Dr Sarah Brewer October 04, 2018

Arthritis is a common musculoskeletal condition, but it's often assumed that its symptoms are limited to the joints. However, it can actually lead to a range of other conditions — including depression.

In fact, depression is fairly common in people diagnosed with arthritis, with as many as one in six people with rheumatoid arthritis having major depression.1 The pain caused by arthritis plays a large role in this, as 68% of people with arthritis report feeling depressed when their pain is at its worst.2

This can have a big impact on your quality of life.3, 4 While the first step to take when experiencing depression is to consult your local GP, there are some ways you can try to support your mental health in the meantime. From diet to supplementation, let’s take a look at how you can manage this.

Symptoms of arthritis-related depression

The symptoms of depression associated with arthritis are similar to many forms of more general depression, and include:

  • Feelings of sadness,
  • Lack of interest in daily activities
  • Weight changes, e.g. loss or gain
  • Insomnia or hypersomnia (excessive sleeping)
  • Low energy levels
  • Poor concentration
  • Feelings of worthlessness
  • Recurrent thoughts of death or suicide

It’s important to remember that not everyone will experience the same symptoms, and that the severity can vary from person to person.5

People with arthritis might be more vulnerable to depression because of the pain they experience. This is due to pain exacerbating depression, and depression having the ability to further lower your pain threshold. What’s more, both pain and depression can leave you at risk of developing other health conditions which can affect pain and depression — becoming a vicious circle if left untreated.6

Natural ways to manage arthritis-related depression

Your local GP or healthcare practitioner should be your first point of call for any symptoms of depression. They may prescribe you medication, therapy and other interventions to help aid you and your symptoms. But you may also want to consider natural interventions on top of this.

Managing your arthritis

One of the most important steps to take is managing your arthritis symptoms. This will help to improve your quality of life and could help to relieve the symptoms of depression. It’s important not to leave arthritis unmanaged, as this can lead to higher risk of complications down the road.7, 8

Diet changes

An easy way to start supporting your mental health naturally is by addressing your diet. Generally speaking, making healthy changes such as reducing your intake of processed foods is beneficial for your overall health, which can in turn help to reduce your symptoms.

More specifically, there’s evidence that a Mediterranean diet can have a beneficial impact in both rheumatoid and osteoarthritis symptoms.9, 10 In fact, new research also shows that it can be a cost-effective intervention for depression.11 Key foods for a Mediterranean diet include fruit, vegetables, nuts, seeds, whole grains and olive oil.

Another dietary change worth considering is to increase your fatty fish intake. Consuming oily fish 4 times per week can reduce the inflammatory compounds in your body, which could in turn be beneficial for your arthritis symptoms.12 Research also suggests that consumption of omega-3 containing foods like fish may be beneficial for mental health conditions such as depression.13 If you don’t eat fish, then it can be worth consider increasing your intake of foods such as walnuts, chia seeds, flaxseed and hemp seeds.

Supplementation

Making dietary changes can sometimes be difficult, so there are also a number of supplements that can be beneficial in supporting your mental wellbeing.

Inflammation is a common link between arthritis and depression, and may be part of why people with arthritis develop depression.14 One type of supplement that has potent anti-inflammatory effects is omega-3s. Research has shown that lower levels of omega-3 fatty acids are associated with clinical symptoms of depression, and there are also a number of studies showing that omega-3 supplements can have antidepressant effects. 15, 16 If you do consider supplementing with omega-3s, a beneficial dose is 250 – 400mg of DHA. DHA is docosahexaenoic acid - one of the most important omega-3 fatty acids found in fish oil, which is important for eye, brain and heart health.

Another supplement to consider is magnesium. Magnesium is an essential mineral for brain health, and low magnesium can reduce levels of the ‘happy hormone’ serotonin. It’s suggested that magnesium may even be a major cause for treatment-resistant depression.17 The average diet is often low in magnesium, due to it being removed during the processing of many foods. Magnesium could also support joint health, as low dietary magnesium is associated with arthritis.18

Practice self-care

There are a number of simple self-care methods that can support your mental wellbeing. Getting sufficient sleep is an important step. 70% of Britons sleep for less than 7 hours per night, and over a third get by with just 5-6 hours per night.19 This is detrimental to overall health, as sleep is essential for healing both the joints and the brain. Try to make sleep a priority, and your body will thank you.

