Real Talk: Depression, Autoimmune Disease, and Infection

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It’s no mystery that individuals with chronic diseases are at higher risk for depression. Who’s mood doesn’t drop when confined to a bed or coughing up a lung?

Battling my autoimmune condition is also battling my mood. My mood is intrinsically (and maybe biologically) linked to the flares of my Rheumatoid Arthritis. I once read a meme that said something like, half of the time I’m trying to convince others of my autoimmune condition and the other half of the time I’m pretending like it doesn’t exist. It’s like this: on one hand, people tend to think I look young and healthy, like I don’t have serious health problems, when in fact I do. On the other hand, I’m trying to look (and feel!) young and healthy, like I don’t have serious health problems, even though I do.

Today I feel the tension and frustration acutely. I've been confined to a bed for most of the past forty-eight hours, except for an urgent care visit. In a lot of ways, the pattern of my viral infection is like other people’s viral infections. I’m needy for rest, feverish for eighteen hours, coughing up phlegm, binging on Netflix without satisfaction, and wanting to feel better as soon as possible. In other ways, the simple viral infection is not so simple for me. 

My lungs are inflamed but the doctor can’t prescribe steroids to open my airways. Because I’m already on long-term steroids. 

My cough is wicked but I can only take the most basic expectorant. Because my liver is sensitive and already inflamed. Heck, I’m not even supposed to use Tylenol.

Sometimes I’m wheezy but I can only use the prescribed inhaler in emergencies. Because it will cause elevated heart rate or palpitations.

Geez, Louise. Even the doctors don’t know what to do with me. Now I know it could be a lot worse, and I know it’s not the end of the world. But see how a simple viral infection can become incredibly frustrating for a girl with an autoimmune condition?

Research shows that depression is more common for those with autoimmune conditions. A recent study published in JAMA Psychiatry explains that both autoimmune conditions and infections suggest a higher risk for mood disorders. And when the individual experienced an autoimmune condition and infection together, the risk was even higher, “indicating the presence of a synergistic effect” of the combined exposures. Some researchers think inflammation from autoimmune and infectious processes is the cause. While most of the complex science is beyond my understanding, one thing does seem clear: I’m not crazy and I’m not alone. 

Dr. Michael C. Miller of JAMA Pyschiatry’s editorial board and Harvard Medical School put it simply: “both infections and mood disorders are very common, making it difficult to tease out what causes what.” The Harvard Health Blog lists three different possibilities for the strong correlations:

• Severe infection and autoimmune disease may cause mood disorders.
• Mood disorders may create a susceptibility to infection or autoimmune disease.
• Mood disorders, severe infection, and autoimmune disorders may share common triggers.
 - Patrick J. Skerrett, Former Executive Editor, Harvard Health

The last point about common triggers interests me most. Why? Because these triggers are manageable with a healthy lifestyle. Triggers like stress, food intake, hydration, sleep, and exercise can be difficult especially during illness. But to say they are out of our control simply isn’t true. In fact, I’m the only person who can change any of these areas of my life. Because at the end of the day I decide what I put into my body, how I treat myself, and how I nourish my mind.

As frustrating as it seems to be, I find the process teaches me more about myself and expands my ability to love.

It expands my ability to love others through frustrating circumstances. And it expands my ability to love myself, even when I feel weak, insufficient, and foggy-minded from a virus. I learn that strength takes different forms, and it’s not always a difficult yoga pose. Sometimes strength is the willpower to drink as much Pedialyte as I can. To put myself on the bench for three days. Or to wait patiently for the brain fog to clear. My favorite sick-day yoga practice states it beautifully, to be

as curious, as compassionate, and as objective about the experience being your body as a you can be.
— Jason Crandell

Showing up doesn’t always mean giving 110% to every activity. Some days it means giving a fraction of what’s left in the tank, so my body can multiply the rest for better use tomorrow.