Lupus And Depression

Lupus and Clinical Depression

Life with lupus—with symptoms that come and go, disease flares and remissions, and the uncertainty of what each day will bring—can be difficult and challenging. It is normal to experience feelings of unhappiness, frustration, anger, or sadness when you live with a chronic illness such as lupus. And it is normal to grieve for the loss of the life you had before lupus. As you learn more about lupus, and how to adjust and adapt to necessary life changes, these sorts of negative feelings will lessen. 

Sometimes, though, negative feelings can become overwhelming and long-lasting. How do you know if and when to seek professional help for these feelings? In this fact sheet, we will try to help you understand the difference between temporary mood swings and long-lasting feelings that signal a more serious illness, called clinical depression.

Symptoms

People are considered to be clinically depressed when they have a depressed or irritable mood, decreased energy, and other symptoms in the list below that last for more than a few weeks and are severe enough to disrupt daily life. Probably the best single marker for clinical depression is loss of interest in activities and responsibilities that used to be important. For example, if you find yourself saying, “I used to enjoy gardening, cooking, and going to church. I don’t feel like doing any of those things anymore.” 

Clinical depression may be brought about by lupus, by the various medications used to treat lupus, and/or by any of the factors and forces in a person’s life that are not related to lupus. For reasons that are not entirely understood, this type of depression is often experienced by people with chronic disease. There is good news, however. If recognized and properly treated, symptoms of clinical depression can improve.

Psychological and Physical Symptoms of Clinical Depression

  Feelings of helplessness or hopelessness   Sadness   Crying (often without reason)   Insomnia or restless sleep, or sleeping too much   Changes in appetite leading to weight loss or weight gain   Feelings of uneasiness, anxiety, or irritability   Feelings of guilt or regret   Lowered self-esteem or feelings of worthlessness

  Inability to concentrate or difficulty thinking   Diminished memory and recall   Indecisiveness   Lack of interest in things formerly enjoyed   Lack of energy   General slowing and clouding of mental functions   Diminished sexual interest and/or perfor­mance   Recurrent thoughts of death or suicide

Diagnosis

Clinical depression may not be recognized in people with lupus because its symptoms and the symptoms of active lupus can be so similar. For example, lack of energy, trouble sleeping, and diminished sexual interest can be attributed to the lupus itself. However, these are also symptoms of clinical depression.

Causes

A variety of factors can contribute to clinical depression in people with chronic illnesses. The most common cause is the emotional drain from the stress of coping with the complications of physical illness. Add to that economic, social, and workplace concerns. Various medica­tions used to treat lupus—especially corticosteroids—may cause clinical depression. When certain organs or organ systems are affected by lupus (such as the brain, heart, or kidneys), clinical depression may occur. A flare of lupus also can trigger clinical depression, both because you feel ill, and because it may seem as though you are never going to be free of lupus.

Facts About Clinical Depression and Lupus

• ·         Between 15 and 60 percent of people with a chronic illness will experience clinical depression.
• ·         Clinical depression may be a result of the ways in which lupus physically affects your body.
• ·         Some of the medicines to treat lupus—especially corticosteroids such as prednisone (and at higher doses of 20 mg or more)—play a role in causing clinical depression.
• ·         Clinical depression may be a result of the continuous series of emotional and psychological stressors associated with living with a chronic illness.
• ·         Clinical depression may be a result of neurologic problems or experiences unrelated to lupus.
• ·         Clinical depression also produces anxiety, which may aggravate physical symptoms (headache, stomach pain, etc.).
• ·         Two common feelings associated with clinical depression are hopelessness and helplessness. People who feel hopeless believe that their distressing symptoms may never improve. People who feel helpless believe they are beyond help—that no one cares enough to help them or could succeed in helping, even if they tried.

What Can You Do?

Clinical depression generally improves with a combination of psychotherapy and medication. 

