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A New Free Report - What Is Lupus?
This fascinating new report from UK-based publishing house Health Research Today answers some of the most-asked questions about this baffling disease :
- What is the medical definition of lupus?
- What are the symptoms of lupus?
- What tests are there for lupus? How do you get a diagnosis?
Fill in this form and we will send you the report immediately, which you are welcome to send on to friends or family!
Lupus - Winning the Mental Game
This article is an extract from the ebook Freedom From Lupus!
Depression and Lupus
Many patients with lupus understand that depression may set in due to a number of factors. The lupus itself may cause depression along with the medications a patient takes and life factors completely unrelated to lupus. Depression is not guaranteed in lupus patients, but it can occur due to the pressures of having a chronic illness. Some studies show that approximately 15 percent of people with chronic illness suffer from depression, while other studies report a 60 percent rate of depression in chronically ill patients.17
Depression is not just about being sad. It is actually a clinical condition that goes beyond a mild mood change that most people feel. Feeling sad in some situations or at some point and time is normal for most people. However, people who feel depressed have that sad, helpless feeling for prolonged periods of time.
There are different grades of depression from mild to severe, and they can impact the way a patient copes with the disease. Often the primary concern of physicians is treating the physical ailment in front of them, so the depression can go unrecognized until several months or years into the disease. Some studies show that approximately 30 to 50 percent of major depression goes undiagnosed in medical settings.17 Still, even when recognized, the patient still may not receive proper treatment.
One of the reasons depression can go unrecognized in lupus patients is that clinical depression has many of the same symptoms as the lupus, itself. Both clinical depression and lupus share many of the same symptoms like lethargy, loss of interest, insomnia, pain, lack of sexual interest and more. The overlap of symptoms makes it difficult for physicians to look beyond the lupus to see the psychological impact of a chronic disease.
When patients face clinical depression, they also have a variety of treatments available. Every patient responds differently to medications and therapy, and treatment is often individualized. Yet, it is important that the patient include any psychiatric care in with the treatment team. Depression treatment should not be done outside of lupus treatment, but in conjunction with it.
Symptoms of Depression
With the overlap of a number of symptoms, diagnosing depression in lupus patients can take some time. With between 30 to 50 percent of major depression cases going undiagnosed, how is a patient supposed to know they are depressed? It begins with the patient him or herself. A lot of patients refuse to admit that they are depressed, denying that they even feel unhappy. Often this masking results in patients reporting a number of physical complaints. The patient’s friends and family are important in confronting depression symptoms, as is the physician, who may notice a change in overall mood.
While feeling sad about the illness is normal, being clinically depressed is not. Many people justify the depression by believing that the illness is a valid reason for being depressed. However, that belief prevents people from getting the diagnosis and treatment they need to overcome the depression.
Friends, family, doctors, and patients should all be aware of the common signs of depression in patients with lupus (and even those that do not have the disorder). There are both psychological and physical symptoms of depression. The most common psychological symptoms are hopelessness and helplessness. Not all patients experience all symptoms, but at least some of the symptoms.
Physical symptoms include:
- Headache
- Heart palpitations
- Diminished sexual interest
- Aches and pains
- Indigestion
- Constipation
- Diarrhea
Psychological symptoms include:
- Hopeless feeling
- Helpless feeling
- Overall sad feeling
- Gloominess
- Crying spells for no reason or an overreaction to stimuli
- Insomnia
- Loss of appetite
- Voracious appetite
- Uneasiness
- Anxiety
- Irritability
- Guilt
- Regret
- Low self-esteem
- Lack of concentration
- Diminished memory
- Indecisiveness
- Lack of interest in things the person used to enjoy
- Lethargy
While many patients feel some of these symptoms at various points and times, there are some criteria that result in a diagnosis of clinical depression. When the depressed mood is combined with sleep disturbances, appetite disturbances, and at least two other symptoms that last for several weeks and disrupt daily life, the patient is then diagnosed with clinical depression.
