Emotional problems

Having a chronic illness like RA can be emotionally challenging. In fact, if you are diagnosed with RA, the first thing you may find yourself doing is dealing with the powerful feelings that surface, including anxiety, uncertainty, and fear. After overcoming the initial reaction, the daily challenges posed by RA increase your risk for emotional problems like depression, anxiety, and stress.

Studies have shown that patients with RA, particularly those with active disease who suffer from disability that limits ability to function, are at high risk for depression and anxiety.1-3 These findings highlight the importance of getting the appropriate treatment for RA to control joint involvement and limit the impact of the disease and being alert for emotional problems as they arise so that they can be managed appropriately with the many drug and non-drug treatment options available.


 

Reacting to a diagnosis of RA

No two people will react the same to the diagnosis of RA, but there are some common feelings that you may encounter when you learn that you have RA. These include shock, denial, confusion, anxiety, anger, and relief.

 

Feelings you may experience…

Shock
  • Shock is a typical first reaction to a diagnosis of RA.
  • Allow yourself to acknowledge your shock, then talk to your friends and family and get some support.
  • Once you’ve given yourself space, then learn all you can about living with RA.
Confusion
  • When you learn that you have RA, you may be confused and look for some explanation. You may ask: “Why me? I have always eaten well and exercised and taken care of myself.”
  • We all want to know the reason when we have a health problem. However, unfortunately, with RA you probably won’t ever find an explanation.
Denial
  • You may go through a period where you avoid feeling and thinking about your diagnosis and what it may mean to your life.
  • Allow yourself space for a healthy amount of denial (it’s a natural reaction), but don’t get stuck denying that you have RA.
  • With RA, early and aggressive treatment is a key to limiting joint damage and living a full life.
Anger
  • Anger is a pretty normal way of reacting to something that threatens to change your life.
  • Once you’ve gotten over your initial anger, the challenge will be to find a way of turning your anger into the positive energy you will need to live full and healthy life with RA.
Anxiety
  • You may experience anxiety about what RA will mean for your future.
  • Your challenge will be to take each day as it comes. This is the opportunity of living with a chronic disease like RA: it challenges you learn to live and embrace the present.
Relief
  • Once the air has cleared and you know the facts about RA and how, with the effective treatments now available, a person with RA can live full and productive life, you may experience relief.

 

Emotional problems you may experience

People with RA tend to experience more stress, anxiety, and depression than other people in the general population.

 

Anxiety

Anxiety typically happens in response to circumstances in life, such as living in a war zone or living with the uncertainty, and stress of having a chronic disease like RA. Different stressors, like financial uncertainty and worry about the future can trigger or worsen anxiety.

Stress

Stress affects most people, whether it has to do with work or difficult life situations. However, a person with a chronic disease like RA tends to live with more stress than others. RA challenges a person to live with quite a bit of uncertainty. Stress may have an effect on the immune system and may have a role in triggering an RA flare or worsening of RA symptoms.4 There are many effective interventions that you can use to reduce stress in your life, including a regular exercise program, yoga, meditation and other relaxation techniques, and counseling.

Depression

Depression is common in people with RA, especially those with active disease who experience RA-related disability. Since depression is a dangerous condition that can increase your risk for doing harm to yourself, it is important to be aware of the signs of depression so that it can be diagnosed and treated as quickly as possible. Diagnosing depression can be difficult. If you notice the symptoms of depression in yourself or a friend or family member, alert your doctor and ask for an evaluation.

 

Major depression: symptoms and diagnosis

Definition
  • Typically involves mood states including grief and sadness
  • Key element that sets it apart from mood swings is that mood state persists over extended period of time
Diagnosis
  • At least 5 of the 9 symptoms below
  • Must include depressed mood or decreased interest
  • Symptoms must have persisted for most of every day for at least 2 weeks

 

Symptoms of Depression

  • Depressed mood (feeling blue, down-in-the-dumps, hopeless)
  • A significantly reduced level of interest or pleasure in most or all activities
  • Considerable weight loss or gain (5% or more change of weight in a month when not dieting) or change in appetite
  • Frequent thoughts of death or suicide (with or without a specific plan) or attempt of suicide
  • Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia)
  • Behavior that’s agitated or slowed down, which is readily observable by others
  • Feeling fatigued or very low energy
  • Having thoughts of worthlessness or extreme guilt
  • A diminished ability to think, concentrate, or make decisions

 

How are different emotional problems treated?

The treatment of an emotional problem depends on the nature of the problem. There are many treatment options for common emotional problems, including depression, anxiety, and stress, including medications and counseling.

 

Treating depression

The biggest challenge to successfully treating depression is the reluctance that people have to seek and follow-through with treatment. Some people believe that they need to be strong and resist the emotional difficulties. Admitting the need for help is difficult and can seem like surrendering. However, real strength is reaching out for help when you need it and by so doing, taking charge of your health and welfare.

There is agreement among mental health experts that the best treatment for major depression is a combination of antidepressant medication and psychotherapy or counseling. While each type of treatment can provide some relief for depression, the combination works well together and can be highly effective.

Psychotherapy or counseling for depression can be done individually or in a group setting led by a qualified psychiatrist, psychologist, social worker, or counselor. It generally takes several months of treatment to get the best results. So, be prepared to stick with it for a sufficient amount of time. You may also consider taking part in a support group for people with RA. Getting support from a community of people (including patients online) dealing with the same problems as you can be a useful and powerful experience. While support groups are a useful addition to formal psychotherapy or counseling, they are not a substitute. You can speak to your doctor to get a referral to a qualified mental health professional for psychotherapy or counseling.

Antidepressant treatment

Only a qualified physician (typically a psychiatrist) can determine which antidepressant medication will be best for you. However, a variety of types of antidepressants have been used successfully to treat major depression. These include a group of antidepressants called tricyclics, such as Elavil (amitriptyline), Pamelor (nortriptyline), and Tofranil (imipramine), and another group of antidepressants called serotonergic antidepressants, including Zoloft (sertraline), Paxil (paroxetine), Effexor (venlafaxine), and Prozac (fluoxetine). Other types of antidepressants that may be useful include Wellbutrin (bupropion HCl), Serzone (nefazodone), and Desyrel (trazodone).

Because different antidepressants cause slightly different kinds of side effects and no individual person will react the same to every medication, you will need to work with a psychiatrist to find the right antidepressant for you, based on how well it works and how well you tolerate it. It may take up to 6 weeks to find out how well a particular medication will work for you. So, work closely with your psychiatrist and be prepared to give the process time.

Treating anxiety

Since anxiety typically occurs as a response to certain circumstances in life, which for a person with RA may include the uncertainty of having a chronic illness, treatment approaches that address those life circumstances may be particularly helpful. These include psychotherapy, counseling, or stress reduction training. These interventions can help a person understand the source of anxiety and develop ways to handle those anxious feelings.

In addition to non-drug interventions, there are some medications that are effective in treating anxiety. These include some types of benzodiazepines, such as Valium (diazepam) and Xanax (alprazolam), and certain antidepressant medications, such as Zoloft (sertraline), Paxil (paroxetine), and Effexor (venlafaxine).

Stress

The best way to acquire skills to help you reduce stress is to work directly with a professional trained in strategies for stress reduction. Other resources that may be useful include psychotherapy, counseling, support groups, peer counseling, exercise, and self-help books.

Written by: Jonathan Simmons | Last reviewed: September 2013.
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