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.
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.
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
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.