March 24, 2011

Poor, Depressed, and in Pain

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Joseph V. Madia, MD By:

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Low socioeconomic status linked to depression in rheumatoid arthritis patients

(dailyRx News) Having a crippling disease can be saddening for anybody. A new study shows that rheumatoid arthritis patients who are poor have a greater risk of depression.

From a study that looked at the relationship between disability and depression, researchers found that people with a lower socioeconomic status (wealth and position in society) may be more likely to experience depression, even if they have the same level of disability as people with a higher socioeconomic status.

The differences between depressed and non-depressed patients had to do with race; whether they went to a public or university hospital; how much their ability to function was limited; and doses of drugs for treating rheumatic diseases (e.g. rheumatoid arthritis).

dailyRx Insight: Less wealthy people with rheumatoid arthritis are more likely to become depressed.

According to lead author Mary Margaretten, M.D., from the Arthritis Research Group at the University of California, San Francisco, being able to identify and record how disability is linked to depression in people of different socioeconomic status will help doctors provide the most appropriate care for rheumatoid arthritis patients.

If a doctor knows that somebody is at greater risk for depression because of their disability, then that doctor can provide treatment that address the patient's mental health as well as physical health.

In order to explore the relationship between socioeconomic status and depression in patients with disability, Margaretten and colleagues studied data from 824 hospital visits made by 466 patients.

The researchers found that 37 percent of the participants had moderate to severe depression. Patients who were treated at a public county hospital had higher levels of depression.

Depression impacts an estimated 15 million adults in the United States. Depression is a state of prolonged low mood and aversion to activity. A person's thoughts, behavior, feelings and physical well-being are affected and may include feelings of sadness, anxiety, emptiness, hopelessness, worthlessness, guilt, irritability, or restlessness. The primary treatments for major depression are psychological counseling and medications. Medication therapies include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs). SSRIs include: fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). SNRIs include: duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq). Bupropion (Wellbutrin) is an NDRI. Atypical antidepressants include trazodone (Desyrel) and mirtazapine (Remeron). Each medication category has different side effects.

The study is published in Arthritis Care & Research

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
March 23, 2011

Last Updated:
April 4, 2011