Q: How and why does osteoarthritis (OA) increase a person’s risk for depression?
A: The pathways in the brain that influence how people experience both pain and emotion overlap. That means when you are depressed, you’re more likely to experience pain and vice versa. It’s a vicious cycle. Pain alone is an unpleasant experience. It can also be demoralizing. When you are in pain, you may not take part in activities that provide satisfaction and enjoyment.
Q: How does depression affect OA symptoms—and vice versa?
A: If you’re depressed, you’re more likely to be aware of your OA symptoms, and your pain-tolerance threshold will be reduced. As a result, you’ll be more likely to experience painful sensations in many parts of your body. Depression may also cause you to focus on things that are unpleasant, and feel overwhelmed. Consequently, you may be less engaged in activities that give you pleasure. Doing things you enjoy can take your mind off pain; you won’t notice your pain as much as you would if you were sitting around thinking about it. Pain may also affect the quality of your sleep. If you don’t get a good night’s sleep, you’ll feel tired and also be more prone to depression.
Q: Should treatment for OA and depression go hand in hand—and what treatments can help?
A: Improving your mood will make it easier to get off the couch and be more active. It can also help you sleep better. There is evidence that antidepressant medication can sometimes offer pain-relieving benefits. But that varies from person to person. Also, many different things affect pain, including sleep, activity level, and mood. You have to consider all these factors and address whatever is influencing the pain. For many people with OA, staying physically active and engaged in life will help them feel and function better overall.
Q: How can you tell whether OA pain is affecting your psychological well-being? When should you discuss depression screening with your doctor?
A: Depression produces symptoms that include feeling down and irritable, having difficulty concentrating and/or trouble sleeping, being tired, and, sometimes, thinking about suicide. If you experience any of these symptoms, ask your doctor to screen you for depression. Antidepressant medication and psychotherapy are effective treatments for depression, and some patients may benefit from both.
Q: Can depression and OA ever be cured?
A: There is always hope. If you feel you are a victim of your pain and there is nothing you can do about it, it can become a self-
fulfilling prophecy. But even when a chronic condition like OA can’t be cured, a person can develop the ability to adapt, cope, and enjoy a high quality of life.
Elizabeth Lin, MD, MPH, an expert in depression and arthritis, is also a family physician and an affiliate investigator for the Group Health Center for Health Studies in Seattle.
October/November 2009
Arthritis Health Monitor
Update: July 6, 2010
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