Caring for your emotional symptoms is an important part of arthritis care.

When you feel down or worry excessively, you may feel too overwhelmed to properly care for your rheumatoid arthritis (RA) or your emotional health. But pain, mental health and disability are strongly linked, so not recognising or treating one can impact the others greatly.

For example, having depression may mean you don’t have the will or energy to exercise, which can lead to deconditioning and reduced ability to function. On the other hand, having a lot of pain and inflammation may make it harder to exercise and cause you to be depressed or anxious. This can create a vicious cycle where you can develop a pain-centred life where pain influences all aspects of your life such as disrupting your sleep, daily activity, social interactions, treatment adherence and self-care.

When to see a doctor about depression

Feeling down in the dumps sometimes is part of life. One day you're out of sorts and your spirits are low; the next day you're back in the groove. But if these low feelings last for two or more weeks, you may be clinically depressed. You should speak with your GP if you have any of these symptoms of depression:

• Your low spirits persist for two weeks or more.
• Your depression is interfering with your relationships or job.
• You have thoughts of harming yourself.
• You have physical symptoms such as headaches, digestive disorders and chronic pain not associated with arthritis that do not respond to routine treatment.
• Your symptoms include any five of the following: sleeplessness or oversleeping; loss of appetite or overeating; frequent tears and feelings of sadness; inability to concentrate; little interest in things you usually enjoy; fatigue; irritability, restlessness or moving about in slow motion; a feeling of worthlessness or pervasive guilt.

When to see a doctor about anxiety

Instead of feeling low and with no energy, maybe you feel restless and full of worry and distress. Some people respond to chronic illness and stress with anxiety rather than depression. You should speak with your GP if you have any of these symptoms of anxiety especially if your symptoms are uncontrollable or interfere with your daily life:

• You worry or obsess about concerns both small and large.
• You fear and dread things that may happen now or in the future.
• You feel restless, on edge and irritable.
• You have trouble concentrating.
• You worrying about worrying.
• You can’t make decisions for fear of making the wrong decision.
• You have physical symptoms like muscle tension, rapid heart rate, upset stomach, dizziness or hot flashes.

Treatment options

If you have anxiety or depression, you have many treatment options available, from medications to psychological treatments to deep relaxation. Having a collaborative health care team is vital to success. You need to treat the inflammation and pain of your RA, because we know they contribute to your mental health. Make sure your rheumatologist and mental health specialist are coordinating your treatment so potential drug interactions can be avoided.

Psychological treatments

In 'talking therapy' or counselling, you work with a therapist to reduce your anxiety or depression. Examples include cognitive-behavioural therapy (CBT), interpersonal therapy, and problem-solving therapy. CBT is one of the common treatments. It focuses on changing negative thought patterns and behaviours. Which type of therapy works best for you will depend on your symptoms, personality and preferences.

Medications

Several types of medicine are used to treat anxiety and depression. Talk with your doctor about benefits, risks, possible side effects and how these may interact with other medicines you take.

• Antidepressants. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitor (SNRIs) are the first-line medication treatments for depression and anxiety. Other classes of antidepressants include tricyclics, monoamine oxidase inhibitors, and others.
• Anti-anxiety medicines. Buspirone is an anti-anxiety medicine that may be used long-term. Benzodiazepines are sedatives that relieve anxiety, but are habit-forming and are used only for short-term needs.

Alternative remedies and self-care

A number of remedies and self-care options can help ease your symptoms, especially when used in conjunction with psychotherapy or medication. Follow the links to learn more about each option.

• Acupuncture
• Massage
• Yoga
• Physical activity
• Healthful diet
• Meditation
• Visualisation

Adapted with thanks from the Arthritis Foundation.