Lupus and Depression: The Chicken and The Egg

Living with lupus can feel like a heroic balancing act between preventing flares, slowing disease progression, and trying to live your best and healthiest life. The effort involved is done so bravely and patiently, but it can understandably become overwhelming, which may lead to times of unhappiness, remorse, anger, and sadness. Sometimes these feelings may be temporary and you are able to feel like yourself quickly. And other times, these feelings may last long and can be a sign of a treatable condition called clinical depression. 

What is clinical depression?

It is a mood disorder, diagnosable by a mental health specialist, in which a person can have a combination of life disrupting symptoms for a prolonged period of time. Symptoms include but are not limited to:

  • Depressed or irritable mood
  • Decreased energy and fatigue
  • Feeling helpless or hopeless
  • Crying often
  • Insomnia or restless sleep, or sleeping too much
  • Eating too little or too much 
  • Anxiety
  • Feelings of guilt or low self esteem
  • Inability to concentrate or difficulty thinking
  • Diminished memory and recollection
  • Confusion and mental fog
  • Lack of interest in previously enjoyed activities
  • Changes in sexual interest or libido
  • Recurrent thoughts of death or suicide

Clinical depression is often seen and diagnosed in patients with chronic diseases, particularly autoimmune diseases such as lupus. This makes sense to when you dissect the mental and physical toll chronic illnesses can have on a person- it’s no small feat to stay positive all the time. With lupus, the exact cause for the high incidence rates of depression are unclear. This is because symptoms of depression can sometimes be brought about by lupus itself, its treatment, or the personal circumstances of the individual. It can be hard to tell, but it’s important to try to differentiate because it changes treatment paths. 

What can depression look like in patients with lupus?

There are various opinions regarding the effects of autoimmune disease on the nervous system and how nerve damage affects mental health. Often, there is direct neurological involvement from lupus related to the autoimmune system but it’s unclear how this affects the brain or whether antibodies cause direct damage to nerves. When mood and behavior symptoms present in a patient, it is called neuropsychiatric lupus and its symptoms include:

  • Cognitive dysfunction which includes forgetfulness, worry, mistrust, and a general difficulty in thinking. Some people with lupus describe feeling “fuzzy-headed” or being in a “lupus fog.” 
  • Depression and anxiety
  • Personality changes which can refer to feelings of anger, irritability, and lability (the sensation of not feeling or acting like yourself). Patients may isolate themselves due to this, which can further worsen both their depression and lupus symptoms. 

Research has shown that depression in lupus is influenced by a complicated mix of biological, social, and psychological factors. This study found that the ability to comfortably complete activities of daily life, healthy social interactions, and low levels of autoimmune activity within the body were related to the presence or absence of depression.  Another study found that the prevalence of depression is particularly high in adults with lupus and it is important to recognize and properly treat it. Treatment of depression can lead to better disease outcomes of lupus. 

Therefore, a rheumatologist should screen for depression in their patients and refer them to specialists. Receiving a combination of psychotherapy, appropriate medication therapy, and social support will help treat depression and reduce its effects on lupus remission. In some cases, antidepressant medications have been shown to reduce inflammation within the body and could also reduce lupus symptoms. The relationship between the two seems hard to overlook and makes me hopeful. 

Managing mental health leads to better overall autoimmune disease outcomes

Lupus braves who are known to be actively engaged in treatment  and research have been able to have longer periods of disease remission. The mental shift towards autonomy, hope, and being optimistic allows them to better manage their disease and remain present in the things that matter to them. Ongoing clinical studies hope to better understand depression and autoimmune diseases, particularly the effects of disease on the neurological system and its presentation of symptoms. 


By Nadia Bhatti

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