RA Ups Depression Risk

OB/GYN News, Feb 15, 2001 by Sally Koch Kubetin

For many patients with rheumatoid arthritis who also have major depression, selective serotonin reuptake inhibitors are the treatment of choice, Karen L. Smarr reported at the annual meeting of the American College of Rheumatology.

Studies conducted by Ms. Smarr and her associates revealed that 17%-27% of patients with rheumatoid arthritis also had major depression. In most of these patients, the depression developed after their rheumatoid arthritis first appeared, and it was considered secondary to their pain and functional limitations, said Ms. Smarr, a psychologist at the Veterans Affairs Medical Center in Columbia, Mo.

To assess the efficacy of drug and behavioral therapy 41 patients on a stable treatment regimen for rheumatoid arthritis were enrolled in a randomized study Fourteen patients were treated with a selective serotonin reuptake inhibitor, sertraline, and cognitive-behavioral therapy Another 13 patients were treated with sertraline and participated in an arthritis educational program. The remaining 14 patients were treated only with sertraline.

The therapy program, which focused on stress management and relaxation, consisted of 10 individual sessions, once weekly.

All patients experienced less depression, stress, anxiety, and fatigue than at baseline and showed improvements in coping and health status. There were no significant differences, however, in outcomes among the three intervention groups.

But on follow-up evaluation, the drug-treated patients were significantly less depressed than were 41 similar patients with rheumatoid arthritis who had not received a selective serotonin reuptake inhibitor.