Mindfulness and meditation could also be beneficial. Some research has shown that a home meditation practice can reduce pain and other symptoms that reduce the quality of life in arthritis, and even that it can help to improve the symptoms of depression.20, 21

It’s also important to socialise with loved ones and to not become isolated, as not doing so can exacerbate depression.22

The bottom line

Ultimately, whether you alter your diet or start supplementing omega-3, it’s incredibly important that you seek advice from a qualified practitioner, such as a dietician or nutritional therapist. They can help take you through the best ways for you to reduce your symptoms and enhance your wellbeing.

In the meantime, if you’re interested in learning more about how to keep your joints healthy, head over to our advice centre for more information.


References
1 Matcham, F., Rayner, L., Steer, S., and Hotopf, M. (2013). The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology, 52
2 Arthritis Care. (2011).Arthritis Hurts: The emotional pain of arthritis.
3 Sharma, A., Kudesia, P., Shi, Q., and Gandhi, R. (2016). ). Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open Access Rheumatology: Research and Reviews, 8.
4 National Rheumatoid Arthritis Society. (2013).Depression and Rheumatoid Arthritis
5 Arthritis Foundation. (2018). The Arthritis-Depression Connection.
6 Arthritis Foundation. (2018). The Arthritis-Depression Connection.
7 Hernborg, J. S., and Nilsson, B. E. (1977). The natural course of untreated osteoarthritis of the knee. Clinical Orthopaedics and Related Research, (123)
8 Johns Hopkins Arthritis Center. (2017). Rheumatoid Arthritis: Symptoms, Diagnosis and Treatment.
9
Forsyth, C., Kouvari, M., D’Cunha, N.M., et al. (2017). The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatology International.
10 Dyer, J., Davison, G., Marcora, S.M. and Mauger, A.R., 2017. Effect of a Mediterranean type diet on inflammatory and cartilage degradation biomarkers in patients with osteoarthritis. The journal of nutrition, health & aging. 21(5), pp.562-566.
11 Chatterton, M. L., Mihalopoulos, C., O’Neil, A., et al. (2018).). Economic evaluation of a dietary intervention for adults with major depression (the “SMILES” trial). BMC Public Health, 18(01).
12 Lankinen, M., Schwab, U., Erkkilä, A., et al. (2009). Fatty fish intake decreases lipids related to inflammation and insulin signaling — a lipidomics approach. PLoS One 04(04)
13 Sanchez-Villegas, A., Henríquez, P., Figueiras, A., et al. (2007). Long chain omega-3 fatty acids intake, fish consumption and mental disorders in the SUN cohort study. PLoS One, (04).
14 Arthritis Foundation. (2018). The Arthritis-Depression Connection.
15 Adams, P. B., Lawson, S., Sanigorski, A., and Sinclair, A. J. (1996). Arachidonic acid to eicosapentaenoic acid ratio in blood correlates positively with clinical symptoms of depression.Lipids, 31 (1-part-2)
16 Lin, P. Y., and Su, K. P. (2007). A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. Journal of Clinical Psychiatry, (07)
17 Eby III, G. A., and Eby, K. L. (2010). Magnesium for treatment-resistant depression: a review and hypothesis. Medical Hypotheses
18 Qin, B., Shi, X., Samai, P. S., et al. (2012). Association of dietary magnesium intake with radiographic knee osteoarthritis: results from a population‐based study. Arthritis Care & Research, (09).
19 The Sleep Council. (2018). The Great British Bedtime Report.
20 Rosenzweig, S., Greeson, J. M., Reibel, D. K., et al. (2010). Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research, (01)
21 Goyal, M., Singh, S., Sibinga, E. M., et al. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine, (03).
22 Soong, J. (2014). Depression Traps: Social Withdrawal, Rumination, and More. WebMD.

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn't possible, supplements can help. This article isn't intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.

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