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Depression and Lupus: What’s the Connection?

Updated on September 28, 2020
Article written by
Laurie Berger

Depression is a common symptom of systemic lupus erythematosus (SLE) — an inflammatory autoimmune disease. Nearly 1 in 4 adults with SLE, the most common form 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.

What Is Depression? How Is It Different From Feeling Sad?

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:

  • Sadness, irritability, anxiety, or an “empty” feeling
  • Loss of interest or pleasure in activities you usually enjoy
  • Hopelessness or pessimism
  • Changes in appetite
  • Sleep problems
  • Fatigue
  • Feelings of worthlessness or guilt
  • Cognitive problems, such as difficulties thinking or concentrating
  • Persistent thoughts of death or suicide

Because depression and lupus have some common symptoms — including fatigue, insomnia, and cognitive dysfunction or “lupus 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.

What Does Depression Feel Like for MyLupusTeam Members?

On MyLupusTeam, more than 8,200 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:

  • “When the fatigue is overwhelming, or I try to do too much, I get depressed. It sends me into a funk for a few days and I don't even try.”
  • “I was diagnosed with severe clinical depression at age 15, and this disease makes it worse. I honestly never feel well.”
  • “I miss my old self … the self who used to be fun, goofy, and active.”
  • “When I’m so exhausted — and all I can do is sleep — I get depressed and wonder, ‘What's the point of living?’”
  • “I ran into an old friend who asked what happened to my hair. I felt so badly, tears came down my face.”

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.

What Causes Depression in People with Lupus?

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:

  • More than two weeks have passed since a Prednisone dose increase
  • Prednisone dose was less than 40 milligrams daily
  • Emotional symptoms improve with additional steroids

Another cause of clinical depression may be the affect 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.

Treating Depression in Lupus

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

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.

Counseling

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.

Diet

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.

Exercise

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.

Stress Reduction

Experts often recommend complementary therapies to reduce the stress and pain of chronic inflammation that may cause depression. They include yoga, tai chi, Pilates, acupuncture, biofeedback, and meditation. Members of MyLupusTeam have shared that they relax by journaling, playing music, gardening, watching funny movies, cooking, and fishing.

Sleep

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:

  • Get seven to eight hours of sleep each night.
  • Avoid caffeine, nicotine, and alcohol before bedtime.
  • Take any medications that disrupt sleep earlier in the day.
  • Make your bedroom as sleep-supportive as possible, including a quality mattress, sufficient darkness, and a comfortable temperature.
  • Plan naps during the day, when needed.

Social Support

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 Share Ways to Manage Depression

By joining MyLupusTeam, members gain a community of more than 178,000 people living with lupus who understand its challenges, including depression.

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:

  • “I give myself a day to wallow in the depression, then put on my big girl panties and get on with life! If I don’t, my mood gets lower and lower, and it’s harder to pull yourself out.”
  • “I force myself to go outside. There's something about being outdoors that refreshes my mind.”
  • “I like to journal. It helps to get the thoughts out of my head and onto paper.”
  • “You need to know that your new superpower is patience, and the ability to put yourself first, to edit the toxic things from your life, and to find balance.”
  • “It’s important to have a supportive group around you. Like family, friends, or people you can relate to, like us!”

Do you live with lupus and depression? What has worked to help you manage depression? Share below in the comments or post on MyLupusTeam.

References

  1. Lupus and depression: Know the signs and how to get help — Lupus Foundation of America
  2. Prevalence of depression and anxiety in systemic lupus erythematosus: a systematic review and meta-analysis — BMC Psychiatry
  3. Depression — National Institute of Mental Health
  4. Researchers identify key mechanism linked to neuropsychiatric lupus — Science Daily
  5. A surprising new link between inflammation and mental illness — and a potential drug to protect the brain — Boston Children’s Hospital
  6. The Effects of Lupus and Lupus Medications on Mood — Hospital for Special Surgery
  7. Chronic Illness and Mental Health — National Institute of Mental Health
  8. Medications used to treat lupus — Lupus Foundation of America
  9. How lupus affects the nervous system — Lupus Foundation of America
  10. Depression may increase systemic lupus erythematosus risk — Healio Psychiatry
  11. Psychotherapies — National Institute of Mental Health
Laurie Berger has been a health care writer, reporter, and editor for the past 14 years. Learn more about her here.

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