Rheumatoid arthritis (RA) is a chronic inflammatory condition that causes pain and swelling in the joints. However, the effects of RA extend beyond the joints, and the disease may affect other aspects of health and wellness.

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People with RA may also experience health issues that affect their heart, lungs, and mental and emotional well-being.

Depression is common in people with RA, and they may require antidepressants to manage these symptoms.

In this article, we examine the relationship between depression and RA in more detail. We look at what the link means for treatment and how antidepressants may affect the symptoms of RA.

Many people with RA experience depression at some point. According to some estimates, more than one-third of people with RA have had symptoms of depression.

According to one study, people with RA are more than twice as likely to experience depression as people without the disease.

Proper management of mental health in RA is important, as research has linked depression and anxiety to worse outcomes, including:

  • lower likelihood of following through with treatment
  • reduced chance of treatment proving effective
  • higher medical costs
  • lower quality of life
  • adverse health outcomes

Given the effects of mental health on disease outcomes, it is important for people with RA who are also experiencing depression to ensure that treatment addresses both their physical and mental health.

Experts are not sure of the exact connection between RA and depression. It may be that the physical effects of RA affect quality of life to the extent that they cause depression, or RA may somehow directly lead to this mental health condition.

Indirect

Pain and fatigue are characteristic features of RA that substantially affect mood and can contribute to depression.

Research suggests that regardless of underlying disease activity, there is a strong link between the pain, swelling, and limitation of motion that result from RA and the symptoms of depression and anxiety. Studies have also shown depression to be more common among people with higher levels of pain.

High rates of depression occur in other chronic pain disorders as well, including osteoarthritis, which is a type of arthritis associated with older age. As with RA, depression in osteoarthritis is related to functionality and stiffness.

Other factors associated with RA that may contribute to depression include:

  • the emotional impact of receiving a diagnosis of an incurable chronic disease
  • the effects on work, school, and social life
  • medication side effects

Direct

It is possible that depression is not simply a consequence of RA.

In a recent study involving more than 195,000 women, the participants with preexisting depression were 28% more likely to develop RA later in life than those without depression.

Experts are not sure how depression might lead to RA, and they emphasize that more work is necessary to understand this relationship.

However, it is known that RA is an autoimmune disease, which means that the immune system mistakenly attacks the body’s own tissues. This attack leads to inflammation and tissue damage and is the basis for much of the pain and swelling associated with the condition.

Depression has a known association with inflammation, so it is possible that systemic inflammation could contribute to both depression and RA.

Although there is a need for more research to define this relationship, one study found that there is a close relationship between levels of inflammation and depression in people with RA. The authors reported no connection between inflammation and anxiety, which suggests that the relationship between inflammation and depression is specific and not simply related to RA’s overall impact on mental health.

As RA affects functional, emotional, and physical health outcomes, it is important to manage depression effectively to get the most out of treatment. This management often involves the use of antidepressants.

As an added benefit, some antidepressants may also provide pain relief. Doctors have used certain types of antidepressants to help relieve pain in people without depression. These drugs include tricyclic antidepressants (TCAs), such as amitriptyline and nortriptyline, and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine and venlafaxine.

These medications work by regulating chemical messengers that send signals in the brain. In addition to helping with depression, they also interrupt signals related to pain, potentially providing pain relief.

There is also some evidence to suggest that antidepressants may reduce the levels of some markers of inflammation.

In a 2020 study involving people with RA who were in clinical remission, those who took duloxetine reported significant pain relief, better ability to complete daily activities, and an improved quality of life.

Although antidepressants may help relieve pain, they are unlikely to have any direct disease-modifying properties. They are also unlikely to provide significant pain relief as a stand-alone treatment, according to a recent review of more than 30 clinical trials.

Therefore, antidepressants may be more suitable as an additive to current therapy for RA for people with depression rather than as a replacement.

Depression is common in people with RA, and it can have a significant effect on how well treatment works and the course of the disease. Antidepressants may help manage symptoms of depression in RA and may provide pain relief as an added benefit.

Anyone who is experiencing symptoms of depression or other mental health conditions should discuss their concerns with a healthcare professional. Adding an antidepressant to a current treatment plan can help improve mood and maximize quality of life.