Mental Health and Lupus: Coping with the Emotional Impacts

Systemic lupus erythematosus (SLE), or lupus, is a chronic autoimmune condition where the immune system mistakenly attacks healthy tissues. A hallmark of lupus is widespread inflammation affecting various organs such as the skin, joints, kidneys, heart, and brain. 

Lupus is unpredictable, with periods of flare-ups and remission that can leave a person feeling like her health is out of her control. 

The unpredictability of lupus’s characteristic inflammatory flares promotes chronic stress, mood swings and mental health symptoms. Neuropsychiatric symptoms—symptoms affecting the brain, nervous system and mental health—are common in lupus, often leading to mood swings, cognitive issues, and emotional distress.

This becomes a vicious cycle where inflammation, chronic stress, and mood disorders exacerbate the underlying autoimmune process in lupus. 

In this article, we’ll discuss the connections between lupus and mental health, including how lupus directly affects mental health as well as the emotional burden of living with a chronic autoimmune condition. 

We’ll also discuss practical strategies, including medication, social support, and lifestyle factors, to help patients manage these challenges and improve their well-being.

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Lupus and Mental Health

Living with lupus often brings mental health challenges like anxiety, depression, and emotional distress. 

More than half of lupus patients experience neuropsychiatric symptoms which range from headaches (the most common neuropsychiatric symptom, affecting 28.3% of lupus patients) to mood swings (affecting 20.7% of patients) to cognitive issues like "lupus fog," where mental clarity becomes compromised.

Depression and Anxiety in Lupus

Research indicates that depression and anxiety are among the most prevalent mental health symptoms in lupus. 

Depression tends to worsen during lupus flares, with certain medications like corticosteroids further exacerbating mood swings. 

Anxiety, which affects up to 40% of neuropsychiatric lupus patients, is also common, especially in those with neuropsychiatric lupus. 

Although less frequent, psychosis—characterized by disconnection from reality through hallucinations, delusions, or impaired thinking—can affect 2-11% of those with active lupus. These mental health symptoms are often linked to disease activity, further complicating emotional well-being.

Cognitive Dysfunction in Lupus: “Lupus Fog”

One of the lesser-known mental health challenges of lupus is cognitive dysfunction, often referred to as “lupus fog.” This can manifest as memory problems, difficulty concentrating and making decisions, or a general sense of mental cloudiness. 

Lupus fog affects up to 88% of patients, but unfortunately it often goes unnoticed due to subtle symptoms.

Lupus fog is brought on by factors like inflammation, immune system activity, and damage to the blood-brain barrier (BBB), which allows toxic antibodies to enter the brain.

For many patients, this cognitive decline is frustrating and adds to the emotional toll, as it can interfere with their ability to work, maintain relationships, and handle everyday tasks.

Linking Chronic Stress, Mood Disorders, and Cardiovascular Disease in Lupus 

Stress, mood disorders, and cardiovascular complications are closely linked in lupus patients.

Stress, Mood Disorders and Lupus

Understandably, stress is another common complaint among lupus patients. 

Stress and mood disorders are common in lupus patients and both can have serious effects on both mental and physical health. Chronic stress and mood disorders like depression can worsen lupus flares and increase the risk of cardiovascular disease. 

This creates a harmful cycle where stress aggravates lupus, leading to more flares, which in turn worsens mental health.

This negative relationship between chronic stress and mood disorders in lupus patients can compound the risk of developing serious complications, especially cardiovascular disease. 

How Stress and Mood Disorders Increase Cardiovascular Risk in Lupus

The unpredictability of lupus flares, frequent medical appointments, and concerns about long-term health lead to emotional stress that can trigger physical symptoms.

Both stress and depression are closely linked to a higher risk of cardiovascular disease (CVD) in lupus patients; cardiovascular disease is a major cause of illness and death in lupus patients. 

Chronic inflammation from lupus speeds up the development of atherosclerosis, increasing the likelihood of heart problems. Depression further contributes by accelerating the thickening of artery walls. Stress, meanwhile, increases fatigue, inflammation, and flares, further escalating cardiovascular risk.

Managing stress and mood disorders in lupus is essential to reduce the risk of both heart disease and lupus-related complications. Identifying lupus patients who experience high stress or depression is the first step toward improving their overall health.

How Lupus Affects Mental Health

The chronic inflammatory process in lupus affects the brain and nervous system, causing symptoms of neuropsychiatric lupus.

Inflammation and Neuropsychiatric Lupus

Lupus can cause inflammation not only in the body but also in the brain, leading to neuropsychiatric symptoms, called neuropsychiatric lupus (NPSLE). 

NPSLE is caused by a combination of factors like autoantibody-related brain damage, blood vessel issues, inflammation from cytokines, and a weakened blood-brain barrier. Autoantibodies can cross the compromised blood-brain barrier, leading to neuron damage and symptoms like cognitive dysfunction and psychosis. 

Damage to blood vessels, often linked to antiphospholipid antibodies, can result in strokes and seizures. Elevated levels of cytokines increase inflammation, and the damaged blood-brain barrier allows these harmful antibodies to enter the brain, causing various neuropsychiatric symptoms.

