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Depression and Lupus


In my extensive research, interviewing, and writing both of my healthcare-related books, as well as in my own experience, I have found that one of the most difficult things for patients with chronic illness to recognize, accept and cope with is depression. Although there are more treatments for it than ever before, and more literature and other information available to patients and their loved ones regarding depression, this one area of health and well-being can be utterly frustrating, confounding, even debilitating. Misconceptions about depression persist (I’ve heard everything from, “Depression is something weak people fall into,” to “I can’t be depressed – I don’t have time.”) Media reports about medications and side effects can be confusing. Medical professionals might be too pressed for time to probe into their patients’ psychological health and possible symptoms of depression.

The lupus patient is not immune from depression. Whether mild or severe, it can affect how we cope with our disease and life in general. Depression can cast a faint shadow over our everyday activities, or it might even prevent us from participating in them. As people living with chronic illness, sometimes is can be difficult to recognize when we are suffering from depression because pain, fatigue, and other physical symptoms can be overwhelming. In fact, it is just that added burden of living with on-going illness that can weigh us down to the point that we feel we might never feel “up” or “happy” again.

Just as it is important to be able to recognize physical symptoms when they occur, it is important to be aware of what depression is and to know what resources are available to us to help us cope better. In this article, I hope to give some basic information about depression and some guidance about how to approach getting help for it. Above all, I write this with one overriding premise: There is no stigma to being depressed, and a lupus patient should never feel like he or she has failed in some way if he or she suffers from depression.

Depression – An Overview

On its website, the Mayo Clinic lists two “hallmarks” of depression: Loss of interest in normal daily activities, and a depressed mood (sadness, helplessness, hopelessness, crying spells.) Depression can sometimes be manifested physically, too, and some of these indications can mimic lupus symptoms (for example, loss of appetite, pain, and “brain fog.”) For this reason, it is very important to consult with your doctor to determine if you might be suffering from depression, if your lupus or other physical condition might be causing your symptoms, or if your particular situation is a combination of these two possibilities. If you are not comfortable speaking with your primary physician, ask for a referral to a healthcare professional with whom you can discuss your feelings and concerns (I’ll speak more about the role of the healthcare professional a bit later).

How depression is treated depends in great part on the cause for it. In my upcoming book, “The First Year™- Hypothyroidism,” I interviewed Lisa Waldman, a licensed clinical social worker and patient educator who works with lupus patients and others who are chronically ill. She says, “Depression needs to be addressed inside and outside the patient. That is, if the depression is biologically based – brought on by a chemical or hormonal imbalance related to an illness or medication – it should be treated medically, just like any other symptom. This type of depression can be effectively treated with medication.

“If life’s stressors or a patient’s own attitudes and behaviors are causing depression, then other methods of coping should be undertaken and psychological counseling may be considered. Quite often, both biological and personal factors play a role in depression. In this case, medication along with counseling will be helpful. Unfortunately, some people still feel a stigma about taking antidepressant medication or getting other psychological help. But it is really important to seek these options.”

Getting Over the Stigma

The history of identifying, treating and perceiving mental health is littered with misconceptions, prejudice, and sometimes horrible results. Despite the excellent treatments available today, and the expertise of those in the medical community, some people still harbor misgivings about seeking help for their “blues,” even if they become quite debilitated because of them. Societal pressure to maintain a “positive attitude” can contribute to this, as well, causing some people to feel guilty if they are depressed, or even feel as though they’ve failed in some sort of human test.
Again, I go back to my overriding premise for this article: There is no stigma to being depressed, and a lupus patient should never feel like he or she has failed in some way if he or she suffers from depression. In fact, if you acknowledge how you feel and take positive, appropriate steps to do something about helping yourself, you are making great strides toward establishing a better quality of life for yourself. Getting your depression under control can open up a new world of possibilities in the plans you can make, the things you can accomplish, and the degree to which you feel comfortable, even happy, with your life with lupus.

Who Cares?

There are many people today who work with patients to deal with their depression in varying degrees. These include physicians, psychiatrists (physicians who specialize in mental health and can prescribe medication), licensed clinical social workers, counselors, clergypeople, and psychiatrists. Others concerned with patient wellbeing, and who might be able to give some relief in conjunction with a patient’s medical treatment, include massage therapists, art and music therapists, exercise specialists, and yoga and tai chi instructors.

On the research front, scientists are constantly developing new medications and protocols to treat those suffering from depression and who can benefit from taking drugs for it. Many community service and other non-profit organizations have telephone help lines, shelters, and other programs designed to address sometimes critical personal situations. These groups are often involved in public awareness campaigns, too, and provide information about depression and other mental health issues through websites, advertisements, and forums for patients and health professionals.

