Gout is a type of arthritis that causes severe pain, joint redness, and swelling. If left untreated, it might lead to major complications such as high blood pressure, heart attacks, diabetes, kidney difficulties, and obesity. Nowadays, researchers are digging deeper into another challenging problem associated with gout: depression.
Even though gout was one of the first diseases to be discovered, in 2640 BC, there is still a lot we don’t know about it. Recently, experts have started examining the potential connections between this type of joint pain and mental health conditions like depression or anxiety.
The relationship between gout and depression is an area of interest for researchers and healthcare professionals. The buildup of uric acid crystals in the joints typically causes gout. This buildup may often lead to pain, swelling, and inflammation. Gout is primarily known for its physical symptoms, but there is growing awareness of its potential impact on mental well-being.
A recent study at the University of British Columbia revealed something interesting. People with gout often also have mood disorders. The researchers looked at data from a large group of 157,426 patients and found that around 13 out of every 1,000 individuals per year had both gout and depression.
On the flip side, about 11 patients (roughly 1.1%) out of every 1,000 patients per year had depression without gout. But there’s an interesting angle to this. The researchers think this number could actually be higher.
Why? Well, it’s because men, who tend to get gout more often than women, don’t typically seek help for psychological issues as much as women do. So, they might not end up getting an official depression diagnosis as often.
Here’s something else the same group of researchers found earlier: individuals with gout have a 29% higher chance of dealing with depression, depending on how well they’re managing their gout. This is pretty important because dealing with intense physical pain might really take a toll on your emotional well-being.
Exploring the Psychological Impact of Frequent Gout Episodes
It doesn’t take a genius to know that physical pain impacts the mind and emotions. Gout sufferers know too well that gout always brings pain. Fortunately, most bounce back after an occasional flare-up.
That being said, the mental game of gout starts when gout episodes become frequent and prolonged. Depression might eventually result from both internal and external issues brought on by untreated and recurrent gout.
The problem is that gout is often undertreated due to its difficulty in diagnosis. As a result, many people who suffer from unpredictable gout flare-ups suffer both physically and psychologically.
Mixed Findings in Recent Studies
To make matters worse, existing research on the psychological consequences of gout is often conflicting. Prior studies have estimated that the prevalence of depression and anxiety in gout patients ranges from as low as 1.9% to upwards of 40% for depression and from 3.8% to 10% for anxiety.
BMC Rheumatology published a population-based study investigating the incidence of depression and anxiety in patients after being diagnosed with gout. Researchers collected health data from around 5 million people in British Columbia between 1985 and 2018.
They focused on 157,426 adults with gout, matching them with an equal number of individuals without gout based on age and sex. They also considered factors like income, urban or rural living, and other health conditions.
The researchers found a small connection between gout and the development of anxiety or depression. Before being diagnosed with gout, about 24.3% of people had depression and 5.2% had anxiety. Women were more likely to have these conditions before being diagnosed with gout. Over six years, around 19,896 cases of depression were seen in total.
People with gout had a rate of 12.9 cases of depression per 1000 people per year, while those without gout had 11.1 cases per 1000 people per year. It took around 3.9 years for people with gout to get diagnosed with depression. For anxiety, there were about 10,483 cases overall.
People with gout had a rate of 5.4 cases of anxiety per 1000 people per year, while the control group had 4.6 cases per 1000 people per year. It took around 4.6 years for anxiety to be diagnosed after a gout diagnosis.
The scientists said their study is really good because they looked at lots of information from people without gout for a long time. They used clear methods to tell if someone felt depressed or anxious.
They also talked about other research that shows how gout may make people feel isolated, depressed, or worried because it’s unpredictable. They found that people with gout do feel more depressed or anxious than others, but this might be because gout comes and goes.
Linking Depression and Gout
Formal studies have concluded that gout could potentially predict depression:
- Back in 2015, researchers in Asia did a study where they checked out patient information over 10 years, from 2000 to 2010. They looked at 34,050 people with gout and 68,100 without. What they found was that people with gout had about an 18% higher chance of feeling down compared to those without gout. And here’s the interesting part: people who didn’t take their gout meds were much more likely to get hit with depressive issues, unlike those who took their meds as prescribed.
