Rheumatoid Arthritis and depression

Dealing with depression is almost definitely part of the chronic illness experience.  With a disease like Rheumatoid Arthritis, you can go from someone who runs 5km each day, has a full time job, raises children and keeps a house neat and tidy (well mostly) to someone who can’t take two steps without pain.  Someone who can’t make a fist.  Can’t hold on to a cup of coffee.  Can’t hug someone without it hurting.

It’s a shock, to say the least.

Then the process of trying to find a medication that relieves the pain and inflammation begins.  For some, that process is endless.  For some, no medications help much.  For some, they have to learn to live with unrelenting pain.

This quite naturally brings with it a fair amount of depression.  I don’t think that’s hard to understand…even though most people seem to find Rheumatoid Arthritis hard to understand.

This complete lack of understanding, lack of caring, lack of empathy and lack of support also contributes to the isolation and depression of suffering a chronic illness, or chronic pain.  Some people leave you.  Friends, lovers, husbands, wives.

Most people are on multiple medications, often including an anti-depressant.

I have tried anti-depressant medications – many of them!  They made me feel worse…much worse.  I gave them a fair shot, but I they weren’t of help to me.

So what do I do to keep depression at bay?

I have rules.

1.  Smile!  Make it a habit.  Studies have shown that just by smiling, the body physically produces endorphins as a result.  And endorphins are the feel good chemicals in the brain.  So make smiling a habit.  You’ll also find that people are drawn to people who smile, so as a result you’ll be less isolated.
2.  Don’t isolate yourself.  I know you don’t want to be around people.  You may not want to be alone either, but it does seem a hell of a lot easier sometimes .  You don’t want to bring other people down. You know they won’t understand what you’re feeling. You can’t relate to their conversation…it’s all too hard and bright and senseless.But don’t isolate yourself.  Once you lose touch with people, it’s so very hard to re-connect.  Being alone becomes a habit – and connecting with people becomes a skill you have to relearn.  Stay in touch with people…just a few people.  No matter what.
3. Only one pity party day allowed.  When a bout of depression hits, if it’s really bad, you are allowed to stay in bed, or on the couch and watch TV and do absolutely nothing, for ONE day.  Only one.  Not the next day as well.  Definitely not the day after that.  Your day is a mental health day and it is for you to rest, and recover.  And  gather strength, because you have to face your life the next day.  Good chance you’ll be feeling a bit better, but even if you  don’t, you get up.  You get dressed.  You go. To work, to school or wherever. But you go.
4. Baby steps.  You didn’t fall into a big heap overnight…it took time.  And lots of factors came into play.  When everything seems overwhelming, just choose one thing to tackle.  I have a ‘to do’ list that’s about a mile long.  But today I am going to do my tax return.  And that will be enough.  Tomorrow I’ll tackle something else.  I’m not going to freak out about how long it’s going to take me to get through everything at that rate.  I’m just going to set myself the task of one thing.  And slowly you will find you are able to tackle more things…tackle one thing and the other things will follow.  Even on your worst days, achieve ONE thing.    That way you won’t then put yourself down for not doing anything…for wasting a whole day.  You achieved something.  Even if only one thing, it counts.
5. Give yourself credit.  When you have achieved something, even something small, take the time to pat yourself on the back.  You COULD have sat on your butt and felt sorry for yourself.  But you didn’t.  You went for a 20 minute walk around your suburb.  It was hard to get yourself out there, so be proud of yourself!  You took a step forward, you helped yourself, and congratulate yourself for it.  DON’T wait for someone else to congratulate you.  It’s not about what they think.  In fact, they won’t even notice, because they don’t understand how hard that was for you to do.  Give yourself credit. You have to find that in yourself.
6. Realise that you have depression for life.  It’s a tendency you have.  Sometimes when people have been broken, they don’t quite go back together the same way again.  There’s a hole, and it becomes gaping wide when depression hits.  But it’s always there.  Sometimes you’re managing it really well, and it’s not even noticeable.  Sometimes not so well.  .  If things get too much, you might fall down again.  So never forget these steps.  Never let yourself fall too far.  If you feel yourself start to fall, get help!  Talk to someone.  Never forget how far bottom is, and realise the further you fall, the harder it is, and the longer it takes to get back up.  But remember you WILL always get back up.  And the only one who can do it is you.
7. Exercise!  I don’t care if you hate it.  You will love it when you realise how much better it makes you feel.  You need to find something you don’t completely hate…luckily there are a million options.  Work out at the gym, do a class, go for a ride on your bike, go for a run, go for a brisk walk, swim.  You have to get your heart rate up, and you have to sweat.  That’s the only way you’ll get the endorphins going.  After about 15 mins, the depression will be background noise, and the feeling will last a few hours.  So do a bit every day!  Admittedly this one is doubly hard with a painful, chronic illness. There are days when you can’t exercise.  You just can’t.  But on the better days, start small. Increase slowly.  Improve your strength and endurance slowly.  Just walk.  Stretch.  It doesn’t take much to make a difference.
8. Diet.  Fuel your body properly.  Don’t cut carbs – it’s been shown to lower serotonin levels in your brain.  You don’t need that!  Don’t starve yourself.  You may not be hungry, but eat something nutritious…fruit is fairly inoffensive.  A sandwich.  Some soup.  You will feel worse if you eat nothing.  Find something you can keep down.  On the other hand, some people become ravenous and eat everything in sight.  Try to curb that. You will only beat yourself up for it afterwards.  Keep healthy foods around you, so they are the only option.
9. Medication.  Anti-depressant medication can make the world of difference.  It takes time to work, and it can interfere with other medications.  So go see your GP and talk about options.  As I said, I’ve gone down this route, and it didn’t work for me. But I tried.
10. See a psychologist.  One who specialises in depression and chronic illnesses.  I see my psychologist once each month.  I vent. I complain.  I talk about my illness, my pain, my medications, my side effects. The crappy way people treat me, and my fears for the future.  I get them out of my head. And it makes me feel better to get it out.

These are the things I am doing to keep depression at bay.  Some days are better than others.  Some medications definitely bring out depression in me.  Methotrexate certainly had a side effect of severe depression.  Humira is causing depression and anxiety.  But humira also appears to be helping my pain.  So I will persevere and try to keep working within my ‘rules’ and hope that the depression improves and the side effects wane.

I’d love to hear how you deal with depression….what helps you?