Romatolojik Hastalıklar ve Depresyon

Öz

Romatolojik hastalıklarda klinik depresyon toplumda görülenin 2 katı oranında görülmektedir. Depresyon tanı kriterlerini karşılamayan psikolojik stresin varlığı ise daha fazla görülmektedir. Kanıtlar bu yüksek prevalansını çok faktörlü olduğunu göstermektedir. Hastalıkta gözlenen bedensel belirtilerin, fiziksel kısıtlılıkların, pro-inflamatuar sitokinlerin, hastalığın tahmin edilemez ve kontrol edilemez seyrine karşı ortaya çıkan çaresizliğin ve kronik bir hastalığa sahip olmanın getirdiği diğer faktörlerin depresyonla ilişkili olduğunu göstermiştir. Romatoid artrit, fibromiyalji, sistemik lupus eritetamatosus, Behçet hastalığı ve osteoartrit gibi romatolojik hastalıklarının tümünde yüksek depresyon oranları gözlenmiştir. Depresyon düşük sosyal işlevselliği ve tedavi yanıtına hatta intihara neden olması sebebi ile tüm bu hastalıklarda önemli bir faktördür. Bu derlemde, romatolojik hastalıklarda depresyon prevalansı, tanı ölçütleri ve depresyonla ilişkili faktörlerin gözden geçirilmesi amaçlanmıştır.

Anahtar Kelimeler

• Romatolojik hastalıklar, depresyon, fibromiyalji

Rheumatic Diseases and Depression

Öz

The prevalence of clinical depression in rheumatic diseases is about twice the prevalence seen in the general population. At a milder level, the occurrence of psychological distress that does not fulfil diagnostic criteria of depression is even higher. Evidence indicates that this high prevalence is multifactorial. Correlational studies suggest that possible factors for depression include the suffering accompanying somatic symptoms, functional limitations, pro-inflammatory cytokines, helplessness due to the uncontrollable, unpredictable and progressive nature of the disease, and other factors associated with having a chronic disease Higher prevalence of depression was found in rheumatic diseases like rheumatoid arthritis, fibromyalgia, systemic lupus erythematosus, Behcet's disease and osteoarthritis. Depression is an important factor in all of these disorders because it leads low social functioning, treatment response and even suicide. This article reviews the prevalence and diagnosis of depression and related factors in rheumatic diseases.

Anahtar Kelimeler

• Rheumatic disease, depression, fibromyalgia

Kaynakça

1. Michaud CM, Murray MC, Bloom BR. Burden of disease: Implications for future research. JAMA 2001; 285:535–539.
2. Uluşahin A. Depresyona genel yaklaşım. Türkiye Tıp Dergisi. 2003; 10:79-88.
3. Rihmer Z, Angst J. Mood disorders: epidemiology. In Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 7th Edition (Eds BJ Sadock, VA Sadock):447-459. Philadelphia, Lippincott Williams & Wilkins, 2005.
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Washington, DC , American Psychiatric Publishing, 2013.
5. Patten SB. Long-term medical conditions and major depression in a Canadian population study at waves 1 and 2. J Affect Disord 2001; 63:35-41.
6. Smit F, Beekman A, Cuijpers P, de Graaf R, Vollebergh W. Selecting 5. key variables for depression prevention: results from a population-based prospective epidemiological study. J Affect Disord 2004; 81:241-249.
7. Goldberg D, The detection and treatment of depression in the physically ill. World Psychiatry 2010; 9:16-20.
8. Dworkin S, von Korff M, LeResche L. Multiple pains, psychiatric and psychosocial disturbance: an epidemiologic association. Arch Gen Psychiatry 1990; 47:1025-1037.