Seek psychotherapy. You should not feel embarrassed or hesitant about asking your doctor for a referral to a psychiatrist, psychologist, or therapist. Psychotherapy, under the guidance of a trained professional, can help you learn to understand your feelings, your illness, and your relationships, and to cope more effectively with stress. Cognitive behavioral therapy—a special type of psychotherapy—can be very helpful when you are living with chronic illness. Support groups led by a therapist or trained counselor, such as those organized by the LFA national network of chapters and affiliates, also can be instrumental in helping you deal with symptoms of clinical depression. To find a group in your area, go to lupus.org/chapters or call toll-free (800) 558-0121.

Take antidepressant medications. Several types of prescribed drugs can help ease the effects of clinical depression. Anti-anxiety medicines are also available to reduce worry and fearful feelings. These improvements can occur in a matter of weeks in some people once medication is started. 

Find ways to reduce pain. Chronic pain can be a factor in the development of clinical depression. Besides medication (which can also play a role in clinical depression), experts often recommend non-medication ways to conquer—or at least reduce—chronic pain, such as yoga, tai chi, Pilates, acupuncture, biofeedback, meditation, behavioral changes, play therapy, and chiropractic care. 

You may be considering over-the-counter treatments for your depression and/or pain. It is important to remember that all herbs and supplements should be discussed with your rheumatologist or primary care provider before you try them, as certain ingredients can cause reactions with your prescribed medications.

Get more exercise. If you are physically able, take part in some sort of physical activity every day. This can be as simple as walking the dog, yard work or gardening, or window shopping at the mall.

Improve your sleep habits. Not getting enough restful sleep can cause many health problems, including symptoms of clinical depression. To improve your sleep, and, in turn, your mental well-being, try to:

• ·         Get seven to eight hours of sleep in a 24-hour period.
• ·         Do aerobic exercise every day, such as brisk walking—or whatever you can manage.
• ·         Avoid caffeine, nicotine, and alcohol several hours before bedtime.
• ·         Know which medications keep you from sleeping and take those early in the day.
• ·         Have a good mattress, comfortable bed linens, the right room temperature, and the right amount of darkness.
• ·         Include rest periods throughout your day when needed.

If you still aren’t getting enough sleep, find a reputable sleep center and talk to your doctor about sleep medications.

Build a support system. Stay in touch with family members, former work buddies, or long-time friends. Make phone calls, join Facebook, try videoconferencing, or consider adding an animal companion to your family.

Stronger Ties With Friends & Family

Treating depression may improve your social life. Depression isolates people. It can sap your self-esteem, making you feel unlikeable. While therapy and medication can help restore some of that lost confidence, you still need to decide to reach out. Reconnecting to old friends when you’re depressed -- not to mention making new ones -- is hard. But it’s a crucial part of getting better.

Getting Help

Some people with depression try to wait it out, hoping it will get better on its own without treatment. That's a mistake. Studies have found that the longer depression lasts, the worse your symptoms may get and the harder it is to treat.

See your doctor. Schedule an appointment with a therapist. The sooner you get help, the better your odds for a healthy future.

Better Love Life

Some antidepressants may dampen the libido. But often, the bigger roadblock to a happy love life is depression itself. One study showed that 70% of people with depression reported a loss of sexual interest while not taking medicine. Treatment may help restore your self-confidence and strengthen your emotional connection with your partner.

Pain Relief

Treatment for your depression can make you feel better emotionally and may reduce pain. That’s because depression can contribute to the discomfort of pain. Studies have found that people who have conditions like arthritis and migraines actually feel more pain -- and are more disabled by it -- if they're depressed. Seeking treatment may help provide relief.

Improved Health

If you are depressed, getting treatment may help prevent some serious diseases down the road. That’s because depression can take a toll on your body. One study found that women who were depressed had double the risk of sudden cardiac death than women who weren’t. Getting treatment may help lessen health risks.

Better Performance at Work

Depression can make it hard to hold a job. If you’re depressed, you might lose focus at work and make more mistakes. If you think depression might be affecting you at work, getting help now could head off serious problems.

