Depression Makes the Pain Worse

Depression increases symptoms of knee arthritis

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Knee arthritis can be so painful that standing seems impossible. Even those with mild arthritis say they feel extreme pain, especially if they have depression.

In a recent study, researchers found that depression can seriously affect the way a patient experiences pain related to knee arthritis.

According to study author Tae Kyun Kim, M.D., it can be difficult for doctors to treat arthritis because depressed patients often say they feel more pain than what is shown with X-rays.

dailyRx Insight: Inform both your doctor and therapist if you are experiencing knee arthritis pain.

This study shows that depression may have a strong effect on how patients experience knee arthritis. In fact, says Dr. Kim, the impact of depression on knee arthritis symptoms was nearly as important as the damage shown by X-rays.

Using X-rays, interviews, and questionnaires, Dr. Kim and colleagues evaluated the severity of knee arthritis and symptoms in more than 600 men and women 65 years of age and older.

They found that even those with mild to moderate arthritis reported increased amounts of pain. These findings suggest that both physicians and mental health professionals should be involved in treating knee arthritis in depressed patients.

Osteoarthritis (gradual wearing of the cartilage) is the most common form of knee arthritis. However, rheumatoid arthritis (an inflammatory form of the disease) and post-traumatic arthritis (occurring after an injury) can also take a crippling toll on the knee.

Patients and doctors often decide on knee replacement surgery once knee damage becomes very severe and other treatments do not work.

For the most part, knee replacement surgery is very effective. However, medical professionals sometimes cannot explain why a patient still experiences pain and disability. Mental health screening would be beneficial for these patients too, says Dr. Kim.

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 appears in the Journal of Bone and Joint Surgery.

Reviewed by: 
Review Date: 
March 21, 2011
Last Updated:
April 4, 2011