9. Rittner HL, Brack A, Stein C. Pro-algesic and analgesic actions of immune cells. Curr Opin Anaesthesiol 2003; 16:527-533.
10. Çakır S. Genel tıpta depresyon. Klinik Gelişim Psikiyatri 2009; 22:61-64.
11. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a metaanalysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J 2006;27: 2763-2774.
12. Larson SL, Owens PL, Ford D, Eaton W. Depressive disorder, dysthymic disorder and risk of stroke. 13 year follow up study from Baltimore ECA study. Stroke 2001; 32:1979-1983.
13. Boztaş HM, Arısoy Ö. Tıbbi hastalıklarda depresyon: tanısal sorunlar. Psikiyatride Güncel Yaklaşımlar 2010; 2:318-332.
14. Sertöz ÖÖ, Mete HE. Bedensel hastalıklarda depresyon. Klinik Psikiyatri Dergisi 2004; 7(Ek 2):63-69
15. Egede LE. Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. Gen Hosp Psychiatry 2007; 29:409-416
16. Oğuzhanoğlu NK. Tıbbi durumlar ve depresyon. Duygudurum Dizgisi 2001; 3:116-125
17. Mann JJ. A current perspective of suicide and attempted suicide. Ann Intern Med 2002; 136:302-311
18. Öykeçin DG, Şahin EM. Ayaktan takibi yapılan psikiyatrik hastalarda intihar düşünce ve davranışları. Nobel Medical Journal 2013; 9:61-66.
19. Rossau CD, Mortensen PB. Risk factors for suicide in patients with schizophrenia: nested case-control study. Br J Psychiatry 1997; 171:355-359.
20. Rouchell AM, Pounds R, Tierney JG Depression. In Textbook of Consultation-Liaison Psychiatry (Eds MG Wise, JR Rundell):307-338. Washington DC, American Psychiatric Publishing, 2002.
21. Ekici G, Savaş HA, Çıtak S. Tamamlanmış intiharlarda iki önemli risk etmeni: fiziksel hastalığın varlığı ve yetersiz dozda psikiyatrik tedavi. Klinik Psikofarmakoloji Bülteni 2001; 11:168-173.
22. Grabovich A, Lu N, Tang W, Tu X, Lyness JM. Outcomes of subsyndromal depression in older primary care patients. Am J Geriatr Psychiatry 2010; 18:227-235.
23. Merskey H. The taxonomy of pain. Med Clin North Am 2007; 91:13-20.
24. Gonzales VA, Martelli MF, Baker JM. Psychological assessment of persons with chronic pain. NeuroRehabilitation 2000; 14:69-83.
25. Bair MJ, Robinson RL, Katon W. Depression and pain comorbidity: a literature review. Arch Intern Med 2003; 163:2433-45 Greist JH, Jefferson JW, Trivedi MH. Depression and pain. J Clin Psychiatry 2008; 69:1970-1978.
26. Tütüncü R, Günay H. Kronik ağrı, psikolojik etmenler ve depresyon. Dicle Tıp Dergisi 2011; 38:258-263.
27. Waheed A, Hameed K, Khan AM, Syed JA, Mirza AI. The burden of anxiety and depression among patients with chronic rheumatologic disorders at a tertiary care hospital clinic in Karachi, Pakistan. J Pak Med Assoc. 2006; 56:243–247.
28. O’Dell JR. Rheumatoid arthritis: the clinical Picture. In Arthritis and Allied Conditions (Ed WJ Koopman):1157-1186. Philadelphia: Lippincott Williams & Wilkins, 2001.
29. Matcham F, Rayner L Steer S, Hotopf M.The prevalence of depression in rheumatoid arthritis:a systematic review and meta-analysis Rheumatology 2013; 52:2136-2148.
30. Altan L, Bingöl Ü, Sağırkaya Z, Sarandöl A, Yurtkuran M. Romatoid artritli hastalarda anksiyete ve depresyon. Romatizma 2004; 19:7-12.
31. Murphy H, Dickens C, Creed F, Bernstein R.. Depression, illness perception and coping in rheumatoid arthritis. J Psychosom Res 1999; 46:155-164.
32. Kim HA, Jeon JY, Koh BR, Park SB, Suh CH. Salivary cortisol levels, but not salivary α-amylase levels, are elevated in patients with rheumatoid arthritis irrespective of depression. Int J Rheum Dis. 2013; doi:10.1111/1756-185X.12224.
33. Pinho de Oliveira Ribeiro N, Rafael de Mello Schier A, Ornelas AC, Pinho de Oliveira CM, Nardi AE, Silva AC.. Anxiety, depression and suicidal ideation in patients with rheumatoid arthritis in use of methotrexate, hydroxychloroquine, leflunomide and biological drugs. Compr Psychiatry 2013; 54:1185-1189.