Impact of Lupus Medication on Mental Health

Certain cornerstone lupus treatments can also affect mental health. For example, corticosteroids, even at low doses, are associated with worsened emotional health in lupus patients, especially increased feelings of anxiety and depression, and even psychosis.

High doses of corticosteroids (beginning at 7.5 mg/day), commonly prescribed during lupus flare-ups, have been linked to mood swings, anxiety, and even steroid-induced psychosis.

Hydroxychloroquine, another cornerstone treatment for lupus, reduces disease activity and lowers the risk of lupus flares, while also being associated with fewer serious side effects compared to corticosteroids. 

Immunosuppressant drugs are less likely to cause mood disorders than corticosteroids and are effective in reducing lupus activity. 

Biologic agents are a type of medication also considered in lupus therapy. Belimumab is approved for SLE although there is a noted risk of depression associated with belimumab, which is a concern for lupus patients with pre-existing mood disorders. 

Anifrolumab is another biologic that helps reduce glucocorticoid usage but does not have the same noted risk of mood-related side effects.

Managing mood-based side effects through careful medication adjustments and monitoring is necessary for maintaining both physical and emotional well-being.

Coping Strategies for Lupus-Related Mental Health Issues

Once mood disorders are identified, the proper treatment plan can be created to help lupus patients feel better. 

Medical Interventions

For many lupus patients, addressing mental health issues involves seeking medical interventions such as therapy, counseling, or pharmaceutical support. 

Cognitive-behavioral therapy (CBT), which helps patients reframe negative thoughts and develop healthier coping strategies, has proven particularly beneficial for people with chronic illnesses like lupus as well as for depression.

In some cases, pharmaceuticals like antidepressants or anti-anxiety medication may be needed to manage mood symptoms. These medications can improve mood, energy levels, and overall emotional balance, allowing patients to better manage their condition. 

It’s important to work closely with healthcare providers to find the right combination of treatments.

Self-Care Techniques

Self-care is a critical part of managing lupus and its emotional impact. Simple practices like mindfulness, meditation, and deep breathing exercises can help reduce stress and anxiety, providing mental clarity and emotional calm. 

Journaling is another powerful tool for managing emotions, helping patients express their feelings and track their mental and physical symptoms over time. It may also uncover hidden patterns or thought processes that keep them stuck in the stress cycle. 

Physical activity, sleep, and nutrition also play a vital role in physical and emotional health. Regular exercise can boost mood by releasing endorphins, while maintaining a balanced diet rich in nutrients supports both physical and mental well-being. 

Adequate sleep is crucial for mood regulation and cognitive function, helping to manage “lupus fog” and other mental health symptoms.

Support Networks and Social Connections

Building a support network is essential for lupus patients. Friends, family, and support groups can provide much-needed emotional comfort and practical advice. 

Lupus support groups, whether online or in-person, provide patients a safe space to share their experiences and feel understood by others facing similar challenges.

It’s also important for patients to communicate openly with healthcare providers about their mental health concerns. Physicians and specialists can help guide them to appropriate resources, including mental health professionals, and ensure that mental well-being is considered as part of their overall treatment plan.

Addressing Mental Health as Part of Comprehensive Lupus Care

Given the many connections between lupus and mental health, mental health assessment and treatment should be standard components of routine lupus care. 

Integrating Mental Health Assessment and Treatment into Lupus Care

It’s well known that lupus can cause neuropsychiatric symptoms including depression, anxiety, cognitive dysfunction, and more serious mood disorders through various inflammatory mechanisms. 

Studies show that these neuropsychiatric manifestations not only impact quality of life but also contribute to the progression of disease, particularly in cardiovascular outcomes. 

By routinely screening for and addressing mental health concerns in lupus patients, healthcare providers can improve disease management, enhance quality of life, and potentially reduce disease-related complications. 

Advocacy for Holistic Care

Holistic care is essential in managing lupus due to its complex, multisystem nature. 

Effective treatment should go beyond controlling disease activity and inflammation to include mental health support, as lupus patients frequently experience depression, anxiety, and cognitive dysfunction, which can worsen disease outcomes, particularly cardiovascular health. 

Integrating mental health assessments and treatments can improve quality of life and reduce disease progression. 

Additionally, diet, lifestyle modifications, and stress reduction therapies, such as adopting an anti-inflammatory diet, engaging in regular physical activity, and practicing stress management techniques like meditation, may help reduce symptom flare-ups and support overall wellness. 

By addressing both physical and emotional health, holistic care empowers lupus patients to manage their condition more effectively.

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Key Takeaways

• Lupus and Mental Health: lupus frequently causes neuropsychiatric symptoms such as anxiety, depression, and cognitive issues (like "lupus fog"). These mental health challenges are closely linked to disease activity and can significantly affect patients' quality of life.

• Chronic Stress and Cardiovascular Risk: chronic stress and mood disorders, common in lupus patients, can worsen disease flares and increase the risk of cardiovascular complications. Stress and depression drive inflammation, which accelerates the development of heart disease in lupus patients.

• Holistic Care for Lupus: a comprehensive approach to lupus treatment should include mental health support, lifestyle modifications, and stress management. Integrating strategies like cognitive-behavioral therapy, medication adjustments, and self-care practices can help improve both mental and physical outcomes in lupus patients.