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Lupus and Depression: Understanding the Connection
Erika Krull, MSEd, LMHP
2020-11-05T22:58:40Z
Medically reviewed on by
Regional Medical Director Greater St. Louis
Living with lupus is hard on the body. At times, you can experience several physical symptoms at once like fatigue, pain, swelling, and a low-grade fever. Managing lupus can also be emotionally taxing, with up to 25 percent of
people with lupus also experiencing depression, and up to 37 percent experiencing anxiety.
Depression and the emotional effects of lupus have a lot in common, but there's a key difference. The temporary sadness or disappointment you might feel while adjusting to lupus is significant and may feel like you are grieving the loss of your previous lifestyle. But as you adjust, you'll likely understand your condition better and learn how to manage your symptoms. As with the typical grieving process, you'll eventually have fewer sad moments and spend more time getting back into your life. Depression, on the other hand, is a condition that can worsen over time and may not resolve on its own. Without treatment, depression can add to your difficulty with lupus, so it's important to know these distinctions.
Many specific symptoms of lupus and depression overlap, making them difficult to differentiate. Further,
depression and lupus have a high comorbidity , meaning that they frequently occur together. The stress of a chronic illness also makes it more likely for depression to develop. Here, you'll learn about the connections between depression and lupus as well as some treatments that can help you feel better.
Factors of Lupus That Can Lead to Depression
Lupus is an autoimmune disorder, which means that your body's immune system can't tell the difference between healthy body tissue and foreign particles, such as bacteria or viruses. Your body attacks itself, leading to high levels of inflammation that can trigger a variety of health problems.
Depression often develops with lupus, given that this autoimmune disorder often disrupts daily activities, leading to isolation and discouragement. Anxiety from the unpredictable nature of flare-ups can become stressful, as well. When these factors emerge together, the chances of developing depression increase.
Stressors from Lupus
Living with lupus means that you may deal with several stressors at the same time. Just the long process of getting a diagnosis can add stress and frustration. Many people may go several months or years living with undiagnosed lupus symptoms. This uncertainty can be an invisible load on a person's mind until they get more clarity. Some of these stressors may include:
- Difficulty enjoying life due to the unpredictability of symptoms
- Uncomfortable changes in your body
- Physical limitations from pain and fatigue
- Being unable to fulfill usual parental, work, or social roles and duties
- Added medical costs and appointments
- Time spent managing or treating symptoms
- Isolation
Lupus Flares
A
lupus flare occurs when certain organs or body systems are affected by inflammation. Flares can be brought on by physical or emotional distress, typically causing fatigue, pain, swelling, and a low-grade fever. When flare-ups hit, it's easy to feel frustrated and discouraged. Even things you do every day can feel uncomfortable and difficult, like getting dressed in the morning or performing your normal work activities. Like depression, lupus can seem like an invisible condition. Sometimes it's hard for people to understand that you don't feel well even when you look okay on the outside.
Flare-ups occur due to outside stressors, and feeling discomfort or having life interrupted can also cause emotional distress. This distress can transform into a negative mindset, making you feel overwhelmed by the frustrations of your lupus symptoms. Without support and care, this cycle of stress and flares can lead to depression.
Lupus Medications
Some medications used to treat lupus can cause depression symptoms as a side effect.
Corticosteroids are known for this effect despite their effectiveness in treating flare-ups. Steroid medications can be life-saving when inflammation is severe, but depression symptoms are a potential risk. This complication can put people with lupus in a tough spot. Some may feel like taking medication forces them to choose their physical health over their mental well-being.
Depression and Typical Lupus: Similar Symptoms
It can be difficult to know if a person with lupus is also struggling with depression. To identify the condition and best prepare for treatment, watch for these primary symptoms of depression:
- Feelings of sadness, worthlessness, and hopelessness
- Rumination on negative thoughts, failures, and mistakes from the past
- Changes in sleep patterns: disrupted sleep, insomnia, or too much sleep
- Changes in eating patterns: irregular or low appetite, cravings, or emotional eating
- Anger and irritability
- Lack of mental focus, where everything seems to take more effort
- Lack of interest in activities that are normally enjoyable, such as hobbies or socializing
- Physical symptoms such as headaches, body aches, and back pain
- With moderate to severe depression, suicidal ideation
Some of the above symptoms commonly occur with lupus as well. Fatigue, feelings of sadness, pain, irritability, and changes in sleep patterns are likely. The typical ups and downs of coping with a chronic condition can be discouraging, but these feelings are temporary. When problems with sleep, mood, thinking patterns, or fatigue linger for several weeks or months, it's time to seek help for depression.
Seeking Treatment for Depression
Talk therapy and antidepressants are the two methods most people try when treating depression for the first time. Cognitive behavioral therapy helps by connecting thoughts, emotions, and behaviors to deal with depression symptoms. The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors, such as fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft). Many people find relief with these two treatments, but some need to keep looking for a more effective method. In fact, about one in three people don't find relief from antidepressant medication.
If this situation sounds familiar, you might be frustrated that you still don't feel well after several attempts at treatment.
transcranial magnetic stimulation (TMS) therapy is a safe, effective, and non-invasive treatment for depression. If you feel stuck in your search for a depression treatment that works for you, consider looking more closely at TMS therapy.
Above all, remember that depression doesn't have to be part of your life, and don't give up on feeling better.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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