New link with arthritis and mental health

Hi. Has anyone else seen this? I just wondered if anyone has any thoughts?

The title suggests that mental health issues cause more severe disease. But the way they report the findings it sounds more like chicken and egg.

I would think that anxiety and depression might constitute one of the many possible triggers for PsA. And then there’s the view that PsA and other inflammatory conditions affect brain chemistry. My Mum had multiple sclerosis and I remember reading her MS Society magazines in secret when I was a kid, nearly 50 years ago. One scientist’s or doctor’s opinion stayed with me, it was that his MS patients had very often endured ‘10 years of sadness’ before the disease became obvious. And even back then there was also the belief that MS caused depression and anxiety etc. by some physical means. It’s a conundrum.

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Its nothing new. It always amazes me when folks like Dr. Renée El-Gabalawy who is a Psychologist (not an MD) suddenly discover the world of phisiology not that they are ready to admit that more often than not depression is a physical problem with a physical cause. Understand I live in a town where MSWs and PhD psychologists are fighting for the best Barrista Positions and the profession is not held in much regard. But the fact is a basic ungrad course in A & P covering the basics of how the immune system works (or even reading the chapter in the text book. would have given them the same information their “study” did. I can’t tell you how many presentations from these folks I have sat through over the years. What fascinates me is why lay journals keep picking up these “articles” So rather than saying BS I’ll just say “Yawn” Wouldn’t it be nice if we could go to talk therapy once a week and swallow some anti depressants and wake up arthritis free? The fact it doesn’t work that way sort of invalidates their “revelation” Its not "mental health at all. It is the egg, (assuming the chicken was first)

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I think the underlying cause for mental health issues in those of us with PsA could surely be the symptoms of our PsA. The only time I ever felt depressed is while enduring chronic pain–the kind that isn’t necessarily severe, but that consumes the whole body and wears one down! And, it definitely wasn’t imagined, because I had such a negative attitude about going on Enbrel, if the symptoms were “all in my head” there’s no way Enbrel would have made me feel better! Probably every one of us questions at some point, are we really experiencing all this pain or is it just in our head? I know some doctors, family and friends have a way of trying to convince us our pain is imagined, at least usually until there are outward signs of deterioration and they stop doubting us. In my case, I didn’t look or act sick, so our kids and my husband probably thought I was complaining about something that really wasn’t there! (Even though my joints would lock up continually and to me it was very obvious when I changed positions, whether it be my elbow, wrist, fingers, neck, back–whatever–it was a slow, painful process for a few seconds hundreds of times throughout the day.) But, my psoriasis is VERY obvious, I never complain about it, and my PsA has affected my hands, feet and back enough to be noticeable in my slightly crippled hands and how my walking has changed.
I guess we just need to be our own advocate and know that pain is real when no matter how we try to ignore it or “wish it away” as I did, it doesn’t go away and it makes us sad!

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Of course its all real. The same part of the immune system (the endorphins) that cause pain (or control pain) also are the cause of depression. That’s why opioates make both pain and depression worse.

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I agree totally. But there are also reports coming out now (not mentioned in the link I gave) that depression and mental illness might be caused by inflammation itself. The point these reports seem to making (albeit tentatively) is that someone with depression or other mental health condition but no arthritis etc is more likely than the average person to have the same kind inflammation in their body that we do - it’s just effecting their brain rather than their joints.

The following is edited down from a lengthy BBC news story. I think it’s quite interesting:

It’s not very often we get to talk about a revolution in understanding and treating depression and yet now doctors are talking about “one of the strongest discoveries in psychiatry for the last 20 years”.

It is based around the idea that some people are being betrayed by their fiercest protector. That their immune system is altering their brain.

There is now a patchwork quilt of evidence suggesting inflammation is more than something you simply find in some depressed patients, but is actually the cause of their disease. That the immune system can alter the workings of the brain.

To hear more we visited Carmine Pariante’s laboratory at King’s College London. The professor of biological psychiatry has been piecing together the evidence on inflammation and depression for 20 years.

He told the BBC: "Nearly 30% to 40% of depressed patients have high levels of inflammation and in these people we think it is part of the causal process.

"The evidence supporting this idea is that high levels of inflammation are present even if someone is not depressed, but is at risk of becoming depressed.

"We know from studies that if you have high levels of inflammation today you’re at higher risk of becoming depressed over the next weeks or months even if you are perfectly well."

Raiding the cupboards is already showing signs of success. Those early clues in arthritis mean the anti-inflammatory drug sirukumab is now being trialled in depressed patients.

So are drugs targeting the immune system about to transform the treatment of depression?

Prof Bullmore argues: "I don’t think they are going to be a panacea, I don’t think we’re talking about a scenario in future where every patient with symptoms of depression is going to be offered an anti-inflammatory drug.

"I don’t think that makes sense and frankly that sort of blockbuster one-size-fits-all approach to development of drugs for psychiatry has not been helpful to us in the past.

"We have to take a more personalised or stratified approach, not everyone that is depressed is depressed for the same reason."

That will require a blood test to identify which patients will benefit from immune-based therapies.

Depression is a disease that affects hundreds of millions of people. Even if anti-inflammatories help just a small proportion of them - that would still be a huge number of patients. But if immunotherapy becomes a success, its biggest impact may be on the way we think about the disease, making people less likely to believe sufferers should just “pull themselves together”.

Prof Pariante concludes: "It is groundbreaking because, for the first time, we are demonstrating that depression is not only a disorder of the mind, in fact it is not even only a disorder of the brain, it is a disorder of the whole body."

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Interestingly, an antidepressant, Nortriptyline, in small doses helps relieve neuropathy, which is, I think, a type of inflammation. While I was on it, I noticed my anxiety was diminished.

My anxiety has been diminished by virtually every drug I’ve tried for PsA. I’ve heard some drunks say they were born one gin short of okay. Well I reckon I was born one DMARD or biologic short of happier. (Okay, maybe the shortfall happened a bit later than that).
I heard that radio programme too and thought ‘tell me something I don’t know’. But by ‘know’ I mean intuitively and that doesn’t count for much.

Neurontin (gabapentin) can be used for neuropathic pain, for seizure control, and for anxiety. At one point 3 of us in my house were on it, me and my cat for neuropathy, and my daughter for anxiety.