams, depression, worry about the future, hopes for the future, actions to take today and this week, and more.

I consider talk therapy to be almost as important for treating my autoimmune diseases as is Rituxan and other medications. Without it, my well-being would suffer and then I would suffer.

Take the initiative to bring up mental health

Especially if your doctor doesn’t routinely ask about your mental health, please take the initiative and bring up the subject. And know that it’s equally important to report that you are NOT experiencing problems with depression and anxiety as it is to report problems. Your overall health depends upon it.

Please be well my friends,
Lisa

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