Sharper Thinking and Better Memory

Feeling forgetful? Does your thinking seem fuzzy? Experts have found that depression might cause structural changes to the areas of the brain involved in memory and decision-making.

The good news is that depression treatment may prevent or reverse these changes -- clearing away the cobwebs and strengthening your recall.

Happier Home Life

Irritable and angry? Constantly snapping at your kids -- and then feeling bad about it? Getting depression treatment can help boost your mood. And that can help reduce tension around the house and improve your relationship with your family.

Healthier Lifestyle

Why does depression cause some people to gain weight? In part, it’s behavioral -- you may withdraw and become less active, or turn to food for comfort. It’s also physiological -- low levels of certain brain chemicals can trigger a craving for carbs. Getting treatment may change that while giving you the energy to exercise and eat well.

Less Chaos, More Control

When depression zaps your energy, even the most basic tasks -- like vacuuming or paying the bills -- can become impossibly hard. The more chaotic things get, the less capable you feel. Depression treatment can restore the energy you need to take control of your life and get it organized.

Lower Risk of Future Depression

People who have been depressed have a higher risk of becoming depressed again. But ongoing therapy or medication may help prevent depression from coming back. Even if it does return, treatment now will prepare you. You’ll know the early signs. You’ll know some coping skills. And you’ll know where to get help.

Stronger Ties With Friends & Family

Treating depression may improve your social life. Depression isolates people. It can sap your self-esteem, making you feel unlikeable. While therapy and medication can help restore some of that lost confidence, you still need to decide to reach out. Reconnecting to old friends when you’re depressed -- not to mention making new ones -- is hard. But it’s a crucial part of getting better.

Getting Help

Some people with depression try to wait it out, hoping it will get better on its own without treatment. That's a mistake. Studies have found that the longer depression lasts, the worse your symptoms may get and the harder it is to treat.

See your doctor. Schedule an appointment with a therapist. The sooner you get help, the better your odds for a healthy future.

Change your self-talk. Feelings of anger and self-pity can bring on unproductive thoughts; for example, “It’s not fair. I haven’t done anything wrong. Why me?” “I’m too weak even to fight off this illness.” Replace negative, self-defeating inner language with truthful, productive thoughts, such as: “I feel lousy, but I have many blessings.” 

You can also list the people and things in your life for which you are grateful: A loving spouse or significant other; your children, and the children of your extended family; caring relatives; good friends; a beloved pet; work or hobbies you enjoy and are able to do; a home you love; volunteer activities; fellowship at school, at a place of worship, or at a community center. Try to add to this list every day! 

Discover the values of volunteerism. Volunteerism can provide real emotional benefits. Helping with a charitable cause that is meaningful to you can create social, supportive connections. Helping others can have a positive impact on your sense of well-being.

Strive to accept the new “you.” Pace yourself, and don’t feel badly about delegating some of your responsibilities. Ask for help, and accept help graciously. Finally, focus on what you have, not on what you don’t have, and on what you can do, rather than what you can’t do.

Conclusion

Just as clinical depression develops over time and not overnight, conquering clinical depression is a gradual process. However, most people with lupus find that, in time, their overall attitude and sense of well-being are greatly improved. 

You will also find helpful suggestions for living well with lupus in the LFA Patient Education Series fact sheets, Living with Lupus and Coping with Lupus, and on the LFA Web site,lupus.org.

Related Information

Strategies for Restful Sleep
April 2011 15 Questions with Dr. Michael Smith

Depression and Lupus
December 2008 webchat transcript with Dr. Al Herzog

The Challenges of Dealing with the Emotions of Lupus
June 2007 webchat transcript with Dr. Al Herzog

Coping with Lupus
December 13, 2006 webchat transcript with Dr. Robert Phillips

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Systematic Lupus Erythematosus (SLE) and Depression 

From: http://www.hss.edu/conditions_lupus-depression.asp

Summary of a presentation given at the SLE Workshop at Hospital for Special Surgery, March 24, 2005

Enid Engelhard, LMSW
Director, Social Services
The S.L.E. Lupus Foundation

Introduction

Depression can be an extremely difficult battle to fight, especially when compounded with a lupus diagnosis. It can be particularly hard at times to know whether depression is related to lupus-related mood swings, the side effects of medicines, the emotional impact of coping with a potentially severe and unpredictable illness, or to a separate, unrelated, clinical depression.

