Lupus and Depression: Understanding the Connection

A chronic illness can bring a lot of stressors, and this is often the reason why people with lupus have a higher risk of new or worsening depression.

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, guilt, or pessimism
• Irritability, restlessness, and difficulty sitting still
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Difficulty concentrating, remembering, or making decisions
• Sleep problems
• Appetite or weight changes
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause (which may not ease, even with treatment)

“Worrying about income and paying bills all the time can definitely increase your stress level,” says Patricia Katz, PhD, an author of the study and a professor of medicine and health policy at the University of California in San Francisco.

Black, Hispanic, and Indigenous people with lupus — groups at highest risk for the condition — may also face additional mental health challenges, particularly at work, says Monica Blied, PhD, a clinical psychologist who has lupus and is the founder of Faces of Health Wellness Center in Claremont, California. Beyond depression, it can also trigger feelings of stress and anxiety.

“If you feel like you have to work twice as hard to be respected and acknowledged, then the prospect of asking for time off or accommodations due to lupus is very difficult,” Dr. Blied says. “Just telling people you have a chronic condition that causes pain and fatigue and organ damage is very stressful.”

Depression is a complex condition, and those with lupus can develop it for a variety of reasons.

• Medications Some prescription drugs for lupus, especially corticosteroids like prednisone that are taken at higher doses, may contribute to depression.

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  Given the unwelcome side effects of corticosteroids, recent guidelines recommend primarily using them for symptom control and then tapering off as soon as possible.

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• Poor Sleep, Fatigue, and Chronic Pain Dr. Katz notes that pain, fatigue, and poor sleep — everyday hallmarks of lupus that can rev up stress and depression — aren’t well controlled by the immune-suppressing medications, like steroids, that battle the underlying cause of the disease.
• Lupus Fog People with lupus can have cognitive symptoms such as memory problems, difficulty concentrating, mood swings, and confusion, all of which can have a negative impact on their mood. Medications, fatigue, stress, poor sleep, and the mental health impact of lupus may all play a role in cognitive dysfunction, but you can work with your healthcare provider to help manage it.

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• Stress Perpetual feelings of mental or emotional strain are a common cause of depression. Experts believe that stress can suppress the production of neurons in the hippocampus, which is a region of the brain involved in regulating emotions.

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  Not only does the stress of having lupus impact mental health — it can also trigger flare-ups of lupus symptoms.

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• Quality of Life Issues A lupus diagnosis can instantly impact how you live your day-to-day life. If you experience fatigue, joint pain, or muscle aches that severely limit your social interactions, isolation is yet another depression risk factor.

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It can be a delicate balance to address both of these health issues at the same time.

Katz recommends that people with lupus work with their doctor and look to self-care strategies for pain management and a better frame of mind. Examples include:

• Increase daily physical activity. Even short but intentional spurts of moving your body (like walking to the mailbox or taking your dog around the block) can improve your day-to-day mental health and help ease painful symptoms. If you suffer from chronic pain, talk to your healthcare provider before starting any new exercise routine.
• Build a support network. Because social isolation is so damaging — and yet so common with chronic illness — it is important to seek out a group of people who will uplift you. This can be in person or through digital forums, like online support groups.
• Improve sleep habits. Chronic illness can affect quality rest, but good sleep is vital to your overall wellness and peace of mind. Setting a consistent sleep schedule, creating a restful bedroom environment, and staying physically active are all ways to help improve your sleep quality.
• Consider antidepressant medications. If you do have depression, lifestyle changes alone may not have the power to lift your mood. A healthcare provider can discuss appropriate antidepressant options for your treatment plan.
• Address chronic pain. Complementary and alternative therapies such as acupuncture, yoga, or tai chi, may all help reduce discomfort and improve mood.

• People with lupus are at greater risk of developing depression. Both the emotional and physical stressors of the disease are known risk factors for mental health problems, including stress and anxiety.
• Certain medications that treat lupus, poor sleep, and chronic pain are all factors that can cause depression. Finding balance in managing lupus symptoms along with those of depression involves combining medication with lifestyle changes, such as increasing physical activity, addressing chronic pain, and having strong support networks.
• People with lupus should work with their healthcare provider to discuss solutions for feelings of depression, including antidepressant medications.