Tips for Treating Pain, Depression in Patients with Rheumatic Disease Offered at the ACR/ARHP’s 2013 Annual Meeting

There are many medications available to treat depression and anxiety, including tricyclic antidepressants, selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors, among others. Adverse effects, including anti­cholinergic effects, weight gain, increased appetite, sexual dysfunction and cardiovascular effects are concerns. It is also important to taper down dosages gradually and to educate patients that full therapeutic effects of many antidepressants may take up to six weeks, Dr. Arnold said. Patients should be maintained on antidepressants for one year after remission of symptoms, she added.

Nonpharmacologic interventions may also help patients who experience pain and depression. Approaches include mindful meditation and emotion-regulation therapy, Dr. Arnold said. “Medications will alleviate symptoms, but will not help people deal with their emotional problems.”

Bipolar disorder (BPD) is another common syndrome, and when it is comorbid with fibromyalgia, there might be increased suicide risk, Dr. Arnold said. Screening tests help identify BPD. “Anytime someone [says] an antidepressant made their mood worse, that is a red flag for bipolar disorder,” she said.

In chronic pain patients, predictors of suicide include poor sleep quality, use of illicit drugs, use of antidepressants, and being unemployed or on disability, Dr. Arnold said. Suicide-screening tests are useful in identifying high risk. “Patients will tell you whether they have suicidal [tendencies] or not.”

Severe mood disorders are common in patients with rheumatic disease, and referral to psychiatric professionals may be necessary, Dr. Arnold concluded. Routine screening will help identify patients who may have comorbid psychiatric disorders, leading to faster treatment to alleviate symptoms and manage the patient’s disease more effectively.

Susan Bernstein is a writer based in Atlanta.