If you've had RA for a while, it won't come as a surprise: A serious case of the blues can sometimes tag along with your achy joints.
But it doesn't have to be this way. The right approach can lift your spirits and keep depression from becoming a regular visitor.
Treat the Arthritis
Your first step is to ease the joint pain that can fuel your depression. Megan Koelzer, a 21-year-old with rheumatoid arthritis, has personally seen how those symptoms are connected.
"When I'm having a bad flare [of arthritis], the anxiety and depression will come on," says the student at Central Michigan University. "In the same sense, if I get a really bad day with the depression and anxiety, the arthritis acts up."
"It's like a vicious cycle," says Ozlem Pala, MD, an assistant professor of medicine in the division of rheumatology at the University of Miami Miller School of Medicine. "When you're depressed, then the sensation of pain will also be increased."
If you hurt less, your mood may get a boost. It's important to follow a medical plan and keep up with your meds to get your RA pain under control, says James O'Dell, MD, chief of the rheumatology division at the University of Nebraska Medical Center.
Talk to Your Doctor
Get his input on more than just your arthritis. Your doctor can also trouble-shoot your emotional health and recommend a therapist who treats depression. He can also suggest a psychiatrist who can prescribe antidepressant medications, if that's right for your situation.
"Letting your doctor know and telling them you are willing to see someone to help deal with depression is critical," O'Dell says.
Exercise eases pain and boosts your mood at the same time. Several studies show less depression in adults with rheumatoid arthritis who exercise.
Be careful what kind you choose, though, especially when you have a flare of RA symptoms. Stretching and low-impact activities are a good choice. Try walking, biking, or swimming.
Koelzer finds that social media can put her in touch with others who are going through some of the same things she is. When she's awake at 3 a.m., she signs on to the Twitter account she created to follow other people with long-term illnesses. "People are live-tweeting what they're feeling," she says. "[I realize] I'm not the only one. It's comforting."
Koelzer is also a volunteer spokesperson for CreakyJoints, an online, non-profit support community for people with arthritis. It's another way to reach out to people who are looking for ways to manage their RA.
If you're not part of the Twitter generation, try a traditional support group -- one that meets in person or on the phone. They can fill the same role, leaving you feeling hopeful and empowered.
Write About Your Feelings
Koelzer recently treated herself to a fancy leather-bound journal. She's learned from experience that writing about her emotions relieves anxiety.
Other forms of expression might be just as effective. "If it's not the middle of the night," she says, "I can go play some intense Mozart."
Find a Counselor
Studies show that talking with a therapist, psychologist, or counselor can help people with mild to moderate depression. Cognitive behavioral therapy in particular may boost your mood. It focuses on changing ways you think and act.
When you meet with a mental health professional, it can help boost your self-respect and self-esteem, says Jonathan David Krant, MD, medical director of CreakyJoints.
Watch What You Eat
It's extra important to stick to a healthy, balanced diet when you have rheumatoid arthritis. That means you should cut back on fat while you pile lots of fruits and veggies on your plate.
Also look for food with omega-3 fatty acids, like salmon and other fatty fish. They help fight the inflammation that causes the painful joints that are linked to your depression.
You don't have to completely change your eating habits overnight. You can start by making one or two small food swaps at a time. Substitute whole grains for refined products, for example.
Consider alternative therapies that might relieve your pain and depression. Acupuncture, massage, or meditation can help.
Whatever route you go, the important thing is not to ignore your emotional health when you're feeling down in the dumps. Depression is treatable, so make sure you take the steps to get back on track.