To curb depression in SLE, a little exercise goes a long way
BY JENNIFER LUBELL
Small increases in physical activity can reduce the risk of developing depression among patients with systemic lupus erythematosus (SLE). A recent study found a strong association between sedentary lifestyles and incident depression among SLE patients, signaling a need to promote exercise as an intervention. |
This isn’t about setting rigorous exercise goals, but realistic expectations, Sarah Patterson, MD, the study’s lead author, said in an interview. A little goes a long way, as one of her young patients discovered. The patient was struggling with situational anxiety following an SLE diagnosis. “We discussed a lot of different treatment approaches, and she had a strong preference for avoiding medication. We thought she could start with increasing physical activity, since she was living a mostly sedentary lifestyle,” said Dr. Patterson, an instructor in the division of rheumatology at the University of California, San Francisco. Her intervention was a walking program: 5 days a week with her mother. After just 6 weeks, the patient’s mood improved significantly. “Her Patient Health Questionnaire [PHQ-8] scores no longer met criteria for depression,” Dr. Patterson said. |
![]() Dr. Sarah Patterson |
Lifetime prevalence of depression in SLE is very high, averaging 40%-50% in U.S. patients, compared with 17% in the general population, wrote Dr. Patterson, Patricia Katz, MD, the study’s senior author, and colleagues in Arthritis Care & Research. The reasons are multifactorial: the disease’s impact on function and lifestyle, an increased risk of disability and unemployment, and possibly some biological mechanisms, Dr. Patterson said. Having a proinflammatory condition may predispose SLE patients to incident depression. Previous research has shown that exercise can improve mood, but this was the first study to show an association between sedentary lifestyles and greater risk of incident depression in SLE patients. |
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Depression ‘can be multifactorial’ Given how often depression presents in SLE patients, physical activity is one viable strategy to mitigate its effects, said Rosalind Ramsey-Goldman, MD, DrPH, the Solovy/Arthritis Research Society research professor at Northwestern University, Chicago, who was not affiliated with the study. Depression, however, can be multifactorial, Dr. Ramsey-Goldman noted. Although the study’s investigators evaluated other possibilities, “they were constrained by what was available in the dataset used in this study.” They based their results on just a small number of individuals (n = 41) who did not have depression in the initial patient-reported survey (although approximately 25% reported a history of depression prior to the baseline visit) and identified as inactive. Additionally, the methods investigators used didn’t distinguish between recurring or new-onset depression. “This possible relationship was not discussed and raises concern about the strength of the relationship reported in this study,” she offered. |
![]() Dr. Rosalind Ramsey-Goldman |
Focusing solely on physical activity could potentially miss other useful, concomitant treatments for depression, she continued. “For example, diet, sleep interference or disturbance, pain, psychotherapy or other modalities can contribute to depression. When one has a chronic illness that frequently requires multiple medications, many with side effects, and other lifestyle complaints, it may be difficult to become more physically active when you just do not feel well. Thus, a comprehensive and individualized approach may be another strategy to help these patients,” Dr. Ramsey-Goldman recommended. Nevertheless, the screening tools in the study by Dr. Patterson and colleagues could help identify patients who may need additional services for optimizing their health, either in a busy clinic setting or for large research studies, she suggested. Impact of exercise on RA patientsIn future research, Dr. Patterson hopes to explore how physical activity affects biological and inflammatory pathways in people with autoimmune conditions such as lupus and RA. “I’m currently working on a study to evaluate gene expression profiles from blood samples of RA patients. We are using this approach to determine whether there are differences in inflammatory signaling in RA patients who are active versus inactive, and plan to apply similar methods to investigate the biological effects of physical activity in people with lupus.”Dr. Patterson and coauthors had no financial disclosures. Dr. Ramsey-Goldman is leading a clinical trial on two different coaching approaches for helping lupus patients deal with lifestyle-related complaints. A control group will receive phone calls relating to SLE self-management education, whereas an intervention group will receive coaching on physical activity and nutrition. |