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Depression and Spondylitis: Understanding the Connection

Updated on October 25, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Elizabeth Wartella, M.P.H.

People with chronic diseases such as arthritis and spondylitis often also experience mental health disorders like depression. Research has found the prevalence of depression may range from 20 percent to as high as 55.5 percent in people with ankylosing spondylitis (AS), a severe form of spondylitis.

People with spondylitis may experience higher rates of depression than the general population, too. This increased risk may be because of factors such as chronic pain, inflammation, and the disease activity of spondylitis. Research has found that pain and depression are related — chronic pain can increase the risk of depression, and depression can make a person more sensitive to feelings of pain.

“In a lot of pain. I get so depressed because I have to stop anything I’m doing to rest,” wrote a MySpondylitisTeam member. “Tired and depressed. Today, I feel trapped by pain,” wrote another.

Addressing and treating depression may help improve the quality of life and the symptoms of spondylitis. Here, we’ll explain how spondylitis and depression are related, as well as what you can do if you’re experiencing mood changes that may be related to your condition.

What Is Depression?

Depression is a serious mood disorder that affects how you think, feel, and handle activities of everyday life, according to the National Institutes of Mental Health. Depression is commonly diagnosed if a person experiences depressive symptoms for most of the day for at least two weeks. Some symptoms of depression include:

  • Persistent feelings of sadness, anxiety, or emptiness
  • Sleeping problems such as insomnia or oversleeping
  • Loss of interest or pleasure in hobbies and activities you usually enjoy
  • Fatigue or lack of energy
  • Cognitive changes such as difficulties concentrating or trouble with making decisions
  • Weight loss or gain
  • Suicidal thoughts or attempts

Depression is one of the most common mental health disorders, with an estimated 3.8 percent of the population affected. Worldwide, approximately 280 million people have depression. Chronic illnesses commonly co-occur or are risk factors for developing depression. Diagnosis of a chronic illness — as well as the physical, emotional, social, and financial burdens of living with a chronic disease — may lead to depressive emotions or clinical depression.

Feelings of depression may change or decrease as someone acclimates to life with a chronic illness. However, depression can also develop as a side effect of medications for chronic diseases or may develop and become worse as a chronic disease progresses.

The Connection Between Spondylitis and Depression

Spondylitis is a type of chronic inflammatory arthritis that affects the spine and sometimes the joints in the arms and legs, depending on the type of spondylitis. Spondylitis can cause inflammation, pain, and swelling in affected areas. It can also cause deterioration of the bones, which may lead to spine deformities and functional limitations in areas like the spine, shoulders, and hips.

Spondylitis and depression are thought to be related through several different means.

Spondylitis Inflammation and Depression

Inflammation from spondylitis may affect levels of depression. Research has shown connections between depression and inflammation in the body. For instance, one study in the Journal of Clinical Psychiatry found that people with higher rates of depression also had higher levels of C-reactive protein, a biological marker of inflammation.

Increased levels of cytokines (substances involved in inflammation processes in arthritis) are also linked to depression. The inflammation and inflammatory processes from spondylitis may contribute directly to depression.

Spondylitis Disease Activity and Depression

Worse spondylitis disease activity has also been found to be associated with depression in different types of spondylitis. Disease severity, as well as fatigue and poor sleep due to pain, are shown to be associated with depression.

Poor quality of life and sleep disturbances might create a difficult cycle of symptoms. As a MySpondylitisTeam member wrote, “It’s a vicious cycle. Pain causes tiredness, and tiredness leads to depression and anxiety. It just feels like you have no strength sometimes.”

One mechanism underlying the association between spondylitis disease activity and depression may be feelings of control over one’s life and health status. Research has found an association between depression and AS disease activity, particularly in people who had lower feelings of control over their health.

Disease activity in people with psoriatic arthritis is also higher among those with depression. The direction of this relationship is unclear, as is whether depression worsens spondylitis activity or spondylitis symptoms influence depression.

Spondylitis Pain and Depression

Connections have been made between general pain and depression. Pain is one of the main symptoms of spondylitis, which may explain the increased levels of depression in people with spondylitis.

“Yesterday and today, I have been so miserable from all-over pain. It’s getting to where I can’t walk that much, and it makes me so depressed,” wrote a MySpondylitisTeam member. Another member said, “Today, I am having a bad day. Still in pain. I am depressed. My mind is everywhere.”

