Unfortunately, depression and rheumatoid arthritis seem to go hand-in-hand. Loss of independence, financial troubles, changing relationships and—of course—pain, are all factors that contribute to our tendency to become depressed. But there is a difference in clinical depression and being in an “inflammation funk”. Read on for tips to make you feel better…

Generally speaking, we Americans are viewed as being fairly happy-go-lucky people (we are also viewed as being fat, vulgar, arrogant and violent…but then, that’s another article). Even Henry Miller—and I don’t think anyone ever accused him of being a Pollyanna—confessed that he sometimes irritated his French companions with his chronic cheerfulness, admitting, “I’m just as retarded as any American.”

With the skyrocketing popularity of Prozac, however, I believe we are showing some cracks in our rugged individualism. True, we don’t make depression a national pastime as they do in Sweden, but in America, I believe that depression is finally coming out of the closet.

So if the average American can confess to being depressed, then we in the arthritic community might as well admit it: depression and rheumatoid arthritis go hand-in-hand. Why? Because we have been slapped down by a disease that robs us of our mobility, our independence, our jobs, our social lives and—to a lesser or greater extent—our dignity. We are financially devastated, frightened about the future, lonely, angry and defenseless against the ultimate betrayal: being attacked by our own bodies.

Most of us could adapt to even these changes within time, though. We can survive death and divorce, eventually. So why is it that 90% of people with RA will experience occasional depression and 40% will be treated for severe depression? The number one reason for depression—and as my father-in-law says, this ain’t rocket science, folks—is pain. Pain—that great malefic god—is constant, relentless, capricious and, worst of all, greedy. Pain doesn’t want to share you with anybody; he wants you all to himself.

And only those in pain understand the loneliness that comes with pain.

Okay, now that we’re being honest, I’ll even be more frank: recently, I asked my doctor for antidepressants. Yes, me: the Joan of Arc of arthritis, smile warrior, exercise ninny and happy Heidi. I had a rough summer, arthritis-wise, one of the worst I’ve had. That, combined with some family/financial issues, sank me into deep dark hole. I guess you could say that I lost some of my infamous “adaptive techniques”.

So am I suggesting that we all go on antidepressants? No, of course not. I’m just giving an example how even the most positive of us can get worn down occasionally. And, while there is no evidence that depression exacerbates pain, it does diminish your coping skills which can lead to increased severity of symptoms. It can be argued that in some cases, depression can be more debilitating that arthritis itself…and arthritis and depression can be indescribably miserable.

So what do we do about it?

Well, first of all, roll out of bed, rub the cobwebs out of those unblinking eyes and take a test from the folks at the National Institute for Mental Health. This will help determine whether you are just in an inflammation funk or if you are clinically depressed. If you are experiencing four or more of the following symptoms for more than two weeks, you should seek help immediately.

* Persistent sad, anxious or “empty” feeling
* Feelings of hopelessness and/or pessimism
* Feelings of guilt, worthlessness and/or helplessness
* Loss of interest or pleasure in ordinary activities, including sex
* Sleep disturbances (including insomnia, early-morning waking and/or oversleeping)
* Eating disturbances (changes in appetite and/or weight loss or gain)
* Decreased energy, fatigue and/or a feeling of being “slowed down”
* Thoughts of death or suicide, or suicide attempts
* Restlessness and/or irritability
* Difficulty in concentrating, remembering and/or making decisions

If, however, you are not experiencing four or more of these symptoms, or if you believe that this is a temporary case of the arthritis blues, read on for tips to feel better.
Depression Busters
Will any of these tips “cure” your depression? Probably not. But as easy as it is to get mired in depression, distraction can sometimes be surprisingly effective. Try any or all of these ideas…most of them are free.

Give in to it
You heard me. Sometimes the best thing to do is just…go with it. Allow yourself 24 hours of self-pity. Stay on the couch. Eat ice cream. Watch Gilligan’s Island and the Late, Late, Late show. Cry. After wallowing for a day or two, you just might be ready to take a shower and rejoin life.

