Its popped up in a few threads so lets hit it head on.........
This disease causes depression. if you don't like the term, thats fine, pick one you like. Say like "suppressed endorphin production due to excess TNF production."
Now I'm not talking about "situational depression" death in family, worry about your disease etc. Fact is we (the USA) are one of the few places in the world that treat that with drugs first (and they usually don't work) instead of counseling.
This is an actual physical condition that increases pain level's, lowers the effectiveness of medications, effects blood flow/pressure, interrupts sleep, and cause's fatigue. The next thing that happens of course, because you are sitting on your rear tired, felling pain, lacking ambition etc, you get the other kind of depression.
Because you are not moving everything else goes in the toilet and you PsA symptoms really go to town. So what do you do? you go to your doc whinning you hurt soooo much. Of course you have turned down antidepressant meds in the past so she you throws you out. then you try the ER or your PCP or really scrape the bottom and go to "pain management" Some how some way you find someone to give you MORE depressent medication but it also has another effect it produces those missing endorphins and you "feel" better (if you have normal endorphins to begin wiht, you feel real good or take to much to get that same effect)
So here the question while you will take narcotics with out question, why in the Sam Hill when someone even (a doctor) remotley suggests a tricyclic medication that restores natural endorphins folks get immediatly defensive and start looking elswhere for answers????
We use canes, handicapped parking permits, we board airplanes first, use the electric carts in Wal-mart and sometime feel a bit bad about it all because "we look normal" (to who? put a picture of yourself from high school on your mirror and stand there naked compare and then tell me how normal you look)
But the instant someone says depressed, we freak out and invent all kinds of stigma, false pride and excuses. Get over it. Its a a bad term for a serious problem. few responsible "pain mangers" will prescribe without you using appropriate medication, and those that do will have you sign enough paperwork that you think you are taking out a mortgage on the pee cup they hand you with their other hand. (actually the contract comes anyway but you may not need it if you get your pain mechanism in working order)