Axial spodndyloarthritis (axSpA) can cause depression or anxiety, and in turn, these conditions can make your arthritis worse.

Having axSpA can have a negative effect on your mental health. This most commonly manifests as depression or anxiety.  It works the other way around, too. Mental health problems can make your axSpA worse.

Anxiety is characterised by feelings of tension, worry and irritability along with physical changes like increased blood pressure. Depression is characterised by sadness, a lack of interest in daily activities, weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt, and recurrent thoughts of death or suicide.

Rates of depression and anxiety in people with arthritis-related diseases can be between two- and ten-times greater than the rates of the general population.

Studies show that anxiety and depression can lower your pain threshold. And then the chronic pain aggravates your anxiety and depression. Furthermore, people with arthritis and depression tend to have more functional limitations, are less likely to adhere to their treatment regimens, and have increased odds of developing other health problems.

You can find yourself in a never-ending loop of pain, poor health and negative mood. This vicious cycle can significantly change the course and management of your arthritis.

Pain and Depression

Many studies have shown clearly that people with arthritis with the highest pain levels are the most likely to be anxious or depressed. Exactly why higher pain severity is associated with depression is not clear. It seems to be a two-way street.

Pain incites depression. Living with daily pain is physically and emotionally stressful. Chronic stress is known to change your levels of brain and nervous system chemicals. These stress hormones and neurochemicals – like cortisol, serotonin and norepinephrine -- affect your mood, thinking and behaviour. Disrupting your body’s balance of these chemicals can bring on depression in some people.

Depression makes pain worse. Depression weakens a person’s ability to deal and cope with pain. For people with chronic pain, the presence of depression is associated with more severe pain and a longer duration of pain compared to people who are not depressed. This is because the way painful sensations are relayed through the brain is very complex and can be modified up or down by depression as well as stress, poor sleep and anxiety.

Inflammation and Depression

We know that pain and disability are linked to depression in arthritis, but a developing theory is that inflammation also plays a role.

A 2016 study published in The Journal of Clinical Psychiatry reviewed levels of C-reactive protein – a marker of inflammation – in 10,036 people who responded to the National Health and Nutrition Examination Survey. People with symptoms of depression had CRP levels that were 31% higher than those with no depressive symptoms.

Similarly, there is evidence that depression can sometimes be an inflammatory condition called cytokine-induced depression, where cytokines are increased and depression occurs. Specific cytokines, such as interleukin-1, interleukin-6, and tumor necrosis factor-α, are involved in the pain and inflammation process in arthritis.

Lifestyle and Depression

Having axSpA is painful and exhausting. Inflammation and the fatigue that goes with it can further drag you down. Maybe you then add a co-occurring condition like diabetes or a heart condition. If you are dealing with all of this, the active life you once knew may have gone out the window.

All of these health challenges may cause you to engage less in physical activity, become less social and more isolated, and have worse sleep quality. These negative changes in your lifestyle can increase your pain and dampen your overall mood – bringing on the blues and depression.

No matter exactly what causes depression in people with axSpA, the link is real and potentially life-changing. Treating not only your axSpA but also specifically treating your anxiety or depression are key to living your fullest life.

For more information on depression and treatments visit beyondblue, Lifeline or SANE

For more information see Arthritis and depression - What you can do about it.

This resource has been developed based on the best available evidence. A full list of references is available upon request.