Lupus disease activity may worsen depression - By: Groshan Fabiola

Lupus is a chronic inflammatory disease, and it is known that in the patients who have this autoimmune disorder, the immune system loses its ability to tell the difference between antigens and its own cells and tissues. We can mention that there will be developed antibodies, leading to immune complexes.

It was seen that in persons with lupus, there can appear major depressions. This happens because of the lupus disease activity and also because some negative life events.
It is known that lupus is capable to damage the brain; the brain involvement can be widespread or focal, and may involve inflammation of small blood vessels or interaction of autoantibodies with antigens on neuronal cell membranes.

There was made a study involving 71 patients, and the purpose of this study was to evaluate the presence of a major depressive disorder, the intensity of depression, the life events from the last 6 months that had had a negative aspect on patient’s lives, and also lupus activity. 23 percent of the patients were diagnosed to have a major depressive disorder. Although it is known that Prednisone, a medication used to treat lupus sometimes produces depression, this could not explain the high rate of depression because the amount of prednisone used by subjects with and without depression was essentially the same.
The study also revealed that 9 of the group of the 23% with major depression said that they had experienced at least one major negative life event during the previous six months, and in the group of subjects without a major depression, there were 13 who mentioned the same thing. This result suggests that it is possible negative events to precipitate depressions.
It was seen that the subjects with major depression had more severe lupus disease activity than those without a major depression.
It was concluded that lupus disease activity might have triggered the depression, but also there was still a highly significant link between depression severity and disease activity.

If a lupus flare-up can really trigger depression, we can ask if the depression is due to brain damage by the disease or whether the patient becomes depressed in reaction to the disease. It is possible for both to occur, probably at the same time in the same patient.
We can say that the findings of the study have practical implications for clinical psychiatrists. When evaluating depressed patients with systemic lupus erythematosus, it is important to consider that the disease activity is an important risk factor for the worsening of the depression.

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