Depression Increases Suicide Risk in RA Patients
People who live chronic, autoimmune diseases, such as rheumatoid arthritis, experience depression at higher levels than the general public. When the disease is active and chips away at our quality of life, we may begin to feel hopeless or anxious about the future. Living with a chronic progressive, painful, and debilitating disease is not easy, and rheumatoid arthritis is no exception.
Patients with RA are at increased risk of anxiety, depression and low self-esteem, with high levels of associated mortality and suicide1. It is not surprising that disability and loss of function caused by RA can lead to depression, but there may be other contributing factors, such as medical side-effects, gender, or age. A meta-analysis of 72 studies, involving 13,189 people with RA, revealed that 14.8% to 38.8% of RA patients experience major depressive disorder2.
A case study in 1999 described five patients who experienced adverse psychiatric reactions to non-steroidal anti-inflammatory drugs (NSAIDs) taken for pain due to rheumatoid arthritis, osteoarthritis, or other painful neuromuscular conditions, and who had co-existing mental health disorders. All five patients developed moderate to severe depression, three patients became paranoid, and four had either thoughts of or attempted suicide while using NSAIDs. When the pain medication was stopped, the psychiatric symptoms went away, but returned when the patients tried the medication again3.
A more recent study examined the prevalence of anxiety, depression and suicidal ideation (or thoughts) in 150 RA patients who were treated with methotrexate, leflunomide, hydroxychloroquine, or biological drugs. The results were somewhat surprising. Patients taking biologic DMARDs had the highest rates of depression, anxiety, and suicidal thoughts, while those using leflunomide showed the lowest rates. Patients using methotrexate and leflunomide reported less suicidal ideation than those using hydroxychloroquine and biological drugs4.
In the general public, suicide is almost 4 times more prevalent in males than females, however a study in Oulu, Finland found that females were over-represented among RA patients who had committed suicide over a 13-year period. Researchers found that depressive disorders preceded suicide in 90% of the female RA patients. Also, before their suicide 50% of the female RA patients (vs 11% of the male RA patients) had experienced at least one suicide attempt previously. Researchers found that males were less often depressed, but committed suicide after having had RA for a shorter period of time5. Another study suggests that almost 11% of all RA patients experience suicidal thoughts, a number that rises to 30% in patients who also report depression6.
What can I do if I feel I might harm myself?
September 8-14, 2014 is National Suicide Prevention Week and I want you to take a moment to read the following suggestions of how to deal with suicidal thoughts, excerpted from HelpGuide.org (©)7. If you ever find yourself in a very dark place, these words may come back to you and keep you safe.
Step 1. Promise not to do anything right now.
Even though you’re in a lot of pain, give yourself some distance between thoughts and action. Make a promise to yourself: "I will wait 24 hours and won't do anything drastic during that time." Or, wait a week. Thoughts and actions are two different things and your suicidal thoughts do not have to become a reality.
Step 2. Avoid drugs and alcohol.
Suicidal thoughts can become even stronger if you have taken drugs or alcohol. It is important to not use nonprescription drugs or alcohol when you feel hopeless or are thinking about suicide.
Step 3. Make your home safe.
Remove things you could use to hurt yourself, such as pills, knives, razors, or firearms. If you are unable to do so, go to a place where you can feel safe. If you are thinking of taking an overdose, give your medicines to someone who can return them to you one day at a time as you need them.
Step 4. Take hope – people DO get through this.
Even people who feel as badly as you do right now manage to survive these feelings. Take hope in this. There is a very good chance that you are going to live through these feelings, no matter how much self-loathing, hopelessness, or isolation you are currently experiencing. Just give yourself the time needed and don’t try to go it alone.
Step 5. Don’t keep suicidal feelings to yourself.
The first step to coping with suicidal thoughts and feelings is to share them with someone you trust. It may be a friend, a therapist, a member of the clergy, a teacher, a family doctor, a coach, or an experienced counselor at the end of a helpline. Don’t let fear, shame, or embarrassment prevent you from seeking help. Just talking to someone can release a lot of the pressure that’s building up and help you find a way to cope.
If you are thinking about committing suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the National Hopeline Network at 1-800-SUICIDE (1-800-784-2433). These toll-free crisis hotlines offer 24-hour suicide prevention and support. Your call is free and confidential. To find a suicide helpline outside of the US, visit IASP or Suicide.org.
What can I do to help my loved one who is depressed or suicidal?
First of all, know that a person who is suicidal may not ask for help. They may push you away, but that doesn’t mean that they don’t want help. Most people who commit suicide don’t want to die, they just want to stop hurting. Almost 1 million people attempt suicide each year in the US and it is estimated that 5 million living Americans have attempted to kill themselves at some point in their lives.
Suicide prevention starts with recognizing the warning signs 8, taking them seriously, and speaking up if you are worried. When talking to a suicidal person, let the person know you care, listen (don’t lecture), be sympathetic and non-judgmental, offer hope (but don’t argue, patronize, or try to “fix” their problems), and know that you are not putting ideas in the person’s head when you ask directly if he/she has had thoughts of suicide. Respond quickly in a crisis and get professional help. Once a crisis has passed, however, stay in touch with the person and continue to offer support.
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?