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    Rheumatoid Arthritis: Keeping a Positive Outlook

    Realistic optimism fuels the body's immune system and triggers natural painkillers.

    How Depression Makes Arthritis Pain Worse

    People who are depressed are more sensitive to pain, Raison says. Existing pain can become more intense -- and new aches and pains can develop.

    "There's a lot that's come to light on this in the past few years," he tells WebMD. "People who are medically healthy can experience moderate to severe pain when they are depressed. People with depression can actually feel pain that is comparable to people who have active rheumatoid arthritis."

    That's because depression puts other brain chemicals out of whack -- those that affect how the body functions, Raison explains. Both the emotional and physical symptoms of depression involve nerve pathways into the brain and spinal cord. Two brain chemicals involved in regulating mood -- serotonin and norepinephrine -- also keep the body running smoothly. They help regulate our sleep, our sex drive, and they help keep aches and pains from dominating our attention.

    If those brain chemicals are out of whack, so is the body. We get more headaches, back and muscle pains, joint pain, and digestive problems. We feel exhausted and don't sleep well.

    "If you're depressed, you really need to see a doctor," says Raison. "If you need an antidepressant, you need to stay on it long enough that it starts working. The vast majority of people don't take it long enough to get a benefit. They often quit taking it after the first month." Many people don't realize that it may take up to eight weeks before they feel the full effects, says Raison.

    Getting treated for depression truly can help relieve pain, Raison tells WebMD. "If we can treat people for depression, their pain will get better," he says.

    Make Optimism a Goal When You Have Rheumatoid Arthritis

    Good coping skills are an important part of this picture, Raison says. "You can get a good mental 'loop' going. Start by doing everything possible to keep your physical body in the best physical functioning possible. Treat your pain aggressively and early on. If you don't have pain, you are less likely to be anxious and depressed."

    With rheumatoid arthritis, the unpredictability of the disease is the biggest problem, says psychiatrist Nadine Kaslow, PhD, a professor of psychiatry and behavioral sciences at Emory University and chief psychologist at the Grady Health System, both in Atlanta.

    "It's important to figure out what you can control -- in other areas of your life and in your illness," Kaslow tells WebMD. "We know that the more people take control of treatment and activity level, the better they can cope."

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