“In some people with psoriatic arthritis, depression and anxiety are temporary and related to lack of control of pain, but in others it becomes chronic,” says Stanford Shoor, MD, a rheumatologist at Stanford Health Care in Palo Alto, California. Here are six things you should know about psoriatic arthritis and how it may affect your emotional health. A better understanding of these facts can help you cope with this autoimmune condition and the anxiety and depression that can come with it.
1. The Same Processes That Trigger Inflammation in Psoriatic Arthritis May Also Create Changes in the Brain That Affect Emotions
“Stress is implicated in flares of all autoimmune diseases,” says Aly Cohen, MD, a rheumatologist and integrative medicine practitioner in private practice in Princeton, New Jersey. Indeed, a review of the scientific literature published in October 2018 in the International Journal of Dermatology stated that patients reported stress as a trigger for their psoriasis flares in anywhere from 31 to 88 percent of cases. About a third of people with psoriasis also have psoriatic arthritis, according to the National Psoriasis Foundation (NPF). Another study, published in Biomedical Reports in January 2021, noted a link between rheumatoid arthritis (RA) and depression. The researchers connected the release of cytokines (small inflammatory proteins produced by the immune system) with both RA and depression; Dr. Cohen says the findings could apply to psoriatic arthritis as well. RELATED: 8 Surprising Ways Psoriatic Arthritis Can Affect Your Health Julie Shafer, PhD, a psychologist in Portland, Oregon, says the following may be signs of depression:
You sleep too much or not enough.You’ve lost your appetite or eat more junk food than normal.You’re more emotional than normal. “Things get under your skin more,” Dr. Shafer says.You don’t feel like being with others.You’re tired or fatigued all the time.
The Anxiety & Depression Association of America notes these additional signs of depression:
You have thoughts of death or suicide. Or, you attempt suicide.You have headaches, digestive disorders, or pain that has no known medical cause and that does not respond to treatment.You have difficulty concentrating, making decisions, or remembering important information.
If you recognize these signs, seek professional help. “Find someone who understands how having a chronic illness plays a role in your emotional state,” Shafer says. If you are thinking of harming yourself, the National Suicide Prevention Lifeline provides free, confidential support 24/7: 800-273-TALK (8255).
3. If You’re Depressed, You May Be Less Likely to Take Your Medication and Follow Healthy Behaviors That Make Managing Psoriatic Arthritis Easier
Shafer recommends normalizing your schedule as much as you can. For better sleep, “Go to bed and get up at the same time,” she says. “Eat healthy. Get out and get some sunshine. Find ways to reduce stress. Accept help from other people.” If having too much to do makes you feel stressed, drop nonessential tasks from your list, she says. If you’re forgetting to take prescribed drugs for your psoriatic arthritis, set reminders on your smartphone or calendar, Cohen adds.
4. Mind-Body Techniques Can Help You Change Your Body’s Response to Stress and Manage Pain
Any technique that distracts your mind from pain, both physical and psychological, can reduce pain significantly, Dr. Shoor says: “This is why when you’re engaged in something you enjoy or that requires you to be alert and concentrate, your pain seems to be less.” Deep relaxation, breathing, yoga, meditation, tai chi, guided imagery, and laughter are just a few of the effective mind-body techniques that can help manage pain, he says. A recent study confirms that mindfulness-based cognitive therapy (MBCT) can have a positive impact on people with rheumatoid arthritis, and Shoor believes the results would apply to psoriatic arthritis as well. The study, published in February 2019 in Complementary Therapies in Clinical Practice, found that mental health scores of patients with RA improved after they completed an eight-week course in mindfulness meditation practices. RELATED: Your Everyday Guide to Living Well With Psoriatic Arthritis
5. Physical Activity Can Boost Your Mood and Help Alleviate Pain
Exercise helps keep your joints looser and more nimble, according to the NPF. “Exercise also releases hormones that help us to be less vulnerable to pain,” Shafer says. Choose a workout that matches your abilities and that doesn’t cause you pain, the NPF suggests. Some exercises that are low impact but can help build muscle, increase joint flexibility and strength, and lift your mood include yoga, tai chi, walking, bicycling, swimming, and warm water workouts (offered in special arthritis classes at many Ys, aquatic centers, and community pools, according to the patient advocacy group CreakyJoints).
6. Staying Socially Active Can Help You Cope With the Emotional Impact of Living With Psoriatic Arthritis
“Social activity can help take your mind off of pain and reduce depression and anxiety,” Shoor says. You also can seek out support from others with psoriatic arthritis. “Some people find it helpful to talk with others who have the same condition because they understand and can empathize well,” Shafer says. The NPF has a message board where you connect with others who have psoriatic arthritis.
7. Treating Your Depression and Anxiety Can Combat Your Psoriatic Arthritis, and Vice Versa
Think of psoriatic arthritis and depression and anxiety as a two-way street, says the Arthritis Foundation — your PsA can impact your mental health and your mental health your PsA. That’s why you should treat your depression and anxiety as a disease just as you do your psoriatic arthritis. Otherwise, the foundation says, your anxiety and depression can make the pain from your psoriatic arthritis seem that much worse, and your PsA pain can exacerbate your depression and anxiety.
