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Depression and Arthritis

While we all get depressed sometimes, serious psychiatric depressions constitute major illness. The patient feels helpless and worthless. Everything is down, down, down. Sleep may be disturbed by obsessive, recurring, pessimistic thoughts, and the musculoskeletal system works very slowly. Speech is slow, body movements are slow, and there is frequently stiffness throughout much of the body. These pains and stiffness may be called "rheumatism" or "arthritis"; they are most frequent in older individuals.

Depressive reactions may follow loss of a loved one. These grief reactions, while similar, are ultimately less serious since they resolve after several months of adjustment.

Features

This syndrome is a vague one. It may blend with psychogenic rheumatism or with fibromyalgia. The sleep deprivation mechanism that operates in fibromyalgia probably accentuates the symptoms associated with depression. And the patient may use the musculoskeletal symptoms to explain why he or she just isn't getting along very well, thus using a mechanism of secondary gain like that of psychogenic rheumatism.

Again, the symptoms frequently don't come from specific body areas or follow usual nerve or muscle paths. The depression is general, so these syndromes will involve many parts of the body.

Similar symptoms occur with an inactive thyroid gland. Parkinson's disease, due to hardening of the arteries, is common in older people and can result in slowness and stiffness. Both thyroid disease and Parkinson's disease can be treated effectively, so it is important to recognize their presence.

Treatment

These syndromes are a signal to consider major lifestyle changes, even if the person's age is advanced. It is important to look forward to future events rather than only backward at what has gone before. New activities, new social groups, and new friends should be encouraged. It is a time for physical activity and for staying out of the house, even if such activities must be forced. Plant some young new trees and plan to attend the grandchildren's college graduation, even if they are only seven.

Medication may be required for treatment of the depression; such medication is often successful. On the other hand, the usual nonsteroidal musculoskeletal drugs should not be used. Drugs like Valium and codeine should be avoided. These drugs are themselves depressants, can aggravate symptoms, and may perpetuate the problem. Minor painkilling medications, such as acetaminophen (Tylenol) may be used but are unlikely to help a great deal.

     
     

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