Types of depression

Clinical depression is often described as being "chemical" or "reactive". Chemical depression involves chemical changes or neurological factors in the brain that trigger depressive symptoms. Reactive depression, on the other hand, stems from an emotional response to something that occurred in one's life, e.g., personal loss, death, or a variety of stressors that can trigger a sense of sadness that does not go away for weeks or months.

Is it depression or is it the "blues"?

There is a big difference between clinical depression and what is often referred to as the "blues". The "blues" can merely cause someone to feel "down in the dumps" as a result of a variety of life stressors, including job difficulties, money problems, or relationship issues. The "blues" typically last for several days, and a person can feel sad one day and happy the next. 

Most people experience the "blues" at some point in their lives. The holiday season, for example, or anniversaries of sad events, can frequently evoke the "blues".

In the case of depression, however, the symptoms are more fixated or permanent and not transient, unlike the "blues". When someone is depressed, it might seem that nothing excites or "tickles" them anymore.

Some Symptoms of Clinical Depression

·         Depressed mood (usually lasting all day)
·         Feeling of emptiness
·         Lack of motivation
·         Loss of interest in hobbies or activities that brought pleasure before
·         Weight gain or weight loss related to loss or gain of appetite (not from medicines)
·         Trouble sleeping or sleeping too much
·         Lack of concentration
·         Loss of sexual interest
·         Low energy or fatigue
·         Low self-esteem
·         Feeling helpless or hopeless

What can be confusing for those with lupus is that a number of these symptoms can alternatively be explained by the symptoms of their condition, e.g., fatigue or lack of concentration. It can be challenging to differentiate between the emotional and physical factors that may be contributing to feelings of depression. This underscores the need to talk to a physician about these symptoms.

Some of these symptoms can occur when someone is experiencing the "blues." However, if any or all of these symptoms persist for more than two weeks in a row, professional help should be considered. In any case, if these symptoms of depression get in the way of the ability to function normally, they should be brought to a physician's attention.

Some Additional Facts

Depression is a very common problem, whether there is a chronic illness involved or not. 20% of women have experienced clinical depression at some time in their lives.

Studies have reflected rates of depression varying from 15-60% in people with chronic illnesses. In lupus patients, depression may sometimes be experienced during or after a flare. 

This may be related to the lupus itself or to the emotional feelings that are triggered by having to cope with an active illness episode.

It is important to note the dangers of alcohol while depressed, because alcohol - as a natural depressant - can markedly increase the severity of depression and its symptoms.

Treatment/Medication

There are several treatment options for depression. Both psychotherapy and antidepressant medications can be quite effective. Those suffering from the symptoms of depression should ask their physician, social worker, or nurse, or contact their local professional association, medical society, or Lupus/Arthritis Foundation for the name of a licensed mental health professional experienced in treating people with chronic illnesses such as lupus. Working with a mental health professional can be useful in identifying additional ways to cope with the stress of chronic illness.

Joining support groups such as those offered by Hospital for Special Surgery, the Lupus Foundation, or the Arthritis Foundation may be additionally helpful. It is important to keep communication open between the primary care physician, the rheumatologist, and the patient about feelings of depression so they can all work together early and effectively.

Some of the newer antidepressant medications can be very effective partners in the treatment process. Serotonin reuptake inhibitors (SSRIs) tend to have fewer side-effects than older medications. Patients can take SSRIs for 2-12 weeks to be fully effective, and sometimes different medicines and dosages need to be tried to find what works best. Generally, these medicines will be used for at least six months after the patient begins to feel better.

