Lupus and Depression: Understanding the Connection

by Erika Krull, MSEd, LMHP

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.

If Covid-19 and social isolation are heightening your symptoms of depression, Greenbrook TMS therapy may be able to help. At Greenbrook, we specialize in TMS therapy — an FDA-cleared, non-invasive treatment for treatment-resistant depression and OCD without harmful side effects. See if TMS therapy is right for you by clicking here to take a brief assessment:

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