Research has found that people with higher levels of pain due to arthritis, in particular, are more likely to be depressed. Living with chronic pain every day is very stressful. Stress affects the brain’s biochemistry and may cause depression.

Depression may also make a person more sensitive to feelings of pain, which may in turn lead to worsening depression.

How To Treat Depression When You Have Spondylitis

You and your doctor have many different treatment options for depression related to spondylitis.

Talk To Your Doctor

If you experience persistent feelings of sadness, low mood, fatigue, or other symptoms of depression, speak with your primary care doctor, rheumatologist, or other health care provider. Your doctor can help assess whether your depression may be a side effect of your medications or other medical treatments.

Doctors can also help refer you to a psychiatrist or suggest other treatment options for depression. Do not feel ashamed by symptoms of depression. The more information the doctor has about your symptoms, the better they can help you. Also, the sooner you begin treatment for depression, the more effective it is likely to be.

Antidepressants

Antidepressant medications may help with both symptoms of depression and spondylitis. Antidepressants treat depression and are also sometimes prescribed for chronic back and neck pain as well as pain and depression in other types of arthritis, such as rheumatoid arthritis.

There are several different classes of antidepressants that work to alter brain chemistry and improve depressive symptoms. Selective serotonin-noradrenaline reuptake inhibitors, such as Cymbalta (duloxetine) and Effexor XR (venlafaxine), work to treat both depression and chronic pain.

“I have been on Cymbalta for 10 years. I started taking it for depression, but it also has helped my nerve pain. I feel it still helps,” said a MySpondylitisTeam member.

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) increase circulating levels of calming hormones like serotonin and dopamine in the brain and may be more tolerable (have fewer side effects) than other types of antidepressants. SSRIs include Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline).

Another class of antidepressants, called tricyclic antidepressants, has also been shown to help reduce pain and address symptoms of depression. Tricyclic antidepressants include Elavil (amitriptyline) and Pamelor (nortriptyline).

Wellbutrin is another common antidepressant that has worked well for some members. “I have had bad back pain for more than half of my life and struggled with depression for about that long, too. My doctors have had me on a dozen or more different pills, none of which really made any difference. A new doctor decided to try a new pill … Wellbutrin. What a difference that made!” wrote a MySpondilitisTeam member.

If you’re interested in trying antidepressants, work with your doctor or a psychiatrist, who can help determine the best type and dosage of antidepressant medication.

Try Talk Therapy

Talk therapy, or psychotherapy, is an effective treatment for depression. In talk therapy sessions, you work with a trained mental health professional to change troubling thoughts, emotions, and behaviors. Therapists or counselors also identify tools and exercises that can help you cope with stress and improve your well-being.

There are many different types of talk therapy, but speaking with your primary care doctor to find a therapist or counselor that specializes in chronic pain may be a good place to start.

Manage Your Spondylitis Well

Keeping your spondylitis under control may benefit your mood. Spondylitis treatment options include different medications and physical therapy. Drugs that aim to reduce inflammation and pain include:

  • Nonsteroidal anti-inflammatory drugs
  • Tumor necrosis factor blocking drugs
  • Interleukin-17A inhibitors
  • Corticosteroids
  • Disease-modifying antirheumatic drugs, such as methotrexate or Azulfidine (sulfasalazine)
  • Biologics such as Enbrel (etanercept) or Remicade (infliximab)

Talk to your doctor to ensure you’re on the right treatment plan for managing all of your symptoms.

Talk With Others Who Understand

Another option for managing depression with spondylitis may be joining a support group. Talking with other people who understand what you’re going through can help you feel supported and validated in your feelings.

MySpondylitisTeam is the social network for people with spondylitis. On MySpondylitisTeam, more than 70,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Are you living with spondylitis and depression? Share your experience in the comments below, or start a conversation by posting on your Activities page.

A MySpondylitisTeam Member said:

I'm tired of being tired an hurting, I tired of canceling on family an friends cause I'm in pain an exhausted from the pain

posted about 1 month ago

hug (5)

Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Elizabeth Wartella, M.P.H. holds a masters in public health from Columbia University and is passionate about spreading accurate, evidence-based health information. Learn more about her here.

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