Frequently Asked Questions About Arthritis and your Moods

Q: How do you know if you are depressed?
A: The risk of depression is much higher for people who are struggling to manage a chronic illness; approximately 20% of Rheumatology patients will experience a bout of depression. The primary symptoms of depression are depressed mood or sadness or a loss of interest or pleasure in previously enjoyed activities. Additional symptoms include a change in appetite or weight, insomnia or excessive sleep, fatigue or loss of energy, feeling restless or slowed down, feelings of guilt or worthlessness, and concentration problems. Depression ranges from mild to very severe. Many people experience a few of these symptoms occasionally and these fluctuations in mood are normal. People with severe depression experience a large number of these symptoms and these symptoms are frequent, long-lasting and disruptive. Depression is not the same as the normal sadness or grief you experience after a significant loss. Depression lasts longer, and includes feelings of self-criticism, hopelessness and despair.

You should seek treatment for your depressed mood if: 1) your depressed mood feels overwhelming or out-of-control, 2) your old methods of "boosting" your mood aren't effective and you are unable to overcome your depression, 3) your depressed mood has a negative impact on your ability to work, enjoy leisure activities, or maintain satisfying relationships with family and friends, or 4) you have had thoughts of suicide. The Arthritis Institute offers Depression Treatment Groups designed specifically for people with rheumatological disorders, such as fibromyalgia, arthritis, lupus, scleroderma etc. Visit the Depression Treatment Group page for information on depression, and a description of the treatment program.

Q: I used to be so calm and easygoing. Now that I have rheumatoid arthritis, I lose my temper at the drop of a hat. What has happened to me?

Many patients with chronic pain report that they have a reduced tolerance for stress, and that they frequently become frustrated and upset by situations or events that they would have handled easily in the past. This low stress or frustration tolerance often leads people to feel "out of control", which causes further confusion and distress. One of our patients described it best when she stated "I understand how arthritis affects my joints, my pain level and my fatigue, but I don't understand how arthritis caused a personality change!".

In order to understand this process, I would like you to visualize your stress levels and your coping resources as a set of scales. Prior to your illness, you would have experienced a certain number of stressors in your life, associated with work, relationships, financial concerns etc. You would also have had certain personal resources or coping strategies that helped you to manage these situations. Most of the time, there would have been a reasonably good balance between your stressors and your available resources. Occasionally, major life stressors (e.g. the death of a loved one) might "tip the scales", leaving you feeling overwhelmed and unable to cope for a period of time.

Developing a chronic illness can "tip the scales" in three ways. First, pain is a stressor; it triggers your body's stress response, resulting in increased muscle tension, heart rate, blood pressure etc. Chronic pain, therefore, results in prolonged stress and a constant drain on your resources. Second, living with a chronic illness results in many lifestyle changes or "secondary stressors". For example, you may struggle to meet the demands of your job or household chores, you may be unable to participate in some of the leisure activities you used to love, or you may be uncertain about your future. All of these things add to your daily stress levels. Finally, you may find that during this stressful time, the personal resources or coping strategies you relied on are less effective. For example, if you were the type of person who used to cope with stress by working harder than ever, this might not work for you anymore because you may not have the same energy level or because overexerting yourself results in a pain flare-up. We spend a lot of time in the Rheumatology Day Programs discussing the relationship between stress and chronic pain.

The solution? You need to find ways to "balance the scales", both by decreasing the number of stressors in your life and by finding new and effective coping strategies. The Rheumatology Day Programs teaches relaxation skills and general stress management strategies.