Things for patients to do to help themselves

• ·         Changes in behavior may be helpful in combating a serious depressive onset as well as fighting the "blues".
• ·         Exercise regularly
• ·         Take medication consistently
• ·         Pace yourself and get enough rest
• ·         Assertiveness - ask for help when needed
• ·         Find effective ways to communicate with family members
• ·         Join a support group or program
• ·         Eat healthily

Although depression is often a normal reaction and sometimes sadness may even help the healing process, one must be careful and vigilant about these kinds of feelings and trust their instincts when it is clear that something is wrong.

The Ultimate Goal

It is normal for someone to grieve the loss of their old self. It's important to learn to come to terms with a disease -- to try to befriend it and not to deny it. It's important to give oneself permission to be depressed for short periods of time and to develop a sense of humor along with a positive attitude. And most importantly, to get on with living.

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Systematic Lupus Erythematosus (SLE) and Depression 101

Adapted from a presentation at the SLE Workshop at Hospital for Special Surgery by Dr. John Barnhill and Su Jin Kim. April 26, 2012. http://www.hss.edu/conditions_systematic-lupus-erythematosus-sle-and-depression.asp

John Barnhill, MD

 Chief of Psychiatry, Hospital for Special Surgery Professor of Clinical Psychiatry, Weill Cornell Medical College Professor of Clinical Public Health, Weill Cornell Medical College Lecturer, Columbia University Center for Psychoanalytic Training and Research

Su Jin Kim, LCSW Social Work Manager, Rheumatology; Hospital for Special Surgery

Introduction

John Barnhill, MD, a psychiatrist and Su Jin Kim, LCSW, a social work manager, engaged in an interdisciplinary talk about depression and its connection to lupus to the SLE Workshop, providing unique perspectives of two professionals from two different disciplines.

Dr. Barnhill stressed that depression is not just feeling sad. Rather, it’s a disorder of feelings, thoughts, and behaviors.

Someone experiencing depressive feelings may be unable to enjoy things. They may feel physically restless, run down and fatigued, he explained. An individual experiencing depressive thoughts may be thinking their situation is helpless, they may not believe there is any hope left for them, and they could be thinking of harming themselves.

Depressive behaviors include eating too much or too little, having difficulty sleeping or sleeping too much and not partaking in activities that an individual once found pleasure in. Additionally, a depressed person may be acting destructively by engaging in risky behaviors and may be thinking of ways to hurt themselves.

Types of Depression

Major depression is a depression that is characterized by an all-encompassing low mood. Dr. Barnhill believes major depression may be the most debilitating disease in all of medicine because it impairs an individual’s ability to function overall, which most physical diseases do not do.

Dysthymia/Chronic Mild Depression differs from major depression in that the sad feeling may last for longer duration of time, but an individual does not feel as depressed.

Adjustment disorder is a depression that is brought on as a reaction to stress and lasts less than six months.

Demoralization is a type of depression for people who try and maintain active goals and interests, but who are unable to participate because they are so ill. If you removed the illness, they would be functioning individuals. This differs from major depression because you cannot take away the stress and sadness in major depression and have the person function normally.

Substance-induced mood disorder is a depression that is brought on by using drugs, either illicitly or by prescription. Steroids have been associated with depressed moods, and using cocaine can give an individual a high, followed by a deep low.

Related Issues

Dr. Barnhill also added that anxiety often accompanies depression. This may lead a depressed person to feel paranoid and confused. Additionally, many patients will somatize their depressive feeling, meaning that they will complain of physical symptoms rather than reporting feeling depressed.

When an individual is feeling depressed, Dr. Barnhill stressed that overall they just don’t feel right reporting both physical and mental problems, such as lack of concentration.

Dr. Barnhill stressed that it’s a difficult and cyclical process, because depressed individuals who don’t feel good about themselves think in a very binary fashion which may make them more likely to withdraw from social situations.

This black/white thinking is important, he noted, because it is an avenue for intervention.

Depression and Lupus

Depression is common in lupus, just like depression is common in all chronic illness.

