Arthritis is a chronic health condition that can affect your physical health and your mental wellbeing. It is understandable that the ongoing physical symptoms such as chronic pain, fatigue and disturbed sleep can cause distress and affect your mood.
Anxiety and depression are common in people with arthritis. The good news is that there are effective treatments both for arthritis and for anxiety and depression. With careful management, the symptoms of anxiety and depression can be treated along with those of arthritis so you can live as well as possible.
Managing anxiety and depression can greatly improve people’s wellbeing and quality of life as well as their arthritis and their attitude towards it.
Arthritis and emotions
Many people think that arthritis only affects older people. However, that is not true.
It can occur at any age including in children and young adults. It is not great news to find out you have a chronic health condition and it is not surprising that people can have negative thoughts and emotions such as a sense of loss or distress.
These thoughts and emotions along with decreased participation in enjoyable activities can lead to the development of stress, anxiety and depression (see Figure 1). As a person living with arthritis you need to take care of both your physical health and your mental health and with the right management plan you can live well with arthritis.
Figure 1: chronic pain and mental wellbeing
Anxiety is more than just feeling stressed or worried. While stress and anxious feelings are a common response to a situation where we feel under pressure, they usually pass once the stressful situation has passed, or the ‘stressor’ is removed.
Anxiety is when these anxious feelings don’t subside – when they’re ongoing and exist without any particular reason or cause. It’s a serious condition that makes it hard to cope with daily life. Everyone feels anxious from time to time but, for someone experiencing anxiety, these feelings can’t be easily controlled.
Many people with anxiety experience symptoms of more than one type of anxiety disorder and may experience depression as well. Having arthritis is one of many factors – such as a family history of mental health conditions, stressful life events and personality factors – that may trigger anxiety. Anxiety is common and the sooner you get help, the sooner you can begin to recover.
Signs of anxiety
The symptoms of anxiety conditions are sometimes not very obvious as they often develop over time and, given we all experience some anxiety at different points in time, it can be hard to know how much is too much. Normal anxiety tends to be limited in duration and connected with some stressful situation or event such as a job interview.
The type of anxiety experienced by people with an anxiety condition is more frequent or persistent, not always connected to an obvious challenge, and impacts on their quality of life and day-to-day functioning. While each anxiety condition has its own unique features, there are some common symptoms including:
- Physical: panic attacks, hot and cold flushes, racing heart, tightening of the chest, quick breathing, restlessness, or feeling tense, wound up and edgy.
- Psychological: excessive fear, worry, catastrophising, or obsessive thinking.
- Behavioural: avoidance of situations that make you feel anxious which can impact on study, work or social life.
There are effective treatments available for anxiety. For more information on anxiety and treatments visit beyondblue.
While we all feel sad, moody or low from time to time, some people experience these feelings intensely, for long periods of time (weeks, months or even years) and sometimes without any apparent reason. Depression is more than just a low mood – it’s a serious condition that has an impact on both physical and emotional wellbeing.
Depression affects how you feel about yourself and makes life more difficult to manage from day-to-day. You may lose interest in work, hobbies and doing things you normally enjoy. You may lack energy, have difficulty sleeping or sleep more than usual, feel anxious or irritable, or find it hard to concentrate.
The encouraging news is that there are a range of treatments, health professionals and services available to help with depression as well as information on how you can help yourself.
Signs of depression
You may be depressed if you have felt sad, down or miserable most of the time for more than two weeks or have lost interest or pleasure in usual activities and have also experienced some of the signs and symptoms in the list below.
It’s important to remember that we all experience some of these symptoms from time to time, and it may not necessarily mean you’re depressed. Equally, not everyone who is experiencing depression will have all of these symptoms. The symptoms will not provide a diagnosis – for that you need to see a health professional – but they can be used as a guide.
Some common symptoms of depression include:
- not going out anymore, loss of interest in enjoyable activities
- withdrawing from close family and friends
- being unable to concentrate and not getting things done at work or school
- feeling overwhelmed, indecisive and lacking in confidence
- increased alcohol and drug use
- loss or change of appetite and significant weight loss or gain
- trouble getting to sleep, staying asleep and being tired during the day
- feeling worthless, helpless and guilty
- increased irritability, frustration and moodiness
- feeling unhappy, sad or miserable most of the time
- thoughts such as, ‘I’m a failure’, ‘life’s not worth living’, ‘people would be better off without me’.
It is important to understand that for people with arthritis, some of the above symptoms may be the physical symptoms of arthritis and not necessarily due to depression. So it is vital to discuss how you are feeling with your GP or rheumatologist rather than try and go it alone.
