Dr. William Deardorff is a clinical health psychologist who specializes in evaluating and treating patients with chronic pain.
For part 2 of this series, Dr. Deardorff discusses treatment options for depression in arthritis patients with chronic pain. You can also read part 1, about the relationship between chronic pain and depression.
What are common obstacles in treating depression for people with chronic pain?
One of the biggest obstacles in treating major depression in the patient with chronic pain—due to arthritis or anything else—is missing the diagnosis. This occurs for two reasons: patients with chronic pain may not realize they are also suffering from major depression, and physicians may not be looking for it.
In fact, one study suggests that only 1 in 5 people with rheumatoid arthritis and depression discuss their depression with their doctors. Patients with chronic pain often define their problem as strictly medical and related to the pain. The depressive symptoms may be downplayed by the patient with chronic pain who believes, “If I just get rid of this pain, I won’t feel depressed.”
Or they may feel that acknowledging depression is a sign of weakness in dealing with the pain. When the diagnosis of major depression in the chronic pain patient is missed or ignored, treatments directed strictly at the pain are much more likely to fail.
How is depression in chronic pain patients treated?
Treatment of depression associated with chronic pain requires a specialized approach. It is generally accepted that the pain and the depression should be treated simultaneously in a multidisciplinary fashion.
The treatment of clinical depression most often includes psychological interventions such as cognitive behavioral therapy (CBT) and anti-depressant medication. There's evidence that CBT, which focuses on coping skills, relaxation training, and the management of flare-ups, can relieve depression in people with rheumatoid arthritis. For instance, in a study looking at people newly diagnosed with RA, the group that underwent CBT sessions with a psychologist were less depressed and had less joint inflammation 6 months later than similar patients who did not receive CBT treatment. Also, studies suggest that antidepressant medication, when used appropriately with RA patients, can improve depression, anxiety, and feelings of helplessness. As a bonus, many of the antidepressant medications may have pain-relieving properties.
Simultaneous treatment directed at the chronic pain is also critical. Research has found that chronic pain may interfere with depression improvement, and this makes sense. Treatment options for the chronic pain might include physical rehabilitation aimed at restoration of function, measures to “normalize” one’s life as much as possible even with the pain, and/or appropriate medications.
In addition to medication treatments, movement and exercise are also important measures for reducing both pain and depression. Many people with arthritis find it difficult to exercise because of the pain. However, aerobic exercise such as walking and swimming may improve function, reduce pain, and help with depression.
If this type of exercise is not physically possible, try gentle stretching , tai chi, or water aerobics. It is important to work with your doctor to find an exercise program that is physically safe and beneficial while also being one that you will enjoy. If you don’t enjoy it, you are much less likely to do it.
How do you know if you have depression?
Only a medical professional can make an official diagnosis of depression. However, this Depression Questionnaire is a self-administered test that can help indicate the presence of typical depression symptoms and their severity. If your score is in the moderate to severe range, you should make an appointment to discuss the results with your doctor.