It is common in the general population as well. In any given year, about 10% of the general population will become depressed, without any added stressors. In the SLE population, the prevalence of depression in a given year increases to 30%. Dr. Barnhill explained that the increase in depression among those living with lupus can be related to psychological or physical reactions to lupus or the lupus medications, or some combination of those, or the depression can be independent.

Psychological Reaction to Lupus

Living with lupus can be very isolating because you never know if you will be able to plan a picnic with your family and friends, for example, and that feeds into a depressive cycle. You may not want to initiate plans, which feeds into a feeling of isolation, which then may make someone feel depressed.

Of course, living with lupus is also stressful. We know stress does not cause lupus, but there is some debate about whether stress can cause a lupus flare. While there is no definitive link between stress and lupus flares, there does seem to be some kind of association between the two. It would make sense on the surface, but the complicating factor is when you start to undergo a flare you might be more likely to look back at the past month or so and say it was stressful.

Biological Reaction to Lupus

We don’t know how lupus affects the nervous system. Neuropsychiatric lupus is an umbrella term that includes 12 central nervous system conditions as well as 7 peripheral nervous system conditions. There is a lot of research dedicated to uncovering the cause and effect relationship of lupus to the nervous system and how it impacts lupus health outcomes.

Essentially, Dr. Barnhill said we don’t have a great understanding of why some people may develop neuropsychiatric lupus conditions, but when you account for conditions such as headaches or cognitive dysfunction, it is clear that for some people living with lupus their central nervous system is affected. However, Dr. Barnhill stressed that not everyone develops a neuropsychiatric condition.

Reaction to Lupus Medications and Treatment

Steroid therapy is commonly used for lupus patients. These medications alone can cause feelings of depression and anxiety. Many patients report feeling depressed after beginning a course of steroids; however, there are other patients who report an improvement in mood.

Steroid Psychosis is a condition where a patient experiences a psychotic event brought on by steroids. Lupus cerebritis is an infection in the brain caused by inflammation, but this condition can also lead to psychotic symptoms. If a patient with lupus is experiencing psychosis related to the steroid treatment, it may be necessary to reduce the dosage. However, if the psychosis is related to the lupus independently of the steroids, it may be necessary to increase the steroid dosage.

Dr. Barnhill discussed the variety of treatment options that are available to individuals who are depressed. He stressed that most of the treatments he recommends for depression do not involve medications. Rather, Dr. Barnhill suggests psychotherapy, as well as support groups, exercising, keeping a healthy diet, getting enough sleep, and keeping a routine.

Of course, medications are commonly used to effectively combat depression. There are several types of medications and every person is different, so not everything will work for everyone. Dr. Barnhill broke down medications for depression into several groups, which are explained below.

Types of Depression Medications

Selective Serotonin Reuptake Inhibitor (SSRI’s) Dr. Barnhill said SSRI’s are the most famous group of medications. This classification includes drugs such as Prozac, Celexa, Lexapro, Paxil, and Zoloft. Currently, this group of drugs is most commonly used to treat depression. All the SSRI’s are very similar in their treatment. They all take several weeks to begin working and have relatively mild side effects such as minimal weight gain and problems with the gastroinstential tract. On the whole, the SSRI’s are safe, which is why they are so commonly prescribed.

Serotonin-norepinephrine reuptake Inhibitor (SNRI’s) This group of medications includes Cymbalta and Effexor. SNRI’s have the added effect of treating pain. These medications essentially do “double duty” and may help to alleviate feelings of depression as well. These drugs may be difficult to withdraw from, however, and it must be done slowly.

One of the side effects of both SSRI’s and SNRI’s is sexual dysfunction, including difficulty becoming aroused and delayed orgasm.

Wellbutrin: Wellbutrin is a medication that does not have sexual dysfunction as a side effect. It is an activating medication, meaning that it provides the individual with more energy. This makes it quite popular.

Remeron: Remeron is a sedating medication that should be taken at night. Because it helps to cause sleep, a depressed person may get a better night’s sleep while taking Remeron and therefore feel better.