Get Outside
Get out of the house. It doesn’t matter where you go or what you do…just get out and stop staring at those same four walls. Who knows? Even the fresh air could revive you.

Exercise
(I can actually hear all those eyeballs rolling in their sockets). I know, I know…exercising is the last thing you want to do. But endorphins and adrenaline are powerful drugs…some studies suggest that vigorous exercise is as effective as Prozac. In any case—provided the exercise is arthritis-friendly—it can’t hurt.

Keep a Journal
There’s something about writing that stops all those dark thoughts from circling in your head.

Listen to Music
Choose songs that have strong, positive meaning for you. And who doesn’t feel better after a rousing chorus of R-E-S-P-E-C-T?

Go for a Long Walk
True, I could have put this under either “Get out of the House” or “Exercise”, but I think that long, meandering walks have a way of “wearing out” bad feelings.

Sing
It doesn’t matter if you’re Beverly Sills or if you torture dogs…throw your head back and sing. I don’t know why this works, but try it: I guarantee that you’ll feel a little better.

Seek Out Other People
This one is tricky. Being depressed causes you to withdraw but the more you withdraw, the more depressed you’re likely to become. Call one of your friends…especially if they’re troubled too. It might sound a little sadistic, but sometimes listening to other people’s problems helps you keep your own in perspective. As a corollary:

Participate
In your own small way, rejoin the human race. Drag yourself to your support group, book club, coffee circle…whatever you usually do, keep doing. Sometimes if you pretend that you feel alright, you start feeling alright.

Check your Medication
We all have our own unique chemistry; some of us react more strongly to certain drugs. Corticosteroids (Prednisone and the like), in particular, are notorious for causing depression and anxiety.

Distract Yourself with Something Boring
Clean out one drawer. Pay your bills. Organize anything. Not only will it distract you from your problems, it will give a (small) sense of accomplishment, which always makes you feel better. When you’re through being practical:

Do Something Frivolous
Buy flowers. Read a comic book. Eat a banana split. Challenge your kids to a bubble-blowing contest. Buy something useless. Pour an entire bottle of Mr. Bubble into your bath. Remember what it is like to have fun.

Invest in Comedy
Read A Confederacy of Dunces. Or, if you don’t have the energy to read, rent five comedies from the video store. My pick for impossible-not-to-laugh videos? Raising Arizona, Funnybones, After Hours (the one by Martin Scorcese), Being John Malkovich and anything by Monty Python.

Do Unto Others
It’s corny, but true…doing something nice for someone else just makes us feel all warm and fuzzy inside. Volunteer—community agencies are always short of volunteers and are not picky about abilities. Or buy something for a friend for no reason. Cook a fancy dinner and take it over to an elderly person. It doesn’t matter what you do, as long as you are doing for someone else…which takes the focus off of yourself.

Try to put Things into Perspective
Chronic pain is so overwhelming that it can take over our thoughts. Sometimes we need to take a step back and truly examine our lives. Take an inventory of what is good, helpful or positive in yourself and in the people around you. You might discover happiness that you hadn’t recognized before.

Now, Here’s a few “Don’ts”…
Do Not Make any Major Life Decisions
You are literally not in your right mind. Don’t sign any papers, pack any bags or kick anyone or anything out of your house just yet…wait until you are feeling better.

Don’t Lash Out
Depression often leads to irritability. Lashing out at others—and receiving a tongue-lashing in kind—will only make you feel worse, and could damage important relationships.

Leave Your Credit Card at Home
There’s nothing wrong with buying yourself a small gift, if it makes you feel better…but save the sprees for after you win the lottery. There’s nothing like an unpaid stack of bills to send you spiraling back into depression.

Padlock the Refrigerator
Go ahead and have that indulgent treat…and then give your waistline a break. Obesity, like bankruptcy, will not help your condition.

Now it’s your Turn
Talk to me…what causes you to become depressed and what do you do about it? Tell me about it in Feedback. This is your time to vent, rage, cry or offer hope…and you may remain anonymous. Depression is something that we all experience from time to time…let’s share our experiences—not only to help each other, but to remove the stigma that keeps some of us from getting help when we need it.