- In 2017, a meta-analysis focused on seven studies with a total of 411,745 patient cases. According to this lengthy study, people with chronic gout are 19% more likely to have depression.
- In 2020, a big meta-analysis backed up the link between gout and feelings of depression and anxiety. They checked out 20 research studies that also looked at other things related to mental health. After taking into account the many health concerns that patients already had, they discovered that 17% to 29% of those with gout had experienced depression at least once.
Obviously, if you’ve ever hurt your leg, like with a sprain or break, it can make you feel stressed out mentally. Gout might not keep you stuck in a cast for months, but those first days may feel just as tough with pain and discomfort. It’s no wonder that a big foot or leg injury may make you feel frustrated and lead to symptoms of depression.
Well, gout is a bit like that too, but sometimes even worse. Why? Well, gout may keep coming back every few months and stick around for weeks!
What Makes Depression So Dangerous?
Gout Pain’s Impact on Quality of Life and Depression
Having gout flares often can really mess with how good your life feels. And when life gets tough, depression may sneak its way in. Here are three big ways that dealing with gout again and again may put you at risk of feeling down.
#1) Lack of Social Interaction
A gout flare-up might make you skip activities you love, social gatherings, and family get-togethers. It’s normal to feel a bit let down when you can’t make it to important events.
The trouble starts when gout symptoms stick around for weeks. This means you miss out on your regular and enjoyable activities. This loss of fun and escape can mess with your mental and emotional well-being. Feeling like you’re missing out and stuck might also make you feel more anxious.
Engaging in enjoyable activities triggers the release of brain chemicals like dopamine and serotonin, which keep our mood upbeat. When we’re kept away from these stress-relieving activities, we might start feeling down because we’re missing out on those natural mood-lifters.
It’s important to find a substitute for the activities we’re missing. If we don’t, it might lead to a mix-up in our mental and physical well-being. Think of it like an injury from sports: we develop new ways to cope and calm our mind and nerves. These new methods might be helpful or not so good for us.
An even more concerning signal is when someone who used to have gout starts saying no to social invites or quits doing things they love. This can happen because after being inactive for a while, your excitement and drive might drop.
If this keeps going on, keep an eye out for signs of depression like doubting yourself, pulling away from others, forgetfulness, feeling lazy, and changes in how hungry you are.
#2) Limitations in Movement and Ongoing Pain
Severe pain may really mess with anyone’s thoughts unless they happen to have an unusually high pain tolerance. When the mind gets overwhelmed by pain, it might set off a chain reaction of emotional and behavioral responses.
People with gout understand how intense pain might make even the tiniest movement impossible and may stick around for days. Being physically restricted and stuck in bed due to intense pain can lead to feeling pretty frustrated. Of course, when negative thoughts start to take over, it’s natural for our mood to take a hit.
After an occasional gout attack, most folks tend to bounce back to their usual selves pretty soon. However, things get more challenging when gout keeps happening and becomes chronic. Chronic gout is basically chronic pain, and it’s not uncommon for the mental “immune system” to weaken because of the ongoing pain.
Depression may start to show up if certain not-so-great behaviors become more noticeable with each gout attack that comes back. In this situation, you might see some common signs of depression, like mood swings, feeling helpless, getting really mad, struggling with sleep, and feeling anxious.
#3) Weight Gain
It’s not just the whole being less active and catching more Z’s thing. And it’s not just the fact that your cravings might kick up, and you find yourself munching on more junk food when the blues hit.
Nope, your body’s metabolism takes a nosedive, which might bring on some extra pounds. On top of that, you might also deal with physical pain and feel wiped out from your depression, making it quite the challenge to get moving.
For most teenagers, putting on a bit of extra weight usually isn’t too concerning for their health. However, the bigger problem is that obesity is on the rise, and if weight keeps piling on, it may lead to some pretty serious health troubles.