Dr. Barnhill said the above medicines work much of the time, but not all the time. Somewhere between 20-30% of people will not get better taking these drugs. If the drugs are not working, you and your doctor may want to change them after six weeks or adjust the dosing. Additionally, your doctor may try some of the older anti-depression medications or try adding stimulants. Dr. Barnhill also added that because depression is a cycle, sometimes people will get better on their own.

Depression and Lupus: How You Can Find Help

Su Jin Kim spoke next about HSS initiatives about lupus and depression, what we know about depression and lupus, what type of talk therapies exist, communication tips, and resources to help cope with depression.

Ms. Kim noted that research shows that up to 60% of lupus patients will have depression at some point, depending on the factors the researcher is looking at. The Rheumatology Division at HSS and the Department of Social Work Programs did a small pilot study last year, using a depression screening tool known as the Patient Health Questionnaire (PHQ-9) and found that depression rates were high. 

They also provided a psychosocial intervention and mental health referrals and found that 80% of patients actually completed the intervention. Ms. Kim believes the results of this pilot study will be helpful in designing effective interventions for depression in the lupus community.

Challenges

There are clearly many challenges related to living with lupus, which can take an emotional toll on the person living with lupus, as well as their family members. Ms. Kim listed the following as some additional stressors that may contribute to feelings of depression among those living with lupus:

• Challenge of managing a chronic illness (i.e., pain and fatigue)
• Unpredictability of illness and flares, both of which make it difficult to schedule/plan
• Effects on self-esteem and identity
• Impact on your career choices
• Impact on your relationships
• Role changes/shift in family and couple dynamic
• A recent exploratory study, by Beckerman and colleagues (1), illustrated that among those with lupus, the highest causes of depression and anxiety are related to changes in physical appearance, such as weight gain and hair loss, and physical limitations.

The more chronic your lupus symptoms are, the more feelings of depression you may have. Individuals without health insurance have increased rates of depression. If an individual feels that they have control over their lupus, they are less likely to feel depressed. African Americans and Hispanics report more unmet psychosocial needs and higher rates of depression than Whites with lupus.

Talk Therapy

Ms. Kim then brought up the treatment option of talk therapy, stressing that it’s a personal choice. Sometimes patients will tell Ms. Kim that they would talk about their feelings with their pastor, or a family members, and that’s completely fine, Ms. Kim explains. There is no right or wrong choice, she adds. Something different can work for different people. However, talking to a professional can be beneficial in providing clarity and helping you through a difficult transition.

Engaging in talk therapy is also a commitment, as it generally requires once weekly meetings for about 50 minutes and can involve traveling as well. Additionally, many feelings and issues can come up during therapy, and you need to make sure you have carved out the proper amount of time to work through that.

If you’ve decided that you want to try talk therapy, you may become confused trying to decide which type to pursue. Ms. Kim provided a description of several of the most popular types of talk therapy:

Cognitive Behavioral Therapy (CBT) CBT is a short-term, focused psychotherapy where a therapist works with you on examining your present day negative thoughts and behavior patterns. It is grounded in the understanding that our thinking plays an important role in how we feel and what we do. The therapy sessions are structured and within a set length of time, and the therapist will often assign homework. CBT is an active therapy because it requires you to work on issues between sessions. It has been shown to be effective with the lupus population and it is a good therapy option for people who are more solution-focused.

Psychodynamic Therapy This is a form of therapy where you explore your behaviors, feelings, and early life experiences and how these have influenced your current behaviors, feelings, and relationships. The length of therapy can range from a few months to a longer, ongoing period of time. This is a good match for an individual who is more self-exploratory.

Interpersonal Therapy Interpersonal therapy is not performed on its own; rather it is integrated into CBT or psychodynamic therapy. It is a short-term intervention that focuses on the interpersonal context and building interpersonal skills. While depression is not caused by interpersonal stressors, depression can be made worse by interpersonal conflict, and this therapy works to improve this domain.