As with anxiety, there are effective treatments available for depression. For more information on depression and treatments visit beyondblue.
What are the links between anxiety, depression and arthritis?
Around three million Australians are living with depression or anxiety. One in five women and one in eight men will experience depression at some time in their life. On average, one in four people will experience anxiety.
Research indicates there is a link between anxiety, depression and arthritis. As is the case with other chronic illnesses, research shows that people with arthritis are more likely to also have anxiety and/or depression. Up to a third of people with arthritis may be clinically depressed. Anxiety is more common in people living with arthritis than those without arthritis and is more common than depression in people with arthritis. For example, one study found that up to seven in ten people with rheumatoid arthritis also had anxiety.
Both arthritis and depression, if untreated, can impact greatly on a person’s ability to keep active and enjoy life. When both conditions coexist, a person’s ability to function in everyday life, socially and at work or study is often impaired.
We also know that people whose arthritis is well controlled are less likely to be depressed than people whose arthritis is not well controlled. Similarly people without depression achieve better control of their arthritis than people with depression.
Managing anxiety and depression can greatly improve people’s wellbeing and quality of life as well as their arthritis and their attitude towards it. People with anxiety and/or depression can find it difficult to take the first step in seeking help. They may need the support of family, friends and a health professional.
What are the treatments for anxiety and depression?
Talking and emotional support can help to reduce the stress of coping with arthritis but if things become more difficult, professional help may be needed. There is no one proven way that people recover from anxiety or depression and it’s different for everybody. However, there is a range of effective treatments and health professionals and other support people who can help you on the road to recovery.
There are also many things that people with anxiety or depression and arthritis can do to help themselves recover and stay well. The important thing is finding the right treatments and the right health professionals and support team that work for you.
Different types of anxiety or depression require different types of treatment. This may include lifestyle changes such as regular physical activity, healthy eating and adequate sleep, family and peer support, and psychological therapy for mild-moderate anxiety and depression through to more specialised psychological and medical treatments for severe depression and/or anxiety provided by a team of health and mental health professionals. What’s important is getting the treatment and support that’s right for your condition and situation.
The treatment for anxiety and depression in someone with arthritis involves a coordinated approach managed by your primary health professional that monitors and treats the symptoms of anxiety, depression and arthritis.
Psychological treatments (also known as talking therapies) can help you change your thinking patterns and improve your coping skills so you’re better equipped to deal with life’s stresses and conflicts.
As well as supporting your recovery, psychological therapies can also help you stay well by identifying and changing unhelpful thoughts and behaviour. These treatments help build skills in coping with stressful life circumstances and can be provided by a psychologist, psychiatrist or other trained health professional.
- Cognitive behaviour therapy (CBT) is one of the most effective treatments for people with anxiety and depression. It works to change your thoughts and behaviour by teaching you to think rationally about common difficulties, helping you to shift negative or unhelpful thought patterns and reactions to a more realistic, positive and problem-solving approach.
- Interpersonal therapy (IPT) is also effective for treating depression and some types of anxiety. It helps people find new ways to get along with others and to resolve losses and conflict in relationships.
Antidepressant medication is sometimes used along with psychological therapies to treat moderate to severe depression and some anxiety conditions.
Making a decision about which antidepressant is best for a person can be complex. The decision will be made in consultation with your doctor, after careful assessment and consideration. The doctor should discuss differences in effects, possible side effects of medications and whether they can interact with other medications you are taking. Stopping medication should only be done gradually with a doctor’s recommendation and under supervision.
A doctor or treating health professional will take into account several factors when suggesting the most suitable treatment. Regular contact with and ongoing assessment by a doctor to check that treatments are working effectively is an important part of becoming and staying well. Most people taking medication will also benefit from psychological therapies which will reduce the likelihood of anxiety or depression coming back after the person has stopped taking the medication.
Exercise and staying active can also help
For people living with arthritis, not only will exercise help you build your physical fitness, it has also been shown to help build your mental fitness. Being active and regularly exercising helps reduce the symptoms of depression.
Please talk with your doctors or a physiotherapist to work out what exercises will be most appropriate for you. A mix of aerobic exercises such as swimming or walking, muscle strengthening and balance exercises is often helpful. In general, any activity that works your muscles a bit harder or makes you ‘puff’ a little, without increasing your pain or other symptoms, will be beneficial. Most importantly, do activities that you enjoy and make them part of your everyday routine.
Who can assist?
Most of us wouldn’t try and treat a broken leg ourselves. But when it comes to our mental health we sometimes think we can fix things on our own, or hope the issue just goes away by itself.