Getting treated for depression is really important to prevent this from becoming a long-term issue. Once you find a treatment that suits you, you can handle many of the symptoms that lead to weight gain, and you might get back the motivation to shed any extra pounds.
And let’s talk about the elephant in the room: gout. Weight gain and gout are connected in a significant way. When you put on extra pounds, it might actually increase the risk of gout flare-ups. Gout is notorious for causing painful attacks due to the buildup of uric acid crystals in the joints.
Here’s the kicker: Carrying excess weight may lead to higher levels of uric acid in your body, which in turn might trigger more intense and frequent gout attacks.
So, it’s not just about health issues in general, but also about making gout even trickier to manage. It’s a bit like a double challenge. That’s why it’s crucial to take care of both your mental well-being and your physical health.
#4) Impact on Career and Finances
Financial issues add to the strain on our minds. The mix of work, debt, and feeling down is like a complicated puzzle. Do we really need a research study to tell us that?
When gout gets out of control, it can make someone skip work for days or even weeks. And for most people, less work means less cash coming in. When the money we make starts to get smaller and smaller, the stress of not having enough funds becomes a big weight on our shoulders.
Even if people with gout manage to get to work, it doesn’t always go well. When you’re dealing with chronic pain, your job performance can really take a hit. It’s frustrating when you make mistakes because you can’t concentrate properly.
Plus, the pressure to catch up on the time you missed and the worry about job security pile on even more stress. And when gout unexpectedly flares up, it might make you miss important work stuff like meetings with clients, big conferences, and company events.
Over time, struggling at your job and not being able to earn as much as you want can really knock your self-confidence. When self-confidence drops, it’s harder to fend off feelings of depression.
Just like with family, you can start feeling guilty and unhappy when you keep disappointing your boss or anyone who relies on you. If gout keeps messing with your work and money, it can lead to feeling pretty down.
In this kind of situation, you might notice more signs of depression, like feeling unsure, being quick to get frustrated, struggling to concentrate, blaming yourself, and talking negatively.
#5) Additional Health Risks
Depression brings along a bunch of ongoing physical symptoms, and one of the toughest to handle is insomnia. It might surprise you, but insomnia may bring on a whole range of other health problems, like high blood pressure, diabetes, and even certain types of cancer.
It’s like a chain reaction – when you don’t get good sleep due to insomnia, it might cause more mental health problems, which in turn make insomnia worse, and it just keeps going.
And hey, there’s more – depression may also mess with your stomach, leading to things like Irritable Bowel Syndrome (IBS). And for women dealing with depression, there’s a higher risk of osteoporosis to watch out for.
A major health danger connected to depression is heart disease, affecting a significant number of individuals with conditions like heart failure or coronary heart disease. Moreover, depression often plays a significant role in substance use, leading to a whole new set of mental and physical issues.
Chronic health issues may also trigger depression. This forms a kind of cycle where depression makes the symptoms of these problems worse, and in turn, the conditions might worsen the depression.
Some of these ongoing health conditions include cancer, coronary heart disease, diabetes, epilepsy, multiple sclerosis, stroke, Alzheimer’s disease, HIV/AIDS, Parkinson’s disease, Lupus, and Rheumatoid arthritis. And even if these conditions get better with treatment, the depression may stick around if it’s not addressed.
Individuals with gout are at a higher risk of experiencing heart disease, blocked arteries, and even heart failure. Gout is also linked to an increased likelihood of developing kidney disease, diabetes, cancer, and sleep apnea. This connection is likely due to the presence of chronic inflammation at elevated levels.
Gout patients are at Greater Risk of Depression
Other studies have shown that many people with depression also have metabolic problems. However, we don’t fully understand how gout is related to depression. In a recent study, researchers investigated whether gout, antigout medication, and the chances of getting depression are somehow connected.
In this big nationwide study, researchers checked the health records of 34,050 people with gout and 68,100 people without gout. They wanted to see if any of them would get depressed during the study.