Mindfulness Based Therapies This type of therapy combines talk therapy with the practice of meditation. One example is “Mindfulness Based Stress Reduction,” which was established by Jon Kabat-Zinn. It is a structured 8-10 week course in a group that involves talking, body scanning, meditation, and homework assignments. The focus of the therapy is on reducing pain and improving physical and mental well-being. This type of therapy is well researched with patients who have chronic pain, such as patients with fibromyalgia or rheumatoid arthritis.

Other Talk Therapies Ms. Kim said that group support, such as the SLE workshop, or group therapy, which would be more intensive, can be beneficial for patients, as well as peer-to peer support programs such as LupusLine® andCharla de Lupus/Lupus Chat® or LANtern® Lupus Asian Network, all of which are offered at HSS. Couple and family therapy may also be beneficial, particularly if there is a shifting of roles due to your illness.

It may be difficult to decide what kind of therapy is right for you. Ms. Kim suggests doing some research on your own and asking your health professionals and friends who have engaged in therapy or are knowledgeable about the subject for advice. There is no right answer. Sometimes you may have to “shop around”, meaning try a different type of therapy for a period of time and decide if it is effective for you.

The same approach goes with finding the right therapist. First impressions of a therapist may not always be right. Try working with your therapist a few sessions in order to decide if you feel comfortable and heard by them. When you are looking for a therapist, some good questions to ask are: what kind of therapy they offer, do they have any experience working with chronic illness/ lupus patients, if they offer a consultation, and what their fee is. Most importantly, Ms. Kim stressed that therapy has become much more mainstream and accepted and the stigma of using a mental health provider continues to decline.

The Importance of Good Communication

Ms. Kim then spoke about ways to communicate with yourself, your family members, and your providers when struggling with depression.

Communicating with yourself First, you need to be gentle with yourself. Ms. Kim said that in her experience many patients experience stress and depression from believing they must accomplish everything quickly. Ms. Kim reminds them to breathe and take it easy, and often, this simple reminder helps to calm them.

Use positive self-talk, such as “You can do it!” and “Keep it up!” Ms. Kim pointed to the strength of her patients, saying many of them have gotten through very stressful situations as a result of their strength. Remind yourself of what worked in the past and make modifications to your schedule based on your health.

Communicating with your Family and Friends If you are the person feeling depressed, often the last thing you want to do is reach out and talk to others. But Ms. Kim stressed that it is important to talk to others and express how you feel. “It’s okay to ask others for help,” she explained. If you are the family member or friend, it can be frustrating dealing with a depressed loved one. You need to stay patient and connected. Being aware that sometimes depression causes a person to withdraw can help you normalize what is going on with your loved one. It might be useful for everyone affected to seek therapy in order to cope with the changes occurring within your family.

Communicating with your Providers Remember that your emotional and psychological well-being are important. It is important to share how you are feeling emotionally with your provider as well as how you are feeling physically.

Ms. Kim realizes that depending on the style of your provider, sharing your emotions with them can range from easy to difficult. She recommends sharing a little bit of your life naturally with your provider at each visit so that a relationship is builds over time, so that if you are ever in a crisis situation, your provider is in a better position to help you.

Ask the health care provider you feel most comfortable with - whether that is your general practitioner, your nurse, or your social worker - for behavioral health resources.

• More  Depression Resources:

http://www.lupus.org/webmodules/webarticlesnet/templates/new_about.aspx?articleid=92&zoneid=2

Lupus and Depression

http://lupus.webmd.com/community-tv-lupus-11/lupus-depression

Lupus and Depression: 11 Ways to Help You Cope

http://www.nlm.nih.gov/medlineplus/depression.html

Depression is a serious medical illness that involves the brain. It's more than just a feeling of being "down in the dumps" or "blue" for a few days. 

http://www.apa.org/topics/depress/index.aspx

Depression is more than just sadness. People with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide.

http://www.cnn.com/2012/11/28/health/seasonal-affective-disorder-raison/index.html

Seasonal Affective Disorder