34. Abdel-Nasser AM, Abd El-Azim S, Taal E, El-Badawy SA, Rasker JJ, Valkenburg HA. Depression and depressive symptoms in rheumatoid arthritis patients: an analysis of their occurrence and determinants. Br J Rheumatol 1998; 37:391-397.
35. Mella LF, Bértolo MB, Dalgalarrondo P. Depressive symptoms in rheumatoid arthritis. Rev Bras Psiquiatr 2010; 32:257-263. Stebbings S, Herbison P, Doyle TC, Treharne GJ, Highton J. A comparison of fatigue correlates in rheumatoid arthritis and osteoarthritis: disparity in associations with disability, anxiety and sleep disturbance. Rheumatology (Oxford) 2010; 49:361-367.
36. Scheidt CE, Mueller-Becsangèle J, Hiller K, Hartmann A, Goldacker S, Vaith P et al. Self-reported symptoms of pain and depression in primary fibromyalgia syndrome and rheumatoid arthritis. Nord J Psychiatry 2014; 68:88-92.
37. Ulus Y, Akyol Y, Tander B, Durmus D, Bilgici A, Kuru O. Sleep quality in fibromyalgia and rheumatoid arthritis: associations with pain, fatigue, depression, and disease activity. Clin Exp Rheumatol 2011; 29(6 Suppl 69):92-96.
38. Kapoor SR, Hider SL, Brownfield A, Mattey DL, Packham JC. Fibromyalgia in patients with rheumatoid arthritis: driven by depression or joint damage? Clin Exp Rheumatol 2011; 29(6 Suppl 69):88-91.
39. Şengül CB, Ateş A, Şengül C, Okay T, Dilbaz N, Karaaslan Y. Fibromiyalji ve romatoid artritli hastalarda anksiyete, depresyon, aleksitimi ve disosiyasyon seviyeleri ve bu parametrelerin hastalık şiddeti ile ilişkisi. Türkiye’de Psikiyatri 2008; 10:104-108.
40. Ataoğlu S, Özçetin A, Ataoğlu A, İçmeli C, Makarç S, Yağlı MT. Fibromyaljili ve romatoid artritli hastalarda ağrı şiddeti ile anksiyete ve depresyon ilişkisi. Anadolu Psikiyatri Dergisi 2002; 3:223-226.
41. Nordahl HM, Stiles TC. Personality styles in patients with fibromyalgia, major depression and healthy controls. Ann Gen Psychiatry 2007; 9:6-9.
42. Soran N, Altındağ Ö, Demirkol A. Fibromiyalji sendromunda depresyon düzeyi ve klinik parametrelerle ilişkisi. Romatizma 2008; 23:1-4.
43. Dunne FJ, Dunne CA. Fibromyalgia syndrome and depression: common pathways. Br J Hosp Med (Lond) 2012; 73:211-217. Hudson JI, Hudson MS, Pliner LF. Fibromyalgia and major affective disorder: a controlled phenomenology and family history study. Am J Psychiatry 1985; 142:441-446.
44. Doğan O, Hizmetli S. Fibromyozitisli hastalarda depresyon ve anksiyete düzeyleri. Fizik Tedavi ve Rehabilitasyon Dergisi 1990; 16:6-8.
45. Altunören Ö, Orhan ÖF, Nacitarhan V, Özer A, Karaarslan MF. Fibromiyalji sendromlu kadınların depresyon ve mizaç karakter özellikleri açısından değerlendirilmesi. Nöropsikiyatri Arşivi 2011; 48:31-38.
46. Ozcetin A, Ataoglu S, Kocer E, Yazici S, Yildiz O, Ataoglul A et al. Effects of depression and anxiety on quality of life of patients with rheumatoid arthritis, knee osteoarthritis and fibromyalgia syndrome. West Indian Med J 2007; 56:122–129. Evren B, Evren C, Yapıcı A, Güler MH. Fibromiyalji hastalarında ağrı şiddeti ile psikiyatrik belirtiler arasındaki ilişki. Anadolu Psikiyatri Dergisi 2005; 6:69–74.
47. Kozora E, Thompson LL,West SG, Kotzin BL. Analysis of cognitive and psychological deficit in systemic lupus erythematosus patients without over central nervous system disease.Arthritis Rheum 1996; 39:2035-2045.
48. West GS, Emlen W, Wener MH, Kotzin BL. Neuropsychiatric lupus erythematosus: a 10 year prospective study on the value of diagnostic tests. Am J Med 1995; 99:153-163.
49. Erimoğlu N, Serim B. Çocuk ve ergenlerde sistemik lupus eritematosus’un nöropsikiyatrik görünümleri. Nöropsikiyatri Arşivi 2008; 45:92-96.
50. Özen Ş, Özbulut Ö, Sarı Y, Işıkdoğan A, Yücel Y, Başak F. Sistemik lupus eritematosus’dan kaynaklanan kısa psikotik bozukluk: iki olgu nedeniyle. Klinik Psikofarmakoloji Bülteni 1999; 9:159-166.
51. Abdelraheem T, Habib HM, Eissa AA, Radwan NM. Psychiatric disorders and MRI brain findings in patients with systemic lupus erythematosus and Behcet's disease: a cross sectional study. Acta Rheumatol Port 2013; 38:252-260. van Exel E, Jacobs J, Korswagen LA, Voskuyl A, Stek M, Dekker J et al. Depression in systemic lupus erythematosus, dependent on or independent of severity of disease. Lupus 2013; 22:1462-1469.
