Management of depression in rheumatoid arthritis: A combined pharmacologic and cognitive‐behavioral approach

Abstract

Objective. To examine the effectiveness of cognitive-behavioral and pharmacologic treatment of depression in rheumatoid arthritis (RA). Methods. Subjects (n ‫؍‬ 54) with confirmed diagnoses of both major depression and RA were randomly assigned to 1 of 3 groups: 1) cognitive-behavioral/pharmacologic group (CB-PHARM), 2) attention-control/pharmacologic group, or 3) pharmacologic control group. Measures of depression, psychosocial status, health status, pain, and disease activity were collected at baseline, posttreatment (10 weeks), 6-month followup, and 15-month followup. Data were analyzed to compare the treatment effectiveness of the groups; data also were aggregated to examine the effects of antidepressive medication over time. Lastly, a no-treatment control group was defined from a cohort of persons who declined participation. Results. Baseline comparisons on demographic and dependent measures revealed a need to assess covariates on age and education; baseline scores on dependent measures also were entered as covariates. Analyses of covariance revealed no statistically significant group differences at postintervention, 6-month followup, or 15-month followup, except higher state and trait anxiety scores for the CB-PHARM group at the 15-month followup. In the longitudinal analyses of the effects of antidepressive medication, significant improvement in psychological status and health status were found at posttreatment, 6-month followup, and 15-month followup, but no significant improvements were shown for pain or disease activity. In addition, the comparison of the aggregated pharmacologic group with a no-treatment group revealed a statistically significant benefit for the 3 groups that received the antidepressive medication. Conclusion. In persons with RA, cognitive-behavioral approaches to the management of depression were not found to be additive to antidepressant medication alone, but antidepressant intervention was superior to no treatment.

Association of health‐related quality of life with dual use of prescription and over‐the‐counter nonsteroidal antiinflammatory drugs

“…Our MCS-12 summary scores are similar to those reported in other rheumatoid arthritis and osteoarthritis populations (18), which are similar to the US norm. Although depression and anxiety are a common comorbid condition in patients who have arthritis and/or pain (27,28), it is plausible that the MCS-12 was not sensitive enough to detect differences in mental health symptoms between the dual and non-dual users in this study. Additionally, physical health problems, such as those measured on the PCS-12 including pain, limitations in daily activities, and perceived current health status, may be more directly related to dual NSAID use than are mental health symptoms.…”

Psychological Factors Associated with Response to Treatment in Rheumatoid Arthritis

“…Antidepressants have a beneficial effect on pain and reduce disease activity in patients with RA [149]. However, the impact of antidepressants or cognitive behavioral therapy on broad healthcare outcomes such as disease activity, disability, and health status has not been established for persons with RA [150]. At present we can only speculate that, since treatment with antidepressants is associated with reduced levels of proinflammatory cytokines, these drugs hold promise as adjuvant therapies for RA, especially in patients with depression.…”

Analyzing reliability of change in depression among persons with rheumatoid arthritis

“…Results of the previous study (10) indicated no significant between-group differences at any time period for either the depression, cognitive, or health-status measures, but a significant decrease in depression symptomatology over time occurred for all 3 groups. Therefore, the groups were combined for the current analyses of reliability of change.…”

“…Details on subject selection have been provided elsewhere (10). In brief, subjects were screened for eligibility to participate in the study by administering the CES-D. Those subjects who scored Ն1 on the instrument were then assessed for MDD, and those subjects who met criteria for MDD were invited to participate in the study.…”

“…Given both the elevated frequency of depressive symptoms among persons with RA and the body of research indicating that depression is a highly treatable condition (3)(4)(5)(6), recent studies have examined depressionrelated symptoms in cohorts of individuals with RA (7)(8)(9)(10).…”