• Introduction
• Causes of Depression
• Knowing the Signs of Depression
• Getting Help
• Treating Depression
• In Conclusion

Introduction

The uncertainties of day-to-day life can be difficult enough, but when you’re also coping with lupus, you may find yourself feeling hopeless and in despair. You may be feeling so fatigued that you don’t know how you’ll make it through the day – this alone can cause you to feel frustrated and sad. The transition from good to poor health doesn’t only take its toll physically, but emotionally as well as you try to make sense of everything you are feeling. These feelings may be completely unfamiliar to you and downright scary.

Rest assured that it’s understandable to feel frightened and down at times. You and your healthcare practitioner may still be trying to figure out a treatment plan that works – this can cause you to feel overwhelmed by the uncertainty of tomorrow, the next day and the next. If you were recently diagnosed with lupus or are experiencing new symptoms, you may find yourself processing through the five stages of grief – denial, anger, bargaining, depression, acceptance – because you really can be grieving over the loss of your old lifestyle and good health.

Being patient with yourself – and taking the time to not only understand how lupus affects you physically, but emotionally as well – will help provide the insight you need to cope effectively with chronic illness.

Causes of Depression

It’s good to have a basic knowledge of what factors can lead to depression. Like any illness, however, please remember that how you may experience depression is individual to you. It’s always a best practice to talk over your concerns with a trusted healthcare professional.

The National Institute of Mental Health (NIMH) has identified two types of depression:

• Major Depression – You may be experiencing major depression if you have been feeling depressed most days for at least two week and find it difficult to do basic tasks such as eat, sleep or work. You may neglect your appearance or hygiene, an isolate yourself away from others.
• Persistent Depressive Disorder – You may be experiencing persistent depressive disorder (dysthymia) if you’ve been feeling depressed for the better part of two years. Your depression may not always be as severe as when experiencing a major depressive episode, but it’s still lingering.

Depression may be caused by the following:

• Emotional Trauma – The death of a loved one, a recent medical diagnosis, or significant life changes (even the seemingly positive ones such as marriage, the birth of a child or a new job) can cause emotions to go into a tailspin, resulting in depression. Post-traumatic stress disorder (PTSD) can also be a significant cause for depression.
• Seasonal Affective Disorder – Many individuals experience mood changes during the fall and winter when the weather changes, the days grow shorter and there is less and less daylight. You may find yourself always feeling tired and sluggish and which can bring you down.
• Menstrual Disorders: The more extreme hormonal fluxuations that occur prior to a woman’s menstrual cycle that cause premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are also common causes of depression. PMS alone will affect approximately 90% of all women of child-bearing age at some point in their lives. Women with SLE also report more incidents of PMDD than the general population.
• Other Hormonal Irregularities – For women, the changes in hormone levels that occur during and after pregnancy, before a menstrual cycle and during menopause can make you feel melancholy.
• Various Health Conditions and Illnesses – Conditions such as diabetes and heart disease can cause depression. If you suffer from these or any overlap disease, you may be even more predisposed to consistently feeling blue.
• Psychotic Depression – Individuals experiencing psychosis who are delusional or hallucinating may also feel severely depressed as a result of having these disturbing thoughts and visions.
• Fatigue – A study published in 2010 in the journal Psychiatry Research indicated that over 90% of individuals who had experienced a major depressive disorder also experienced severe fatigue. If you have lupus, fighting fatigue can feel like you are fighting a never-ending battle: you feel fatigued from lupus which can cause you to feel depressed, but being depressed can also cause you to feel more fatigued. Either way, severe and chronic fatigue can exacerbate feelings of depression.

Inflammation may also play a key role in depression. A 2017 study published in the Journal of Postgraduate Medicine concluded that levels of inflammatory markers such as C-reactive protein (CRP) were significantly higher in individuals with SLE. In a 2013 meta-study published in the Journal of Affective Disorders, researchers found that the CRP inflammatory marker IL-6 was also found in higher concentrations in individuals with depression indicating that there is a “causal pathway from inflammation to depression.”

There may also be a gender bias towards depression when an increase in CRP levels is present. Researchers of a 2017 study published in the journal Brain, Behavior, and Immunity found that in the 231 individuals studied who experienced moderate to severe depression, women who were more severely depressed had higher levels of CRP while the men who were studied did not. As the majority of individuals with lupus are women, it’s no wonder that if you yourself are a woman with lupus, you may be constantly butting heads with the symptoms of depression.