All of these symptoms may contribute to a depression diagnosis, but to actually determine the appropriate treatment plan, the severity of the depression must be taken into account. Doctors use seven criteria for determining the depth and degree of the clinical depression in a patient:
- Sense of failure
- Loss of social interest
- Sense of punishment
- Suicidal ideations
- Dissatisfaction
- Indecision
- Crying
The more intense the depression, the more intense the treatment may be. However, treatment is absolutely necessary, as the depression can impact the way a patient reacts to their lupus. Patients with depression can forget to take medicines or give up on treatment. Thus treating the depression is just as important as treating the lupus.
The Causes of Depression
There are three major causes of lupus in patients: the disease, the medications used to treat lupus, and the factors that surround the patient that are unrelated to the lupus whatsoever. Coping with chronic illness can often take its toll, especially when combined with the physiology associated with lupus. It is important that doctors first identify that depression is present, and then that they treat the depression as well as the lupus.
The most common cause of depression in lupus patients is the emotional strain associated with having a chronic disease. Lupus itself can create problems with job performance, especially when flares keep patients from working or slow work down. Frequent visits to the doctor can take a toll on finances, and the fatigue and pain can limit activity with friends and family. Teens are especially prone to social problems due to physical symptoms like rashes, and those factors can elicit depressive symptoms. The continuous life adjustments required in lupus patients can eventually take their toll.
The disease itself also affects the neurological system, which causes depression symptoms. It can also affect organs like the brain, heart, or kidneys, which can lead to clinical depression.
Some medications can also trigger depression. Steroids like Prednisone are notorious for causing depression in patients. One Canadian study showed that the incidence of major depression was three times higher for patients taking corticosteroid treatments over non-treated subjects.18 Thyroid medications can also cause depression. While the medications themselves can cause depression, so can their effects. For instance, steroid use can cause puffiness in the face or weight gain, which can lead to low self-esteem and depression.
The risk for depression in chronically ill patients is two times greater for the rest of the population.19 While a majority of patients experience depression due to stress related to having a chronic illness, the physiological impacts of the disease and medication can also contribute. It is important for doctors to note that there is often not one cause, and not all causes may be identifiable, so that appropriate treatment can be determined.
What to Do About Depression
The good news about depression, even in lupus patients, is that it is perfectly treatable. It is best treated if caught early and treated right away. The main courses of treatment include medication and therapy, of which they are sometimes combined. With treatment, most patients experience relief from depressive symptoms within a few months.
Due to the fact that depression can trigger other lupus activity, treatment should be as aggressive as when a lupus flare arises. It is also important for doctors to discover if there is a medical condition present in order to control the depression.
Before beginning any treatment recommendations, doctors should be looking at a variety of components. Blood tests need to be done to rule out medical reasons for the depression and determine appropriate dosages of medication. The treatment team needs to be in communication, and the patient needs to be open about feelings and environmental factors. The people surrounding the patient (family, friends, physicians, etc.) need to be patient and encouraging.
Doctors will commonly prescribe anti-depressant medications to treat symptoms. There are four primary types of anti-depressants used in treatment: tricyclics, selective serotonin reuptake inhibitors (Prozac, Zoloft, Paxil), monoamine oxidase inhibitors (MAOIs), and lithium. Other types of antidepressants used include Effexor, Serzone, Wellbutrin, Remeron, and Desyrel. Since anxiety is often present alongside the depression, doctors may opt to use anti-anxiety medicines in conjunction with anti-depressants.
Therapy is also a commonly used treatment. Psychotherapy can come in the form of individual therapy with a licensed treatment provider or group therapy. Sometimes a combination of therapeutic modalities is used in treating depression. Psychologists use a variety of different approaches to therapy, so it is important that a patient sees a therapist that they feel comfortable working with. The patient should feel comfortable discussing their issues out loud while also being willing to accept constructive criticism and advice. Therapists will often provide patients tools to help them cope with their illness as well as the stressors that surround them.
In treating depression, the progress is often gradual, so patients should not expect an instant recovery. Medications often take 4 to 6 weeks to show improvement, and therapy may take even longer depending on the severity of the depression and the patient’s needs.
Read the rest of this article in Freedom From Lupus!
© Health Research Today
