Less understanding exists around pre-SLE depression and the underlying physiologic changes happening to patients experiencing depression that may make them more likely to develop SLE. Dr. Roberts, Dr. Costenbader and colleagues are exploring findings from this study to further understand whether women who develop SLE have different biological markers of immune function than women without SLE, and whether these markers are also related to depression.
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“The more we understand about the risk factors for SLE, the better we will be at identifying those at risk and predicting onset of the disease,” Dr. Costenbader says.
Dr. Costenbader also notes several ways in which depression may be tied to a future elevated risk of SLE that remain to be determined. “Certainly people living with lupus experience higher rates of depression than do those without lupus, and perhaps this SLE-related depression can have onset even before more specific SLE signs and symptoms. Non-specific early symptoms of SLE, such as pain and fatigue, can also be misdiagnosed as depression. These two possibilities are important for physicians to note and remember in clinical encounters,” she says.
Additionally, Dr. Costenbader notes shared genetic or environmental exposures may exist that lead to the occurrence of the two disease states. Lastly, and perhaps most interestingly, depression is known to cause upregulation of inflammatory cytokine pathways that could fan the flames of brewing autoimmunity. “There is still much to study about this relationship,” she says.
Carina Stanton is a freelance science journalist based in Denver.
- Roberts AL, Kubzansky KD, Malspeis S, et al. Association of depression with risk of incident systemic lupus erythematosus in women assessed across two decades. JAMA Psychiatry. 2018 Dec;75(12):1225–1233.
- Zhang L, Fu T, Yin R, Zhang Q, Shen B. Prevalence of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis. BMC Psychiatry. 2017 Feb 14;17(1):70.