Depression is a common symptom of systemic lupus erythematosus (SLE) — an inflammatory autoimmune disease. Nearly 1 in 4 adults with SLE, the most common type of lupus, experience major depression, according to a 2017 study published in BMC Psychiatry. That rate is twice as high as the general population. Depression in people with lupus contributes to decreased quality of life, as well as higher risk of cardiovascular and other chronic diseases.
Sadness is a temporary feeling in response to disappointments or losses. Depression, on the other hand, is a serious mood disorder that affects daily functioning and can last much longer.
According to the National Institute of Mental Health, you may have clinical depression if you’ve experienced at least five of the following symptoms for most of the day, nearly every day, for more than two weeks:
Because depression and lupus have some common symptoms — including fatigue, insomnia, and cognitive dysfunction or brain fog — it may be hard to tell what’s causing your mood disorders. Understanding the difference between depression and day-to-day sadness and “blues” can help you get proper diagnosis and treatment. If you think you might be clinically depressed, talk to your doctor.
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On MyLupusTeam, more than 8,600 members report depression as a symptom. In this understanding and supportive community, people often share their challenges with depression.
Here are some members’ descriptions of how they experience depression:
While depression may affect people with lupus in different ways, all share the experience of it impacting their quality of life — and proving difficult to shake off.
The risk of depression is higher for anyone who has a chronic illness — not just people with lupus. One reason is that living with a chronic disease can feel like an ongoing and overwhelming burden. Between 15 percent and 60 percent of people with a chronic illness will experience clinical depression at some point, according to the Lupus Foundation of America.
Many people with lupus struggle with the emotional and psychological roller coaster of lupus symptoms, such as pain, fatigue, cognitive issues, and skin rashes. They may also grapple with more life-threatening symptoms, such as cardiovascular disease and strokes, which have a profound impact on mood and quality of life.
Some of the medicines used to treat lupus can also play a role in causing depression. Corticosteroid treatments such as prednisone — powerful medications that suppress immune activity and relieve inflammation — are associated with a range of psychological side effects. These include irritability, agitation, excitability, insomnia, mood swings, and depression.
Prednisone can generally be ruled out as the cause of depression if:
Another cause of clinical depression may be the effect of lupus inflammation on the brain and spinal cord. In a 2019 study published in the Journal of Neuroscience, researchers identified a unique antibody in the brains of people with lupus which attacks nerves and causes inflammation or damage. This may be responsible for neuropsychiatric symptoms — such as depression, anxiety, headaches, seizures, psychosis, and other cognitive impairments — which occur in up to 80 percent of adults and 95 percent of children with lupus. Another study conducted in 2017 on animals found that circulating cytokines (proteins that regulate inflammatory activity in the body) can cross the blood-brain barrier and set off immune responses in the brain, leading to depression and other disorders.
Having a preexisting mental health condition can also increase the risk of developing lupus. A 20-year cohort study published in JAMA Psychiatry found that women with a history of depression had a more than two-fold increased risk of SLE. If you have symptoms of depression, you can ask your doctor for a lupus screening.
The good news is that depression can be treated. Start by talking to your doctor or rheumatologist. If lupus is suspected as the source of depression, your doctor may prescribe medication to manage lupus symptoms. If psychological factors are causing mood disorders, an antidepressant medication may be recommended. Making healthy lifestyle changes can also help manage inflammation and subsequently, depression and fatigue.
Antidepressants, such as Celexa (citalopram), Cymbalta (duloxetine), Prozac (fluoxetine), and Zoloft (sertraline), can address depression in people with lupus. Anti-anxiety medicines are also available to reduce worry and stressful feelings. Some people may see improvements in just a few weeks after medication is started.
Your doctor may refer you to a mental health professional, such as a psychologist or counselor. Many types of psychotherapy, including traditional talk therapy and cognitive behavioral therapy, can help you work through difficult emotions and develop healthy coping mechanisms. Support groups led by a therapist or trained counselor can also be instrumental in helping you deal with depression.
Improving diet and nutrition may reduce lupus symptoms, as well as those of cardiovascular disease and other inflammation-related conditions. Most physicians who specialize in lupus recommend the same low-fat, low-cholesterol, high-fiber diet recommended by the American Cancer Society and the American Heart Association. Check with your doctor before starting any new diet program.
A regular exercise regimen not only promotes general health in people with lupus, it can also reduce fatigue and improve mood and self-esteem. Moderate sessions of yoga, stretching, pool exercises, aerobics, and recumbent bicycling may provide benefits for depression. If your symptoms get worse after exercise, you may need to adjust your workout. Check with your doctor before starting any new exercise program.
Experts often recommend complementary therapies to reduce the stress and pain of chronic inflammation that may cause depression. They include:
Members of MyLupusTeam have shared that they relax by journaling, playing music, gardening, watching funny movies, cooking, and fishing.
Not getting enough restful sleep can cause many health problems, including symptoms of clinical depression. The Lupus Foundation of America suggests the following sleep-improvement tips:
Staying in touch with family members, former colleagues, and long-time friends is an important mood booster. Getting a pet can also improve mental health. Joining an online support group is another effective way to stay connected and share experiences with people facing similar health issues.
MyLupusTeam members support each other and share ways they have found to live their best lives with lupus. In their own words, here are some MyLupusTeam members’ tips for managing depression:
By joining MyLupusTeam, members gain a community of more than 198,000 people living with lupus who understand its challenges, including depression.
Do you live with lupus and depression? What has worked to help you manage depression? Share below in the comments or post on MyLupusTeam.