Another group of people that is important to anyone coping with depression is the personal support group. Comprised of family and friends who know and care about us, this close and vital group is important to each of us and shouldn’t be ignored or taken for granted. Throughout my walk with lupus, I’ve learned many things, not the least of which is that a strong support system, where you have and can be a true friend, is integral to maintaining peace of mind, heart, and health – especially in the face of depression.

Given all the resources available to us to identify and treat depression, how do we know which ones to use? The answer lies in a carefully thought-out plan of action and an honest assessment of your own individual lupus and life picture.

Steps You Can Take

Here are some ideas to help you address and cope with your depression. It is by no means a complete list, but I hope it will help:

• Talk with Your Doctor. An assessment of your emotional and psychological well-being should be a part of your overall health check-ups. You should feel free to speak with your doctor if you don’t think you are coping well, or if you suspect you might be depressed. If you don’t feel comfortable speaking with your doctor, ask for a referral to someone who might be better suited to help you in this area. You might not need to give up your current doctor, but you will feel better in the long run if you can work with someone who is equipped to address depression or other personal issues.

• Keep an Honest Health Journal. In your lupus/health journal, you should record symptoms, medications and side effects, and anything else that relates to your life with the disease – including how you feel emotionally, psychologically and spiritually. It might take some practice to articulate these areas in writing, and it might be difficult to face your feelings on the printed page. But you will benefit from being able to look over the passage of time and identify areas that need to be improved upon and also how far you’ve come.

• Educate Yourself. By keeping close to a lupus support group, organizations such as Lupus Foundation Illinois, and finding out as much as you can about your health, you will be able to be more proactive when you run into symptoms or problems. This goes for depression, too; the better informed you are about it, the more quickly and effectively you will be able to work with your medical team to treat it through the means that are right for you.

• Be Selective in Communicating What You’re Going Through. I think it’s a lupus patient’s rite of passage to have at least one person (non-lupie) tell us: “But you can’t be sick! You look so good!” Sometimes, we can laugh off this comment, but sometimes we find it really bothers us or makes us angry. So, we need to be a bit selective in what and how we communicate our health issues, including depression, to others who aren’t in our medical circle. Some people will understand completely (keep in mind that close support group). Others won’t have a clue what we’re talking about. Choose your audience carefully, and rely on the support of loved ones when the going gets rough.

• Give Yourself Time. We might live in an instant society, but often there’s no speeding up the process of working through depression. Coping with a chronic illness adds layers to our lives, and sometimes we have to give ourselves a lot of time to make sense of it all and/or to let medication work appropriately. When you begin treatment for depression, ask your doctor or other medical health professional what might be a realistic time frame for seeing results. Take this into account when you are going “down the path” of treatment, but also be aware that it might take longer than initially thought. That’s okay. The important thing is that you’re taking steps to manage your mental health. You’re headed in the right direction!

• Be Good to Yourself. Sometimes, we try to force our way through our pain, illness, or other ailment. We lose sight of the importance of being good to ourselves. In fact, taking care of ourselves is vital to our wellbeing. Find healthful ways to pamper yourself. They needn’t be expensive or elaborate, just nurturing. Learn to laugh – a lot. Enjoy the world around you. And be good to others, too.

Some Final Thoughts

As lupies, I think we are in a unique position to get to know ourselves and others more deeply and more completely than many other people do. We have to pay close attention to our physical, emotional, spiritual and psychological health, and we often have to rely on others to help us through the flares, crises, and fears of being lupus patients. Although some people might say an illness like lupus makes one weak, I think it makes us incredibly strong and resilient. We can face depression, just as we face other symptoms and manifestations of our disease. And we can be the better for it – and show others just what we lupies are capable of!

Maureen Pratt

Maureen Pratt is co-author, with David Hallegua, M.D., of Taking Charge of Lupus: How to Manage the Disease and Make the Most of Your Life (New American Library). She is also the author of the upcoming book, The First Year™- Hypothyroidism: An Essential Guide for the Newly Diagnosed (Marlowe & Company, February 2003). Ms. Pratt is a founding Executive Board member of Lupus LA, an Ambassador for the Arthritis Foundation, Southern California Chapter, and a trained facilitator of lupus support groups in Southern California. She is also the author of the novella, “Dear Love,” in Tyndale House Publishers’ Letters of the Heart Anthology. In April, she will be touring Illinois as part of an awareness and fundraising campaign hosted by Lupus Foundation Illinois. Ms. Pratt welcomes comments and suggestions and may be reached through her website:

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