Lupus and Depression: What You Need to Know

A chronic illness can bring a lot of stressors, and this is often the reason why people with lupus are at higher risk for new or worsening depression.

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, guilt, or pessimism
• Irritability, restlessness, and difficulty sitting still
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Difficulty concentrating, remembering, or making decisions
• Sleep problems
• Appetite or weight changes
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause or that do not ease even with treatment

Communities at Higher Risk

“Worrying about income and paying bills all the time can definitely increase your stress level,” says Patricia Katz, PhD, an author of the study and a professor of medicine and health policy at the University of California in San Francisco.

Black, Hispanic, and Indigenous people with lupus — groups at highest risk for the condition — may also face additional mental health challenges, particularly at work, says Monica Blied, PhD, a clinical psychologist who has lupus and the CEO of Faces of Health Wellness Center in Claremont, California. Beyond depression, it can also trigger feelings of stress and anxiety.

“If you feel like you have to work twice as hard to be respected and acknowledged, then the prospect of asking for time off or accommodations due to lupus is very difficult,” Dr. Blied says. “Just telling people you have a chronic condition that causes pain and fatigue and organ damage is very stressful.”

Depression is a complex condition, and those with lupus can develop it for a variety of reasons.

• Medications: Some prescription drugs for lupus, especially corticosteroids like prednisone that are taken at higher doses, may contribute to depression.

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• Poor sleep, fatigue, and chronic pain: Dr. Katz notes that pain, fatigue, and poor sleep — everyday hallmarks of lupus that can rev up stress and depression — aren’t well-controlled by the immune-suppressing medications, like steroids, that battle the underlying cause of the disease.
• Lupus fog: People with lupus can have cognitive symptoms such as memory problems, difficulty concentrating, mood swings, and confusion, all of which can have a negative impact on your mood. Experts aren’t sure what causes lupus fog, but you can work with your healthcare provider to help manage it.

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• Stress: Perpetual feelings of mental or emotional strain are a common cause of depression. Experts believe that stress can suppress the production of neurons in the hippocampus, which is a region of the brain involved in regulating emotions.

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   Not only does the stress of having lupus impact mental health, it can trigger flare-ups of lupus symptoms too.

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• Quality of life issues: A lupus diagnosis can instantly impact how you live your day-to-day life. If you experience fatigue, joint pain, or muscle aches that severely limit your social interactions, isolation is yet another depression risk factor.

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It can be a delicate balance to address both of these health issues at the same time. For example, Katz says medications like corticosteroids are crucial for slowing disease progression and organ damage, but they can cause poor sleep, which can significantly impact your mental health.

Katz recommends that people with lupus should work with their doctor and look to self-care strategies for pain management and a better frame of mind. Examples include:

• Increase daily physical activity: Even short but intentional spurts (like walking to the mailbox or taking your dog around the block) of moving your body can improve your day-to-day mental health and can help ease painful symptoms. If you suffer from chronic pain, talk to your healthcare provider before starting any new exercise routine.
• Build a support network: Because social isolation is so damaging — and yet so common with chronic illness — seek out a group of people who uplift you. This can be in-person or through digital forums, like online support groups.
• Improve sleep habits: Chronic illness can affect quality rest, but good sleep is vital to your overall wellness and peace of mind. Setting a consistent sleep schedule, creating a restful bedroom environment, and saying physically active are all ways to help improve your sleep quality.
• Consider antidepressant medications: Patterson notes that if you do have depression, lifestyle changes alone may not have the power to lift your mood. “If you’re already taking a lot of medications you may be reticent about adding one more,” she says. “But taking an antidepressant to get you through a rough patch can be very helpful,” she says.
• Address chronic pain: Complimentary and alternative therapies such as acupuncture, yoga, tai chi, may all help reduce discomfort and improve mood.

• People with lupus are at greater risk of developing depression. Both the emotional and physical stressors of the disease are known risk factors for mental health problems, including stress and anxiety.
• Certain medications that treat lupus, poor sleep, and chronic pain are all factors that can cause depression. Finding balance in managing lupus symptoms along with those of depression involves combining medication with lifestyle changes such as increased physical activity, addressing chronic pain, and strong support networks.
• People with lupus should work with their healthcare provider to discuss solutions for feelings of depression, including antidepressant medications.