Knowing the Signs of Depression

If you have never experienced depression before, you may not know what it looks like. Having this knowledge will not only help you understand how depression affects you personally, but when it may be happening to someone close to you as well.

While this is not a complete list, the following signs may indicate that you or someone you know is depressed:

• Suicidal thoughts and tendencies.
• Feelings of hopelessness, loss of self-esteem or self-worth.
• Loss of enjoyment in life (going out, spending time with friends, doing hobbies).
• On-going fatigue and inexplicable aches and pains.
• Changes in weight, appetite and diet.
• Irritability and mood swings.

If anything makes you suspect you or someone close to you is experiencing depression, it’s important to seek help as soon as possible.

Getting Help

If you or someone you know is experiencing suicidal thoughts and feelings, call 9-1-1 immediately, the National Suicide Prevention Lifeline at 1-800-273-8255 or text the National Crisis Text Line at 741741. If it’s not an emergency and you are still seeking help to learn how to cope with your feelings, there are other measures you can take to hasten relief:

• Support Systems – Talking to someone you trust and seeking the support of loved ones who truly care about you may be the way to start the conversation about how you’re feeling and what you need to feel better.
• Healthcare Practitioners – Your healthcare practitioner should be someone you trust to look out for your best interests. This person should be made aware of how you’re feeling in order to rule-out underlying health issues or medication side-effects and make sure you are connected with the proper individuals who can put you on the right treatment plan.
• Psychologists, Licensed Therapists or Faith-based Intervention – Mental health therapy professionals or even beloved clergy can offer a you wide-range of options to treat your depression. Ultimately, it’s up to you what will work best and give you what you need in order to feel better. The right person will treat you holistically, taking into consideration your interests, your symptoms and your overall health.
• Local Lupus Support Groups – Ask your therapist or healthcare practitioner if they know of any lupus support groups in your area that may be of benefit and interest to you. A simple Google or Facebook search may unearth something as well. You can also contact Kaleidoscope Fighting Lupus for additional assistance in finding a support group in your area.

Treating Depression

There are several ways in which your depression may be treated. Always keep your primary healthcare practitioner in the loop of which path towards relief you choose to take in order to watch out for medication contraindications, unnecessary physical strain, etc.

The National Alliance on Mental Illness (NAMI) suggests the following as some of the more common treatments for depression:

• Medications – Various classes of antidepressant medications such as serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and norepinephrine-dopamine reuptake inhibitors (NDRIs) are some of the newer and more effective types of antidepressant medications. These medications specifically target some of the neurotransmitters that are responsible for feeling good.
• Psychotherapy – “Talk” therapies such as cognitive behavioral therapy (CBT), interpersonal therapy (IBT) and psychodynamic therapy are effective means for providing relief. Talking through emotions, making sense of the past, improving communication skills and strengthening relationships can really help you cope through the difficult times. Researchers in a 2012 meta-study published in the journal Lupus concluded that it is “effective for SLE patients to manage negative emotions and that there is “potential value of psychological interventions as adjunctive treatment.”
• Complementary Therapies – Relaxation, yoga, herbal remedies, vitamins and supplements may offer effective relief from feeling tired, achy and sad. These therapies can also help you to manage stress more effectively in all aspects of your life.
• Exercise: Moving and getting your heart rate going has also proven to be an extremely effective way to combat depression. Researchers of a 2017 article published in the journal Autoimmunity Reviews determined that the depression often experienced with chronic conditions such as rheumatoid arthritis, fibromyalgia and SLE may benefit from exercise. According to the study, individuals with SLE who were physically active experienced a decrease in the severity of fatigue, the “down-regulation of inflammatory gene expression” (e.g. IL-6), and an improvement of sleep quality – all of which can also affect if and how depression is experienced.

Since you do have lupus, however, always check with your healthcare practitioner first before embarking on any new exercise regime. Together, you can determine what practice may be best suited for you based on your interests, abilities and overall health.

