Nearly all individuals experience depression and anxiety in their lifetime, but those who have a systemic process such as Sjögren’s are more susceptible to manifesting these symptoms. Inflammation, pain, medication side effects, increased risks for infection, and an altered immune system are exacerbating factors. Treatments for depression and anxiety include counseling, improving coping skills, group therapy, strengthening and stretching exercises, and medication. Depression and anxiety in Sjögren’s are very manageable with a team approach where the patient, support system, and treatment providers work together.
What is Depression?
Many people with Sjögren’s suffer from depressive symptoms. Prevalence estimates for depression in Sjögren’s range between 8.33% and 75.56%. Depression can cause significant distress and negatively affect a person’s personal, work, or school life. Depression is caused by a combination of genetic, environmental, and psychological factors. Risk factors include a family history of the condition, major life changes, certain medications, chronic health problems, and substance abuse.
What is Anxiety?
Individuals with Sjögren’s are more likely to have symptoms of an anxiety disorder than the general population. Anxiety and fear are normal human experiences to life-changing events or a reaction to danger or threatening situations. Anxiety affects people physically, behaviourally, cognitively, and emotionally. Similar to depression, anxiety is caused by a combination of genetic, environmental, and psychological factors, and often occurs with depression.
Symptom Overlap
Several symptoms of depression and anxiety, such as fatigue, trouble sleeping, and difficulty concentrating, overlap with symptoms of Sjögren’s. Depression and anxiety can also be associated with a variety of physical symptoms, including aches and pains. Individuals report that Sjögren’s causes a significant negative impact on their ability to participate in hobbies, social activities, and extracurricular activities, which may lead to loss of interest in these activities. Regardless of whether Sjögren’s or depression is the culprit, these symptoms lead to a significantly lower quality of life.
Certain medications for Sjögren’s, including corticosteroids and other immunosuppressants, may increase symptoms of depression and anxiety. If is important to effectively treat comorbid conditions and to rule out effects of medication that may be causing or worsening depression or anxiety.
Medication Treatment
The most common medications prescribed for depression and anxiety are called selective serotonin reuptake inhibitors (SSRIs). SSRIs increase the level of serotonin in the brain. Common side effects experienced when beginning an SSRI include eye and mouth dryness, headaches, joint pain, muscle aches, nausea, skin rashes, diarrhea, insomnia, and decreased sex drive. Unfortunately for patients with Sjögren’s, they may not be able to tolerate these side effects as well as their friends and family members. Even if the patient does not suffer from other associated health conditions, antidepressants may cause an increase in the drying of mucous membranes, which could further aggravate symptoms of Sjögren’s (dry eye/dry mouth).
Behavioral and Psychological Modalities to Address Depression and Anxiety
Lifestyle changes, such as exercise, are simple but powerful tools to improve mood and well-being. Exercise has been shown to treat mild to moderate depression and anxiety as effectively as antidepressant medication. Regularly engaging in physical activity has been shown to enhance neural growth, reduce inflammation, and release endorphins, which trigger positive feelings. Patients should start slowly and gradually build up their stamina and endurance.
Psychotherapy can assist with both symptoms of depression and anxiety and coping with the effects of Sjögren’s. Psychotherapy explores factors that contribute to depression and anxiety and helps the patient understand and cope with the psychological, behavioural, interpersonal, and situational causes. Therapy can focus on improving or building relationships to reduce isolation and increasing social support, setting healthy boundaries, and providing support in handling challenges and problems unique to Sjögren’s.
Sjögren’s support groups provide a resource that may fill a gap between medical treatment, psychotherapy, and need for additional emotional support. Doctors and family members may not fully understand the emotional, physical, and cognitive toll that Sjögren’s takes. Group members often share similar feelings, worries, everyday problems, treatment decisions, or medication side effects. Attending a support group can help patients feel less isolated, lonely, or judged, which can in turn reduce depression, stress, and anxiety and increase hope and control. Group members are encouraged to talk openly and honestly about their experiences and feelings, share resources and coping strategies, and provide motivation for others to remain adherent to medical recommendations.
Conclusion
Depression and anxiety, even when severe, are treatable. The earlier the symptoms of depression and anxiety are identified, the earlier treatment can begin and the more effective treatment is. Patients should first be evaluated by a physician to rule out effects of medications or medical conditions associated with Sjögren’s.
* Excerpt from “The Sjögren’s Book”, Fifth Edition, Wallace DJ. 2022 pp 324-330
Need help finding a support group in your area? Most of our SjSC support groups meet virtually via zoom. Find a support group here.
