Brunilda Nazario, MD
If you have lupus, it’s normal to feel sad or down sometimes. After all, lupus may force you to make big adjustments in your life. Lupus can put a strain on your personal relationships, and make it hard to do some of the things you enjoy. All this can take a toll on you emotionally. But feelings of sadness or depression that last more than a few weeks should be evaluated and treated.
People with a chronic illness such as lupus are at higher risk of depression. Studies show that as many as 60% of people with a chronic illness will have depression at some point in their lives.
But don’t try to diagnose yourself. Some symptoms of lupus -- loss of energy, difficulty sleeping, fatigue -- can mimic the symptoms of depression. See a doctor, and work together to deal with depression.
Here are 11 steps you can take if you have lupus and think you may have depression.
Your doctor can assess, diagnose, and help you decide what kind of treatment is best. In most cases, your doctor will suggest a combination of psychotherapy and an antidepressant medication. “Some people find they need an antidepressant to help get them out of a rut,” says Helen Grusd, PhD, a clinical psychologist in Los Angeles and past president of the Los Angeles County Psychological Association. “Then once they’re feeling better, they can start to do other things on their own to help ease the depression.”
“When you are first diagnosed with lupus, it’s natural to move through the stages of grief, from denial to anger and depression,” says Grusd. These are all normal feelings. But the key is to not stay too long in any of these stages. Instead, try to move toward acceptance. “Accepting that you have lupus and then moving on with your life can help with depression,” says Grusd. This may mean setting new life goals for yourself and finding new things you can do that you enjoy.
“I was used to being very active, but with lupus this just wasn’t possible. I had to slow down,” says Ann S. Utterback, PhD, a broadcast voice specialist in Virginia who was diagnosed with lupus in 2006. “It was a real challenge, but I decided to use the time to do something fun for myself. So I read all the classics I had never gotten around to reading before.”
Whether we realize it or not, most of us talk to ourselves as we go about our day. And what you say can have a big effect on your mood. “What you tell yourself is more important than what others say about you,” says Grusd. “So try to keep your thoughts as positive as you can and beware of slipping into negative self-talk.”
For example, if you can’t do something because your symptoms are acting up, try not to blame yourself. Instead, remind yourself that you’re doing the best you can. Or tell yourself that you’ll do the activity another day when you’re feeling better.
Having a strong support network is important when you have any type of chronic illness. “It’s important to surround yourself with positive people who are willing to be supportive -- even if this means making some new friends,” says Grusd.
You may also consider joining a support group for people with lupus. “It’s important to get empathy and be around others who understand what you’re going through,” says Debra Borys, PhD, a clinical psychologist based in Los Angeles. “A support group can be a great way to find this.” If getting out is too difficult, you can even find support groups online.
Seeing a therapist is another way to get support. “It can be really helpful to talk with a professional about your worries and concerns,” says Borys. “A therapist can also help you improve your relationships with family and friends.”
It can be overwhelming to worry about all the things you need to do. Instead, try to focus on one day at a time. It may help to break up the day into small, manageable pieces. “Every morning, I usually prioritize a few things to get done that day,” says Utterback. “And if I can’t get through everything on my list, I don’t get upset with myself. I just tell myself that I’ll get to it eventually.”
It may be helpful to create an internal barometer of how you’re feeling, using the numbers 1 through 10. “If you notice you’re starting to head down the scale, don’t wait until you’re at a 3 or 4 to do something about it,” says Grusd. “Instead, try to notice small changes right away and do something to pick yourself up if you start slipping a little bit.”
Create a list of things that make you feel good. Some examples may include taking a bubble bath, calling a friend, watching a show or movie that you enjoy, reading, taking a short walk, sitting in your garden, or petting your dog. Keep this list handy and do one of these things if you start to feel down. “Keep in mind that the same activity may not always work, so if one thing doesn’t work, try another,” says Grusd.
If you are religious, this is a great time to reach out to your religious community for support. Depending on your beliefs, it may be helpful to go to your church or temple or simply pray on your own. If getting out is difficult, you can request a home visit from those in your congregation. Or simply ask them to pray for you. “Asking other people to pray for you can be very powerful,” says Grusd. “Even if they are people you don’t know.”
Staying active can also help your mood. “When you’re in pain you may not want to move, but doing just a little bit can really lift your spirits,” says Grusd. “It can also be very empowering to feel like you have some control over your illness.” Do whatever you can, whether it’s a walk around the block, or just into the other room.
Some people with lupus also benefit from taking up an activity such as tai chi, very light yoga, guided imagery, or meditation. “Many people find these types of activities help with depression and may even help improve their physical health,” says Borys.
The more you know about lupus, the more involved you can be in your treatment. “Becoming a vocal, assertive patient can give you more of a sense of control over the illness,” says Borys. “Feeling empowered will help decrease your risk of depression and anxiety.”
Learning about lupus will also help you know what to expect and how to best take care of yourself. But be sure to use trusted sources. Ask your doctor for a list of reading material or organizations that provide reliable information.
To feel your best, both physically and mentally, it’s important to eat well and get enough rest. Try to eat a well-balanced diet and aim for at least seven hours of sleep each night. You should also avoid habits that aren’t good for your health, such as smoking and drinking alcohol. “Taking care of yourself will foster a good attitude and ultimately help you feel better about yourself,” says Borys.
SOURCES:Debra Borys, PhD, clinical psychologist based in Los Angeles.Helen Grusd, PhD, clinical psychologist in Los Angeles and past president of the Los Angeles County Psychological Association.Ann S. Utterback, PhD, broadcast voice specialist and lupus patient, Arlington, Va.Lupus Foundation of America web site: “Depression.”National Institute of Mental Health: “Symptoms of Depression and Mania.”
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