What can be confusing for those living with lupus is that many of these symptoms can otherwise be explained by the symptoms of lupus as well (e.g., fatigue or lack of concentration). It can be difficult to tell between the emotional and physical reasons that may be contributing to feelings of depression.
Not all people who suffer from clinical depression have all of the symptoms. To be considered clinically depressed you will have a depressed mood, difficulty in sleep and appetite, and at least one or two of the symptoms mentioned which last for several weeks and are severe enough to disrupt daily life.
Some studies state that approximately 15% of those living with chronic illness suffer from clinical depression; others put the figure as high as 60%. Although clinical depression is certainly more common in people with a chronic medical illness (such as lupus) than in the general population, not every person with a chronic illness suffers from clinical depression.
Bouts of clinical depression usually last for only a few months with a chronic illness. Depression often goes unnoticed in those who have other medical illnesses because it presents symptoms similar to those of the original medical condition.
In persons living with lupus, symptoms of depression such as exhaustion, loss of energy and interest, insomnia, intensified pain, decreased sexual interest, etc. can quite naturally be attributed to lupus.
Even in those individuals without chronic medical conditions, most cases of depression go unrecognized until the later stages of the illness when the severity of the depression becomes unbearable, and the family or doctor can no longer ignore it. In fact, several studies indicate that between 30 – 50% of cases of major depressive illness go undiagnosed.
How common is depression in a person living with lupus?
What is more troubling is that many studies indicate that major depressive disorders in those medically ill are under and poorly treated, even when depression is recognized. Many patients refuse to acknowledge that they are depressed and will actually deny that they are feeling unhappy, discouraged or depressed. These people often experience what doctors call “masked” depression – a refusal to accept the idea of emotional distress, replacing physical complaints instead.
Doctors who are familiar with their patients’ usual mood and personality are more likely to recognize changes related to depression. Patients are more likely to open up about their feelings when they are encouraged to do so by a doctor with whom they are comfortable and trust.
Unfortunately, there is an all too common distorted impression that those with chronic illnesses have “reason” to feel depressed. This view has interfered with earlier identification, earlier treatment and earlier relief for those suffering from clinical depression.
What is the cause of depression in lupus? There is no one cause of clinical depression in lupus, rather there are various and different contributing factors.
The most common cause is the emotional drain from the continuous series of stresses and strains associated with coping with a chronic illness and medical condition.
A recent study (2004) has shown that those with major depression had more severe lupus disease activity than did those without a major depression, This finding implied that lupus disease activity is an important risk factor for the worsening of depression.
Other causes may be the many sacrifices and losses required by the continuous life adjustments that a person living with lupus must make.
Effective treatment for depression requires early diagnosis and early intervention. Fortunately, most episodes of depression in people with lupus are short- lived and lessen on their own within a few months. Just as some lupus patients can tolerate a lot of pain, some seem to accept and tolerate major symptoms of depression without complaint.
However, depression is very stressful and anxiety-producing, which may aggravate lupus activity. Depression should be treated with the same aggressiveness and persistence you use to treat a lupus flare or any other medical complaint. Naturally, any underlying medical condition that could contribute to the depression must be identified and controlled.
There are several treatment options for depression. Both psychotherapy and anti-depressant medications can be quite effective. Those suffering symptoms of depression should ask their doctor or social worker for the name of a licensed mental health professional experienced in treating people with chronic medical illnesses such as lupus. Working with a mental health professional can be useful in identifying additional ways of coping with the stresses of chronic medical illness. Joining support groups such as those offered by the S.L.E. Lupus Foundation may provide additional support.
Psychotherapy can be very helpful to work through and understand your feelings, your illness and your relationships. The new coping skills will aid you in dealing more effectively with stress and your life situation.
It is important to keep communication open between yourself, your rheumatologist, and primary care doctors regarding feelings of depression so they can all work together effectively. This shared relationship makes the most of the quality of care you receive and provides the most powerful approach to managing your depression.
It’s important to be aware that anti-depressants are not “happy pills” and they are not a panacea. They are prescription-only drugs that come with risks as well as benefits, and should only be taken under a doctor’s supervision. They are, however, one treatment option for depression.
For adults with severe depression there is strong evidence that anti-depressants are more effective than any other treatment. Most people do best with a combination of medication and psychotherapy. If depression is mild or moderate, psychotherapy alone may be sufficient, though even in this case, short-term anti-depressant drug treatment can help individuals get to the point where they can engage in therapy.
Patients who take newer classes of anti-depressants known as SSRIs (selective serotonin reuptake inhibitors) begin to feel the effects in 2 – 12 weeks, and sometimes different medications and dosages need to be tried to find what works best.
It is natural for someone to grieve the loss of their old self. It’s important to learn to come to terms with your lupus – embrace it, don’t deny it. Give yourself permission to be depressed from time to time and develop a sense of humor and maintain a positive attitude. Get on with the business of living!