The researchers’ main objective was to observe if participants in the study received a diagnosis of depressive disorders. They monitored the overall study population until individuals were diagnosed with depression, withdrew from the NHI program, or until the study concluded.
The study looked at the characteristics of two cohorts and how gout might increase the risk of depression. The findings were presented as hazard ratios with corresponding values.
In summary, the study reveals that individuals with gout face a higher risk of experiencing depressive disorders compared to those without gout. Moreover, the risk appears to be more prominent among older individuals, females, and those with hypertension, stroke, or coronary artery disease.
Interestingly, certain medications, such as nonsteroidal anti-inflammatory drugs and prednisolone, seem to be associated with a reduced risk of depression. Additionally, patients with gout who received antigout medication demonstrated a lower risk of depressive disorders compared to those who did not.
Overall, these findings provide robust evidence that gout may indeed heighten the risk of depression. On the other hand, proper use of antigout medication may play a role in mitigating this risk. It is essential to stay informed about these associations to improve patient care effectively.
Is There a Link Between Allopurinol and Depression?
In recent years, there’s been a lot of interest in the antidepressant effects of some unique medications. One of these drugs is called Allopurinol. It’s usually used to treat gout, but it turns out it has some other helpful effects too!
Researchers have found that Allopurinol can actually be beneficial for different conditions. For example, it has been shown to improve hypoxic-ischemic encephalopathy in newborns, which is a condition where there’s a lack of oxygen and blood flow to the brain.
It’s also been studied in cases of ischemia-reperfusion in various organs, and it seems to have positive effects there as well.
However, there’s a bit of a downside. Allopurinol has been found to have some pro-epileptic effects. In other words, it might trigger seizures in some cases. So, it’s not all good news.
Interestingly, the reason behind these effects may be linked to something called oxidative stress in the brain, which may lead to mood swings and even depressive symptoms.
Allopurinol could have some positive effects beyond treating gout, but we need to be careful about possible side effects related to epilepsy and mood changes. Right now, researchers are studying it further to better understand its effects and find the best ways to use it.
The Forced Swim Test
The FST is a popular test for studying depression-like behavior in animals. It’s really good at detecting the effects of different antidepressant drugs. In this test, they watch how long the animals stay still while swimming, and if a drug has an antidepressant effect, it makes them less immobile. They call this stillness “behavioral despair” in animals, and it’s believed to be similar to human depression.
In a recent study, researchers looked at how different doses of allopurinol affect rats’ depression-like behaviors. They found that allopurinol reduced immobility time, similar to fluoxetine, especially at higher doses. Also, the drug didn’t make the rats anxious or hyper.
Brain-derived neurotrophic factor (BDNF) is a special protein that helps brain cells grow, survive, and work properly. Even though the lowest dose of allopurinol didn’t change BDNF much, it still made the rats feel better, like they were less depressed. This means allopurinol might have other ways to help with depression, and scientists need to study it more to understand exactly how it works.
What Are the Symptoms and Warning Signs of Depression?
Gout brings stress due to the pain, limitations on social activities, and work demands. Feeling low and overwhelmed is a natural reaction when things get chaotic. Many people have their own methods for bouncing back.
But if these down times keep getting longer and happening more often, noticing these signs could help prevent a more serious case of depression.
Emotional Indicators of Depression:
- Persistent Sadness: Feeling constantly down or sad, even when there’s no clear reason.
- Loss of Interest: Losing interest in or pleasure in activities that were once enjoyable
- Hopelessness: Feeling like there’s no way things will ever get better and nothing will change.
- Irritability: Getting easily frustrated or agitated, even by small things.
