Depression in Rheumatoid Arthritis

Depression can be easily identified in rheumatology practice. Screening mechanisms can be integrated into the evaluation process and used intermittently to assess depression over the course of managing patients’ disease activity and response to medications. Brief self-report instruments such as the Patient Health Questionnaire (also known as the PHQ9) can be completed within a few minutes and provide cutoff scores that have high specificity and sensitivity for detecting depressive disorder.²⁶ The clinician can use the data to alter the treatment plan for a patient and determine whether the depression should be treated.

After depression has been identified, the rheumatologist must decide on a management approach. If the patient’s depression is mild and does not impair role functioning, some basic education about depression and treatment provided by the rheumatologist or a rheumatology nurse may be sufficient. However, if the patient is likely to have a depressive disorder, consultation with a mental health professional is necessary to arrive at a definitive diagnosis and establish a management approach. Behavioral medicine specialists, either PhD clinical psychologists or psychiatrists who have training in understanding the relationship between psychological factors and chronic disease, are the most qualified to serve RA patients with depression and to coordinate their treatment with rheumatology professionals.

The high prevalence of depression in RA increases the importance of adopting an integrated approach to clinical management in which the medical and psychosocial needs or patients are effectively addressed and managed on a continuous basis. This approach, espousing a comprehensive view of the health of the RA patient, holds the most promise to yield optimal medical and psychological outcomes in rheumatology care.

Dr. Nicassio is clinical professor in the department of psychiatry at David Geffen School of Medicine at the University of California, Los Angeles. Myra Irani is with the California School of Professional Psychology, Los Angeles, at Alliant International University.

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