Lupus and Depression

Summary of a presentation given at the SLE Workshop at Hospital for Special Surgery, March 24, 2005


Enid Engelhard, LMSW
Director, Social Services
The S.L.E. Lupus Foundation

Introduction

Depression can be an extremely difficult battle to fight, especially when compounded with a lupus diagnosis. It can be particularly hard at times to know whether depression is related to lupus-related mood swings, the side effects of medicines, the emotional impact of coping with a potentially severe and unpredictable illness, or to a separate, unrelated, clinical depression.

Types of depression

Clinical depression is often described as being "chemical" or "reactive". Chemical depression involves chemical changes or neurological factors in the brain that trigger depressive symptoms. Reactive depression, on the other hand, stems from an emotional response to something that occurred in one's life, e.g., personal loss, death, or a variety of stressors that can trigger a sense of sadness that does not go away for weeks or months.

Is it depression or is it the "blues"?

There is a big difference between clinical depression and what is often referred to as the "blues". The "blues" can merely cause someone to feel "down in the dumps" as a result of a variety of life stressors, including job difficulties, money problems, or relationship issues. The "blues" typically last for several days, and a person can feel sad one day and happy the next. Most people experience the "blues" at some point in their lives. The holiday season, for example, or anniversaries of sad events, can frequently evoke the "blues".

In the case of depression, however, the symptoms are more fixated or permanent and not transient, unlike the "blues". When someone is depressed, it might seem that nothing excites or "tickles" them anymore.

Some Symptoms of Clinical Depression

  • Depressed mood (usually lasting all day)
  • Feeling of emptiness
  • Lack of motivation
  • Loss of interest in hobbies or activities that brought pleasure before
  • Weight gain or weight loss related to loss or gain of appetite (not from medicines)
  • Trouble sleeping or sleeping too much
  • Lack of concentration
  • Loss of sexual interest
  • Low energy or fatigue
  • Low self-esteem
  • Feeling helpless or hopeless

What can be confusing for those with lupus is that a number of these symptoms can alternatively be explained by the symptoms of their condition, e.g., fatigue or lack of concentration. It can be challenging to differentiate between the emotional and physical factors that may be contributing to feelings of depression. This underscores the need to talk to a physician about these symptoms.

Some of these symptoms can occur when someone is experiencing the "blues." However, if any or all of these symptoms persist for more than two weeks in a row, professional help should be considered. In any case, if these symptoms of depression get in the way of the ability to function normally, they should be brought to a physician's attention.

Some Additional Facts

Depression is a very common problem, whether there is a chronic illness involved or not. 20% of women have experienced clinical depression at some time in their lives.

Studies have reflected rates of depression varying from 15-60% in people with chronic illnesses. In lupus patients, depression may sometimes be experienced during or after a flare. This may be related to the lupus itself or to the emotional feelings that are triggered by having to cope with an active illness episode.

It is important to note the dangers of alcohol while depressed, because alcohol - as a natural depressant - can markedly increase the severity of depression and its symptoms.

Treatment/Medication

There are several treatment options for depression. Both psychotherapy and antidepressant medications can be quite effective. Those suffering from the symptoms of depression should ask their physician, social worker, or nurse, or contact their local professional association, medical society, or Lupus/Arthritis Foundation for the name of a licensed mental health professional experienced in treating people with chronic illnesses such as lupus. Working with a mental health professional can be useful in identifying additional ways to cope with the stress of chronic illness. Joining support groups such as those offered by Hospital for Special Surgery, the Lupus Foundation, or the Arthritis Foundation may be additionally helpful. It is important to keep communication open between the primary care physician, the rheumatologist, and the patient about feelings of depression so they can all work together early and effectively.

Some of the newer antidepressant medications can be very effective partners in the treatment process. Serotonin reuptake inhibitors (SSRIs) tend to have fewer side-effects than older medications. Patients can take SSRIs for 2-12 weeks to be fully effective, and sometimes different medicines and dosages need to be tried to find what works best. Generally, these medicines will be used for at least six months after the patient begins to feel better.

Things for patients to do to help themselves

Changes in behavior may be helpful in combating a serious depressive onset as well as fighting the "blues".

  • Exercise regularly
  • Take medication consistently
  • Pace yourself and get enough rest
  • Assertiveness - ask for help when needed
  • Find effective ways to communicate with family members
  • Join a support group or program
  • Eat healthily

Although depression is often a normal reaction and sometimes sadness may even help the healing process, one must be careful and vigilant about these kinds of feelings and trust their instincts when it is clear that something is wrong.

The Ultimate Goal

It is normal for someone to grieve the loss of their old self. It's important to learn to come to terms with a disease -- to try to befriend it and not to deny it. It's important to give oneself permission to be depressed for short periods of time and to develop a sense of humor along with a positive attitude. And most importantly, to get on with living.

Learn more information about HSS' SLE Workshop, a free support and education group held monthly for people with lupus and their families and friends.


Summary by Jillian Rose, LMSW, Program Manager, LupusLine and Charla de Lupus/Lupus Chat

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