The best way to treat depression, however, may actually be through a combination of these methods mentioned here. A 2012 meta-study published in the Canadian Journal of Psychiatry, for example, suggested that while CBT alone and medication alone have always been effective for helping alleviate symptoms, combining CBT with prescription medications proved “superior to pharmacotherapy alone for the treatment of depression.” Achieving the right balance of medication, psychotherapy and physical activity, therefore, may potentially pack a punch when trying to knock out depression and worthy of a discussion with your healthcare practitioner.

In Conclusion

You don’t have to suffer alone or in silence. Knowing where to turn for help and that you have options can help you to take charge of your emotional well-being. You’ll acquire invaluable tools to use when the unexpected happens – the addition of an overlap disease, a flare, the side effects of medications, etc. Taking more control of how you respond to the unpredictability of life including any changes in your physical and emotional health will allow you to get the upper-hand on depression.

Back to top

References

Cuijepers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. The Canadian Journal of Psychiatry. 58(7) 376-385. Retrieved from: https://journals.sagepub.com/doi/pdf/10.1177/070674371305800702

Depression. (2019). Retrieved from: https://www.nami.org/Learn-More/Mental-Health-Conditions/Depression/Treatment

Depression basics. (n.d.). Retrieved from: https://www.nimh.nih.gov/health/publications/depression/index.shtml

Ferentinos, P., Kontaxakis, V., Havaki-Kontaxaki, B., Dikeos, D., & Papadimitriou, G. (2010). The fatigue questionnaire: Standardization in patients with major depression. Psychiatry Research, 177 (1-2), 114-123. Retrieved from: https://www.researchgate.net/profile/Panagiotis_Ferentinos/publication/43098879_The_Fatigue_Questionnaire_Standardization_in_patients_with_major_depression/links/5a6e1dcca6fdcc317b191067/The-Fatigue-Questionnaire-Standardization-in-patients-with-major-depression.pdf

Figueiredo-Braga, M., Cornaby, C., Cortez, A., Bernards, M., Terroso, G., Figueiredo, M., …Poole, B. (2018). Depression and anxiety in systemic lupus erythematosus. Medicine, 97(28), e11376.Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6076116/pdf/medi-97-e11376.pdf

Gregory, C. (2019). The five stages of grief. Retrieved from: https://www.psycom.net/depression.central.grief.html

Köhler-Forsberg, O., Buttenschøn, H., Tansey, K., Maier, W., Hauser, J., Dernovsek, M., …Mors, O. (2017). Association between C-reactive protein (CRP) with depression symptom severity and specific depressive symptoms in major depression. Brain, Behavior, and Immunity. 62(2017), 344-350, doi: 10.1016/j.bbi.2017.02.020

Sharif, K., Watad, A., Bragazzi, N., Lichtbroun, M., Amital, H., & Shoenfeld, Y. (2017). Physical activity and autoimmune diseases: Get moving and manage the disease. Autoimmunity Reviews. Retrieved from: https://www.autoimmunity-network.com/media/moxie/files/a/ad/adm/admin/1-s2.0-S1568997217302835-main.pdf

Umare, V., Nadkami, A., Rajadhyksha, A., Khadilkar, P., Ghosh, K., & Pradhan, V. (2017). Do high sensitivity C-reactive protein and serum interleukin-6 levels correlate with disease activity in systemic lupus erythematosus patients? Journal of Postgraduate Medicine. 63(2) 92-95. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414434/?report=printable

Valkanova, V., Ebmeier, K., & Allan, C. (2013). CRP, IL-6 and depression: A systemic review and meta-analysis of longitudinal studies. Journal of Effective Disorders, 150(3), 736-744, doi: 10.1016/j.jad.2013.06.004

Zhang, L., Fu, T., Yin, R., Zhang, Q., & Shen, B. (2017). Prevalence of depression and anxiety in systemic lupus erythematosus: A systemic review and meta-analysis. BMC Psychiatry, 17(1), 70. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310017/pdf/12888_2017_Article_1234.pdf

Zhang, J., Wei, W., & Wang, C. (2012). Effects of psychological interventions for patients with systemic erythematosus: A systematic review and meta-analysis. Lupus, 21(10), 1077-1087. Retrieved from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.886.9034&rep=rep1&type=pdf

.

Author: Liz Heintz  (revised November 2020)

Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.

All images unless otherwise noted are property of and were created by Kaleidoscope Fighting Lupus. To use one of these images, please contact us at [email protected] for written permission; image credit and link-back must be given to Kaleidoscope Fighting Lupus.

All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.