52. Mok CC, Chan KL, Cheung EF, Yip PS. Suicidal ideation in patients with systemic lupus erythematosus: incidence and risk factors. Rheumatology (Oxford) 2014; 53:714-721.
53. Yazici Y, Yurdakul S, Yazici H. Behcet’s syndrome. Curr Rheumatol Rep 2010; 12:426–435.
54. Aslan H, Soylu BM, Alparslan N, Ünal M. Behçet hastalığında psikososyal etkenler ve ruhsal bulgular. Turk Psikiyatri Derg 1996; 7:215-221.
55. Taner E, Cosar B, Burhanoglu S, Calikoglu E, Onder M, Arikan Z. Depression and anxiety in patients with Behçet’s disease comparedwith that in patients with psoriasis. Int J Dermatology 2007; 46:1118-1126.
56. Çalıkoğlu E, Önder M, Coşar B, Candansayar S Depression, anxiety levels and general psychological profile in Behcet’s disease. Dermatology 2001; 203:238-240.
57. Yetkin DO, Çelik O,Hatemi G, Kadıoğlu P. Sexual dysfunction and depression in premenopausal women with mucocutaneous Behcet’s disease. Int J Rheum Dis 2013; 16:463–468.
58. Clare J, Jordan K, Croft P. Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain 2002; 100:55-64.
59. Uğurlu N, Karakuş A, Işıkay Ç. Diz Osteoartritli Hastalarda ağrı seviyeleri ile depresyon düzeyleri arasındaki ilişkinin değerlendirilmesi. İstanbul Üniversitesi Florence Nightingale Hemşirelik Yüksek Okulu Dergisi 2007; 15:129-138.
60. Çetin N, Öztop P, Bayramoğlu M, Saraçgil SN, Özçürümez G. Diz Osteoartritli hastalarda ağrı, özürlülük ve depresyon arasındaki ilişki. Turk J Rheumatol 2009; 24:196-201.
61. M.Esenyel, G.Walden, N.Çağlar, S.Tetik, N.Özaras, Farklı etiyolojilere bağlı kronik ağrıda ağrıyla ilişkili sakatlık ve depresyon. Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi 2003; 49,8-12
62. Hedayati SS, Yalamanchili V, Finkelstein FO. A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease. Kidney Int 2012; 81:247-255.
63. Friedberg F, Williams DA, Collinge W. Lifestyle-oriented non-pharmacological treatments for fibromyalgia: a clinical overview and applications with home-based technologies. J Pain Res 2012; 5:425-435.
64. Bryson HM, Wilde MI. Amitriptyline. A review of its pharmacological properties and therapeutic use in chronic pain states. Drugs Aging 1996; 8:459-476.
65. Slaughter JR, Parker JC, Martens MP, Smarr KL, Hewett JE. Clinical outcomes following a trial of sertraline in rheumatoid arthritis. Psychosomatics 2002; 43:36-41.
66. Grothe DR, Scheckner B, Albano D. Treatment of pain syndromes with venlafaxine. Pharmacotherapy 2004; 24:621-629.
67. Skljarevski V, Zhang S, Iyengar S, D'Souza D, Alaka K, Chappell A, Wernicke J. Efficacy of duloxetine in patients with chronic pain conditions. Curr Drug Ther 2011; 6:296-303.
68. Calandre EP, Rico-Villademoros F. The role of antipsychotics in the management of fibromyalgia. CNS Drugs 2012; 26:1351
69. Calandre EP, Morillas-Arques P, Molina-Barea R, Rodriguez-Lopez CM, Rico-Villademoros F. Trazodone plus pregabalin combination in the treatment of fibromyalgia: a two-phase, 24-week, open-label uncontrolled study. BMC Musculoskelet Disord. 2011; 12:95.
70. Moore RA, Wiffen PJ, Derry S, McQuay HJ. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2011; 16:CD007938.
71. Ceyhan Balcı Şengül, Yrd.Doç.Dr., Pamukkale Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı, Denizli; Nuray Akkaya, Yrd.Doç.Dr., Pamukkale Üniversitesi Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Denizli Yazışma Adresi/Correspondence: Ceyhan Balcı Şengül, Pamukkale Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı, Denizli, Turkey. E-mail: [e-mail] Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemiştir. The authors reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol6/no4/ Çevrimiçi yayım / Published online 25 Ocak/January 25, 2014; doi: 10.5455/cap.20140125111548