Autoimmune Issues, & Mood Disorders
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What are They
– More than 80 types of autoimmune diseases
– Rheumatoid Arthritis
– Lupus
– Inflammatory Bowel Disease
– Celiac Disease
– Type 1 Diabetes
– Psoriasis
– Graves Disease
– Multiple Sclerosis
What Are They
– Autoimmune Diseases
– The body’s immune system attacks healthy tissue
– Hallmark symptoms are systemic inflammation, fatigue and sometimes muscle aches and psychomotor retardation
– Fibromyalgia is NOT considered an autoimmune disease because it does not cause inflammation
– A main goal of treatment is to reduce inflammation
– Some microorganisms, such as bacteria or viruses, or drugs may trigger the change, especially in people whose genes make them more susceptible to autoimmune disorders
– Far more common in females
– Characterized by flare-ups and remissions
Mood Disorders and Autoimmune Diseases
• Overlapping/concurrent symptoms
• Fatigue
• Increased pain
• Sleep changes
• Psychomotor retardation
• Guilt
• Depression/Anhedonia
Mood Disorders and Autoimmune Diseases
• Identified Relationships
• Significant infection in people with autoimmune disease may cause mood disorders.
• Mood disorders may create a vulnerability to infection and autoimmune disease.
• Mood disorders, ineffective immune response (reduced cytotoxic (killer) T cell and T Helper cells response) leading to severe infection, and autoimmune disorders may share common triggers.
• Depression and anxiety can be related to autoimmune issues either because of a biological and cytokine-related mechanism or because of the psychological impact of the disorder
• 90% of patients with RA reported fatigue as the main factor causing low mood and depression
Mood Disorders and Inflammation
– During autoimmune disease flare-ups, cytokines circulate in the blood, reach the brain and cause depression, anxiety, anhedonia, social withdrawal, fatigue, and sleep disturbances
– Likewise, Depression, Anxiety and “Stress” can trigger autoimmune flare-ups
– Chronic inflammation also impairs the physiological responses to stress including effective coping behaviors, resulting in depression, leading to a poorer prognosis in autoimmune issues
Other Commonalities
– Association between vitamin D deficiency and cancer, cardiovascular disease, diabetes, autoimmune diseases, and depression
– The gut microbiota is involved in many basic biological processes including stimulation of innate immunity
– People’s genes and lifestyle, foods and drugs consumed (from alcohol to antibiotics) have an impact on the microbiota, which affects physiological systems like the immune system and endocrine system
Other Commonalities
– Lack of microbiota diversity
– leads to many diseases like autoimmune diseases and development of problems such as memory disorders, depression, stress, autism, and Alzheimer's disease (gut-brain axis)
– In the intestine, there is synergy between mucus, the microbiome and immune cells which plays an important role in preventing pathogens from crossing into the bloodstream and stimulating inflammation
Medications for Autoimmune Disorders
– Anti-inflammatories
– Stomach pain
– Difficulty concentrating
– *Antidepressant
– Antidepressants
– Difficulty concentrating
– Fatigue
– Anxiety
– Restlessness
– Replacement of substances the body cannot make/regulate (thyroid hormones, insulin)
– Depression
– Fatigue
– Irritability
– Difficulty concentrating
– Anxiety
Medications for Autoimmune Disorders
– Immunosuppressants
– Well known for their neuropsychiatric side effects.
– Depression
– Fatigue/lethargy
– Agitation/restlessness
– Anxiety
– Insomnia
– Delirium (20-32%)
– Metabolized by cytochrome P4503A4 which is inhibited by many psychotropic medications
Interventions
– Reduce stress and depression to reduce HPA-Axis upregulation
– Distress tolerance
– Factual, likely, distortion free
– Psychological flexibility: Living in the AND
– Dialectics: What parts of the situation CAN you control
– Empowerment (monitoring, disease management)
– Reduce pain
– TENS
– Hot/Cold
– Guided Imagery (color, knob, destroyer, healer, alternate focus)
– Stretching
– Exercise
Interventions
– Social support
– Support groups
– Reduce isolation in those with limited mobility
– Lifestyle Management
– Noise
– Improve nutrition
– Reduce alcohol although light drinking may have some limited benefits
– Hydration to promote kidney and liver function
– Get enough sleep
– Exercise modulates gut microbiota, increases serotonin and impairs inflammatory signaling
– Maintain a healthy weight because obesity contributes to inflammation
– Ergonomics
Interventions
– Mental Health Issues
– Grief/Anger/Depression
– Write a new narrative
– Gratitude
– Positive journaling reduced depressive symptoms and anxiety after 1 month and greater resilience after the first and second month, relative to usual care.
– Guilt
– Anxiety
– Worsening (Health literacy, charting)
– Rejection
– Job Loss / Finances
– Self-Esteem
Summary
– Obesity, poor nutrition, stress, depression, poor sleep and other lifestyle factors can worsen autoimmune issues
– Autoimmune issues and treatments for them can contribute to neuropsychiatric symptoms.