That’s where health professionals come in. There are plenty of effective treatments for anxiety and depression, and the sooner you seek support, the sooner you can recover.
A general practitioner (GP) is the best starting point for someone seeking professional help. Your GP can:
- make a diagnosis
- check for any physical health problems or medication that may be contributing to your condition or may affect your treatment
- provide information and discuss available treatments taking your preferences into account
- work with you to draw up a Mental Health Treatment Plan so you can get a Medicare rebate for psychological treatment (if appropriate)
- provide support, brief counselling or, in some cases, more specialised talking therapy
- prescribe medication
- refer you to a mental health specialist such as a psychologist or psychiatrist (if appropriate).
- provide information and support to family members, if you agree
- schedule regular appointments to check how you are going.
It is recommended that you see your regular GP if you have one, or another GP in the same clinic, as they will be aware of your arthritis and any other health issues.
You should also let your rheumatologist, or the specialist managing your arthritis treatment, know how you are feeling and if you have anxiety or depression.
Psychologists are health professionals who provide psychological therapies such as cognitive behaviour therapy (CBT) and interpersonal therapy (IPT). Clinical psychologists and other psychologists are not doctors and cannot prescribe medication in Australia.
Psychiatrists are doctors who have undergone further training to specialise in the assessment, diagnosis and treatment of mental health problems. They can make medical and psychiatric assessments, conduct medical tests, provide therapy and also prescribe medication. Psychiatrists often use psychological treatments such as CBT, IPT and/or medication. If the depression or anxiety is severe and hospital admission is required, a psychiatrist will be in charge of your treatment.
Mental health nurses are nurses who have undertaken further training to care for people with mental health conditions. They work in specialist mental health services and with psychiatrists and GPs to review your mental health, monitor medication or other treatment recommended by your GP or psychiatrist, and provide information about mental health conditions and treatment. Some nurses have training in psychological therapies.
Accredited mental health social workers specialise in working with and treating mental health conditions. They draw on a range of theories and therapeutic approaches to work holistically with people to support their recovery and help them to effectively manage or change the situations that may contribute to mental health conditions. Many accredited mental health social workers can provide focused psychological strategies, such as cognitive behavioural therapy (CBT), interpersonal therapy (IPT), relaxation training, psycho-education and interpersonal skills training. Oncology social workers have experience in supporting people with cancer, and their families.
Occupational therapists in mental health help people who have difficulty functioning because of a mental health condition to participate in normal, everyday activities. Mental health occupational therapists also provide focused psychological self-help strategies, including relaxation training.
Aboriginal and Torres Strait Islander mental health workers understand the health issues of Indigenous people and what is needed to provide culturally safe and accessible services. Aboriginal and Torres Strait Islander mental health workers are health workers who work specifically in the mental health area and have specific mental health qualifications. Support provided by Aboriginal and Torres Strait Islander mental health workers might include, but not be limited to, screening, assessment, referrals, case management, transport to and attendance at specialist appointments, education, improving access to mainstream services, advocacy, counselling, support for family and acute distress response.
The cost of treatment from a mental health professional varies. However, in the same way that you can get a Medicare rebate when you see a doctor, you may also be able to get part or all of the consultation fee subsidised when you see certain mental health professionals for treatment of anxiety or depression. You will need to see your GP before making the appointment to have a Mental Health Treatment Plan drawn up for you.
Visit the beyondblue to find out more information on getting support and how much it costs.
To find a mental health practitioner in your area, visit beyondblue or call the their Support Service on 1300 22 4636.
Helpful strategies and tips
- Learn about anxiety, depression and arthritis and how these conditions interact.
- Learn how to distinguish the symptoms of arthritis from the symptoms of anxiety or depression.
- Plan with your doctor – have a mental health plan.
- Visit your doctor regularly to review your arthritis and mental health management.
- Use your arthritis medicine as prescribed. Talk to your doctor about possible barriers to taking medicine, such as cost, organisation or planning, as well as what to do if your arthritis worsens.
- Get help, support and encouragement from family and friends and have them help you to follow your arthritis and mental health plans.
- Learn relaxation techniques.
- Get involved in social activities.
- Stay active and exercise under the supervision of a doctor.
- Eat healthily and include a wide variety of nutritious foods.
- Limit your substance use (including alcohol, tobacco and coffee).
How family and friends can help
When a person has arthritis and anxiety or depression, it can affect family and friends. It’s important for family and friends to look after their own health as well as supporting or looking after the person who has arthritis.
- Learn about arthritis, anxiety and depression and their symptoms to help you recognise warning signs.
