Regardless of which blow is dealt first, arthritis, disability, and depression are closely linked, according to patients and doctors alike.
Arthritis, the number one cause of disability in America and one of the leading causes of disability worldwide, affects more than 50 million Americans and comes in more than 100 forms. Depression — another leading cause of disability — is closely linked to arthritis. In fact, people who have been diagnosed with rheumatoid arthritis (RA) are twice as likely to suffer from depression as their peers without arthritis.
Is Depression in RA Patients Biological or Psychological?
Some believe that the reason for the link is simply that rheumatoid arthritis can be a depressing disease to live with. This explanation of depression as a comorbidity of rheumatoid or other forms of arthritis seems to make sense.
Patient Anne Hickley from the United Kingdom said, “I think clinical depression is something you either suffer or you don't. I'm incredibly lucky — I don't. Reactive depression, though, could be another matter. If my RA gets really bad, then I certainly get 'low mood,' but unlike real clinical depression, I can kick myself out of it, and so avoid the vicious circle.”
However, some cases of depression after an RA diagnosis are biological in nature, not reactive. In fact, some of the biological factors that cause RA may play a role in depression, too.
“Biologically, depression is a source of stress, which can hamper the immune system and lead to musculoskeletal decline, both of which can contribute to disability. Behaviorally, one of the symptoms of clinical depression is amotivation — difficulty being motivated to do things. We all know the saying ‘When you don’t use it, you lose it.’ This can be a factor here: people with depression and RA don’t have the motivation to move, so they don’t, which makes muscles weaker and mobility more difficult. It becomes a vicious cycle,” explained Elizabeth Lombardo, Ph.D., a psychologist, physical therapist, and author of the bestselling book "Better Than Perfect: 7 Strategies to Crush Your Inner Critic and Create a Life You Love.”
Dr. Ray Hong, a rheumatologist and member of the Northeast Ohio Arthritis Foundation Medical and Scientific Committee, echoes Lombardo, saying, “RA is an autoimmune disease that leads to an inflammatory attack on joints causing pain, swelling, and loss of function. Depression or symptoms found in depression, such as feeling sad, inability to sleep, loss of energy, or difficulty concentrating, are commonly reported in people with RA. Research indicates that depressive symptoms in RA are associated with loss of function. In other words, the less an RA patient is able to do, the more likely they are to report symptoms of depression.”
Disability and Work-Life Balance
Patients with either RA or depression are more likely to report that they are disabled, and having both conditions often contributes to the development of disability. Occasionally, RA and/or depression can lead to an inability to work. Job loss or a break from one’s career, particularly if the patient has to rely on social security disability payments, can increase depression, worsening the physical symptoms of both depression and RA.
Beth Loy, Ph.D., principal consultant for the Job Accommodation Network, a service of the U.S. Department of Labor’s Office of Disability Employment Policy, said, “It is not uncommon for individuals with arthritis to also experience depression and anxiety. Because arthritis is progressive in nature, limitations tend to compound with age. This, in turn, can have an impact on productivity at work.
“What once was manageable may become very taxing, forcing the individual to disclose a disability at work and ask for reasonable accommodations under the Americans with Disabilities Act,” Loy added. “For those who may still be struggling with accepting their medical condition, making this transition to a new situation can be overwhelming and can have an effect on one’s mental health.”
However, there is help available. Loy said, “A successful transition can be aided with education and resources, leading the individual on a path to enhanced employment.”
It is not always an easy journey for patients. They may struggle with employment options but may also struggle with being approved for disability status in their home states. Constance Rosenbrock, a Texas native now living in Chicago, says she’s had a hard time being approved, despite several rheumatic and chronic conditions, as well as depression.
“I have fibromyalgia, osteoarthritis, and Raynaud’s, and I have depression. I have been denied disability,” Rosenbrock said. A 2011 chart from the Social Security Administration shows that between 2000 and 2010, as much as 53 percent of applicants were denied disability benefits.
Depression and arthritis can create many challenges, including, for some, disability, but many people who live with RA and depression can still work and have a full, thriving life. There are many resources available to people who live with arthritis and depression that may make life with these diseases just a little bit more manageable.