- Low Energy: Feeling constantly tired or lacking the energy to do everyday tasks
Indications of Depression in Behavior:
- Social Withdrawal: Pulling away from friends, family, and social activities that used to be enjoyable
- Changes in Sleep Patterns: Experiencing disrupted sleep, such as trouble falling asleep, waking up too early, or sleeping too much
- Appetite Changes: Noticing significant changes in eating habits, such as overeating or loss of appetite
- Lack of Concentration: Struggling to focus, make decisions, or remember things
- Neglecting Responsibilities: Finding it challenging to fulfill everyday responsibilities at work, home, or school
Ineffective Coping Mechanisms Develop into Unhealthy Habits
Coping mechanisms are the ways we react when we’re dealing with stress, pain, or tough emotions. Sadly, we often end up leaning towards not-so-great and unhealthy coping strategies. Here are a few examples of bad coping habits to steer clear of:
- Isolation: Pulling away from social interactions and isolating oneself
- Emotional Eating: Turning to unhealthy food as a way to cope with emotions
- Excessive Alcohol Use: Relying on alcohol to numb emotional pain
- Avoidance: Ignoring problems and responsibilities instead of addressing them
- Ruminating: Dwelling on negative thoughts and overthinking problems
- Negative Self-Talk: Constantly putting oneself down and having pessimistic thoughts
- Procrastination: Delaying important tasks and decisions, leading to increased stress
- Escapism: Using excessive screen time, video games, or other distractions to avoid facing challenges
- Self-Isolation: Cutting off contact with friends and loved ones, worsening feelings of loneliness
- Suppression: Ignoring or suppressing emotions rather than dealing with them in a healthy way
As time goes on, the new and unhealthy way of coping turns into a harmful habit. The least helpful choices for people with gout are using illegal drugs, having an unhealthy diet, and drinking too much alcohol. Each of these might start a harmful cycle of gout and other health problems.
Approaches and Techniques for Battling Depression
There are ways to keep depression from taking over your mind. We’re talking about psychological techniques and physical strategies here. Learning some practical coping skills may really help dial down stress and stand up against depression.
To be clear, when a major gout attack hits, it’s not easy for most people to conjure up happy thoughts or put on a happy face. But as the intense pain starts to ease off a bit, some of these methods may start to show better results.
Ways to Support Yourself
- Self-Assessment and Acknowledgment: Pause and reflect on your physical and mental state. Have you acknowledged that recurrent gout plays a significant role in your diminishing quality of life? Recognizing a problem or situation early on allows you to overcome obstacles more quickly and work towards improvement.
- Educate Yourself: Make an effort to learn about depression from credible and trustworthy sources. Lack of knowledge or misinformation can leave individuals feeling lost and helpless about their condition. Finding peace of mind comes with understanding the real causes and discovering appropriate treatments.
- Improve Your Diet: Recurring gout is a sign that your health and diet need a boost. Depression drives binge eating, making the situation worse. It’s a vicious cycle: bad diet, gout, depression, bad diet… Track your eating for a month, and you’ll see where improvements are needed. Swap out one unhealthy food at a time, and watch uric acid levels and weight improve.
- Prioritize Consistent Sleep: Lots of research shows that not getting enough sleep messes with how your body and brain work. Getting the right amount of shut-eye at the right times helps keep your mood stable and supports your mental well-being. Ideally, try to sleep for around 7-8 hours every night and keep your bedtime consistent.
Social and Professional Support
When dealing with gout and depression, reach out to loved ones for vital social support. Sharing your experiences with close friends and family may boost your mood and resilience. Staying connected helps combat isolation, a common aspect of depression.
Seek professional help if depression persists. Mental health professionals offer guidance, and your workplace’s HR department might provide referrals to support groups or counseling services. In therapy, discuss challenges openly and learn coping strategies.
For persistent depression, medication might be an option. Collaborate with your therapist to find the right antidepressant and dosage. Be aware of initial side effects and interactions with substances like alcohol and certain drugs. Also, note the potential impacts of medications like corticosteroids, commonly used for conditions like gout.
Over time, depression can sneak up on gout sufferers, especially during those painful flare-ups. While not as severe as permanent injuries, recurring gout attacks may be incredibly frustrating and disruptive. Just like any health challenge, they might influence your thoughts, emotions, and behaviour.
If left unchecked, gout may start to impact your social life and finances, knocking your self-esteem down and making you vulnerable to depression. Recognizing the signs of depression and seeking help is vital – much like tackling gout – to maintain your overall well-being, both physically and mentally.