Because the physical impact of rheumatoid arthritis (RA) can be all-consuming, you may be dealing with psychological effects of the condition that you aren’t even aware of, but which you should definitely address so you can improve your quality of life.
According to the National Institute of Mental Health (NIMH), people with chronic conditions are more likely to develop symptoms of depression than members of the general population who are not chronically ill. This also works the other way around, with mental well-being affecting disease activity. People who experience depression are at an increased risk for developing certain chronic illnesses, compared to those who are not depressed.
Although some people with rheumatoid arthritis may veer away from treating mental health conditions because they feel it might take their attention away from their RA care, the reality is that the opposite is true. If you’re suffering from depressive symptoms, anxiety, or mood disorders, treating them with medication such as antidepressants, psychotherapy (also called “talk therapy"), or both "may help improve the physical symptoms of a chronic illness or reduce the risk of future problems,” according to the NIMH.
Your health care provider can work together with mental health professionals, such as experts in psychology or psychiatry, to ensure that you stay both mentally and physically healthy.
Anxiety is also common in people with chronic conditions, particularly when dealing with the unknowns of what might happen as a result of the disease. This can lead to associated conditions as well. For instance, sleep issues, including insomnia and extreme oversleeping, have been associated with a lower health-related quality of life in people who have chronic conditions.
“Anyone dealing with chronic illness of any kind can really come up against challenges, particularly when there is no cure, or there’s uncertainty in the progression of the illness,” said Dr. Sarah Gray, a pain psychologist with Integrative Psychology in Arlington, Massachusetts, and an instructor of psychology at Harvard Medical School.
Members of myRAteam often talk about the effects of rheumatoid arthritis on their mental well-being. “Sometimes, being in chronic pain can and will take a toll on you,” said one member of their experience. “I decided to seek professional help, as depression/anxiety mixed with chronic pain on a daily basis is not good for anyone mentally.”
There are several reasons why having a chronic health condition may put people at a higher risk for mental health difficulties, according to Mental Health America. For example, you might feel isolated because you’re spending long periods of time in the hospital, or you’re not as mobile as you used to be. In addition, you may spend excessive amounts of time worrying about your condition. You might suffer inflammation in the long-term because of the stress, and you may be going through chemical and hormonal changes.
One myRAteam member noted, “The pain and the anxiety feed off of each other. It's definitely a challenge.”
In some cases, you may feel depressed or anxious because you aren’t getting the right medical care. One research team found that people who felt stigmatized by health care workers had a decreased quality of life. They also accessed health care services less frequently than people who did not internalize and anticipate a negative response.
This situation can prevent some people from seeking care for their mental health conditions, Dr. Gray noted. “Unfortunately, sometimes there can still be a stigma around seeking help for mental health concerns. Thankfully, that's changing and continues to improve, but that can still exist.”
In some cases, you may not recognize that you’re dealing with depression or anxiety because those feelings came on slowly over time, and you didn’t notice how strong they became. Or perhaps you have gotten so accustomed to being blue or stressed that you assumed this was just a way of life now. But recognizing when you have a condition that requires a professional evaluation is important.
“In my experience, and working with so many patients at different phases and stages, the type of stress that comes up early evolves over time,” Dr. Gray said. “Often, people along the way will find ways to cope, to draw on that inner strength that's there, and hopefully get linked in with a number of supports, but the stressors change over time. And that requires ongoing support.”
Symptoms of depression may include:
Common symptoms of anxiety can include:
If you are experiencing these types of feelings, talk to your health care team or contact a mental health provider for help.
Your health care team will make the determination about what type of treatment you should pursue. In addition to the treatments your physician recommends, you can find other ways of treating depression and anxiety with lifestyle changes and therapies that go beyond medication.
Dr. Gray recommends such tools as cognitive behavioral therapy and biofeedback for coping with the many unknowns inherent to having a chronic disease. She also works directly with people to identify the specific stressors that may be troubling them. “For instance, if there's a family member who is bringing up some conflict and the patient finds it particularly difficult to navigate setting boundaries with a certain person, then we might work on concrete, specific tools to address any troublesome interactions there,” she said.
It’s essential that you remain on your treatment regimen for rheumatoid arthritis as you treat your mental health condition, while also pursuing lifestyle modifications. One 2020 study found that for older adults with multiple chronic conditions, maintenance behaviors — such as physical activity and treatment adherence — were the most critical components of self-care to combat depression. The researchers also found that “even mild [depression] symptoms can be associated with poor self-care maintenance,” emphasizing how important it is for people with chronic conditions to be screened for depression of any severity.
Make sure you have a supportive team around you, which can help when dealing with rheumatoid arthritis. A 2020 study found that people with certain chronic conditions reported family as the most important psychosocial resource they had. Positive relationships with other people “are assumed to contribute to physical and mental health, either directly by meeting basic human needs, or through enhancement of coping performance by buffering stress,” the study authors noted.
Remember that your health condition may have an effect on every area of your life, Dr. Gray said. “Relationships, activities that one may enjoy — they may be impacted by the chronic illness and the symptoms,” she noted. “Your sense of self can be affected by the change in activities and relationships, so that in and of itself can really, validly lead to feelings of loss and worry.”
Some risk factors for developing mental health issues — as well as for having chronic illnesses — are easier to modify than others, according to the Centers for Disease Control and Prevention (CDC). Stressful life circumstances, a history of trauma, and a lack of social support may be out of your control. But diet, exercise, and drug use are among the “modifiable risk factors” the CDC identifies for reducing your risk of chronic disease.
You can also consider using mindfulness as part of your journey to alleviating mental health issues.
Dr. Gray explained, “At its core, mindfulness is really approaching the present moment with openness, with curiosity, purposefully, and just being aware of what’s around you. It takes a lot of practice, repetition, and time — it’s really important for people to know it doesn't just happen.”
Managing emotional changes can be difficult, but you do not have to do it alone. On myRAteam, you can join a social network for those living with rheumatoid arthritis. In doing so, you will gain access to a social support group of people who are facing similar challenges and who understand what you are going through.
Are you experiencing emotional changes from rheumatoid arthritis? How are you managing them? Share your ideas in the comments below, or start a new conversation on myRAteam.