Depression and RA – the Link That Cannot Be Ignored

I am writing this post in mid-October 2020. And frankly, I am getting tons of emails from political campaigns asking me for money, or help, or both in the closing weeks of the political campaign.  Most start with the idea that they know or need something that I cannot afford to ignore. 

The more I get, the more frustrated I become. It seems that my email inbox, once the size of a small five-person town, is now a seething metropolis of hundreds of thousands of emails that I am asked to read each month. I mean, come on, people - enough.

Emails about depression draw my attention

One type of email always draws my attention: those with the words depression in the heading.  Maybe it is because I have waged a personal war on depression that anything with that word in the subject matter stops me cold. 

I suppose you could say that I have seen a depression hot spot in my life and, if someone is reaching out, I want to respond. Even if, at first look, it looks like a political advertisement. Oh, and I used to be a politician so - yes, depression and politics go together, especially as election day draws nigh.

I decided to take a look at the literature about the incidence of RA and depression. Not surprisingly, the literature is not great, but not all bad either.

What does the research say?

The first article I found is from 2002. It is a meta-analysis of available literature from a few years about TNF-inhibitors reaching a critical mass in the US marketplace. The author writes:¹

Depression is more common in patients with rheumatoid arthritis than in healthy individuals. This difference is not due to sociodemographic differences between groups, but it may be attributable, in part, to the levels of pain experienced. Variation in the methods of assessing depression partly accounts for the differences among studies examining the levels of depression in patients with rheumatoid arthritis.

Two essential things are being highlighted here. First, depression is more prevalent in people with RA. The author cited pain as the reason most people have a higher level of depression. (Not much of a surprise).

But what is a big surprise is that one of the reasons identified for this uptick in depression is that depression is measured differently in people with RA than in the general population. Now, why would that be?

Study criteria for defining depression

As it turned out, the differences had little to do with the people being assessed. Instead, the challenge was identifying the study criteria for defining depression. 

In a similar study a full 11 years later, another meta-analysis concluded a similar finding when attempting to determine the prevalence of depression in people with rheumatoid arthritis. In Matcham et al., the authors concluded that a "bewildering diversity of assessment measures were used to ascertain depression."²

I did not check it closely, but I suspect that no matter how many of these I dug up, the same fundamental issue would persist. While we know depression is a huge issue among people with rheumatoid arthritis, precisely what depression entails is still open to speculation.

The power of meta-analysis

I know that sounds a little odd, but the first thing I was taught in research class was that researchers select inclusion criteria. That individual selection makes any meta-analysis inherently tricky. That is why meta-analysis is a unique area of research that not everyone can do.

But when it is done right, as in these two studies cited, it can lead to a powerful conclusion.  Here is the overarching finding from Matcham, et al:²

Depression is highly prevalent in RA and associated with poorer RA outcomes. This suggests that optimal care of RA patients may include the detection and management of depression.

Statements like that move opinion about the need to recognize and treat depression as one of the symptoms of rheumatoid arthritis.

That leads to the bottom line. When we see our rheumatologists, it may feel like they ask lots of questions that may not pertain strictly to the physical aspects of RA. If so, they are likely looking for signs of this often unrecognized symptom.

Depression factors into RA treatment outcomes

In summary, depression is a significant factor in our eventual outcome from the treatment of RA. It pays, therefore, to invest in its treatment.  After all, we need every advantage we can secure.

Does your rheumatologist ever discuss issues like depression with you? Would you be open to it if they did?