- Encourage the person to go to the doctor if their arthritis, anxiety or depression gets worse. Make sure you seek help if you think you need it, too.
- Support the person by helping them to follow their arthritis and mental health plans. Gently remind the person to take their arthritis, anxiety and depression medication regularly and to attend all their medical appointments.
- Encourage the person with arthritis to do things that they would normally enjoy.
- Look after your own health by eating well, exercising regularly, getting enough sleep and doing things that you enjoy, too.
Download the Emotional Wellbeing printable information sheet
Sex and Arthritis
Sometimes the physical and emotional symptoms associated with arthritis can affect relationships, including sexual expression and enjoyment. However, there are ways to overcome these challenges.
Will arthritis affect my sex life?
Arthritis rarely affects the sexual organs, although vaginal dryness may be experienced with some conditions. However, the emotional and physical effects of the disease can seriously impact on your appetite for, and enjoyment of, sex. If you experience a change in your physical appearance, such as weight gain or loss, or a decrease in mobility or energy, the way you view yourself may change. You may feel less desirable to others or physically fragile. If you are having a flare of your arthritis your joints may be simply too painful for you to have sex – and you need to be open about this.
The fear of pain may make it difficult to relax and enjoy sex, and may even cause your partner to worry about causing you pain.
It is important to remember that if you can openly and honestly discuss these issues with your partner, arthritis can make you closer and may even improve your sex life. Remember, emotional intimacy is equally important for a romantic relationship – trust, honesty and openness help to build a secure intimate relationship.
Arthritis does not have to signal the end of an intimate relationship. You can learn ways to make the relationship work.
Will having sex affect my arthritis?
You will know from living with arthritis that moving an affected joint can be painful. Therefore any physically demanding activity such as sex may cause discomfort, particularly if your hips or back are affected. Sex itself, however, will not worsen your arthritis, and there are ways to overcome any physical discomfort you experience. If sex is a regular part of your relationship, you should try to keep it so by finding new and comfortable ways to maintain and enjoy that intimacy.
What should my partner know?
It can be difficult and awkward to discuss sexual matters with your partner, even if you have shared a longstanding sexual relationship. However, it is important for you to try to talk about any concerns or fears you have surrounding sex. Work together to overcome difficulties by talking openly and honestly about how you feel both physically and emotionally. Expressing your fears with statements like ‘I am afraid that …’ provides your partner with the chance to reassure and support you.
Remember that your partner will have his or her own feelings about how your arthritis impacts on your sexual relationship. Make sure you share your fears and concerns. Listen carefully to what is said, then work together to ensure you both feel comfortable and physically and emotionally satisfied.
If there are problems, how can we get back on track?
Arthritis does not have to signal the end of a mutually satisfying sexual relationship. With a little creativity, patience and planning, you and your partner can rediscover the pleasures of sexual intimacy.
Talk openly about how both of you are feeling emotionally and physically – this will help you overcome problems together. For example, fear of physical pain, or causing your partner physical pain, may make you apprehensive about sex. This can cause couples to withdraw from any physical contact so that even kissing and cuddling cease. During sex let your partner know if something is either uncomfortable or pleasurable.
Work together to find positions and techniques that give both of you the most amount of pleasure with the least amount of discomfort.
Your appetite for, and enjoyment of, sex is generally greater if you feel physically fit and well. So staying active is not only important for maintaining your muscle strength and joint mobility, it will also help you remain sexually active.
Plan ahead for sex
While it may not be spontaneous, planning ahead is worthwhile if it makes sex more satisfying. Think about the times of day you are likely to be more rested and experiencing the least amount of pain. For instance, if you have morning stiffness, afternoons or evenings may be better times for sex. Also consider:
- If pain is a problem, time pain medication for an hour or so before sex.
- Your joints may feel more comfortable after a warm shower or bath – why not share one with your partner?
- Use a heating pad or electric blanket to help soothe sore joints and muscles before sex.
- Use massage to help relax muscles, even as a form of foreplay.
- Pace yourself during the day to save energy for you and your partner.
- If fatigue is a problem, have a nap before sexual activity.
- Have pillows or rolled towels available to help support sore joints.
If sex causes discomfort, you may need to try different positions. There are numerous positions that will ensure sex is both possible and enjoyable – for example, one or both partners could stand, kneel or sit. Finding positions that are both comfortable and rewarding will take patience and understanding from you both, but if you work together, you have the potential to reconnect with each other and develop a deeper level of intimacy. In particular, during this time of trial and error try not to lose your sense of humour as it’s important to ensure you have some fun along the way!
Download the Sex & Arthritis printable information sheet