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The Depression-Knee Pain Connection

By

Linda Wasmer Andrews

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This content is created or selected by the Healthgrades editorial team and is funded by an advertising sponsor. The content is subject to the Healthgrades medical review process for accuracy, balance and objectivity. The content is not edited or otherwise influenced by the advertisers appearing on this page except with the possible suggestion of the broad topic area. For more information, read the HealthGrades advertising policy.

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The Knee Pain Diaries

Watch personal stories of how people cope with the pain of knee arthritis.
Depression

Osteoarthritis (OA) of the knee is painful enough on its own. When you add depression, that can make the pain even worse. Here’s what you need to know about the link between OA knee pain and depression—two very common, and fortunately very treatable, conditions.

Depression May Worsen Osteoarthritis Pain

OA of the knee can cause joint pain, swelling and stiffness. As it worsens, it may begin to interfere with everyday activities like walking, climbing stairs, and getting out of chairs. And depression seems to magnify the pain and disability.

Research has shown that people with both OA and depression are more likely than those who have OA to have trouble with daily activities at home and work. They’re also apt to view themselves as less healthy overall. Scientists are still sorting out the reasons for this, but multiple factors may be involved:

  • Did you know depression can sap your energy and motivation? That makes it harder to take care of yourself and stick with your OA treatment.

  • Depression itself can cause aches and pains as a symptom. This may be because people with depression tend to have above-normal levels of cytokines—immune system proteins that promote inflammation.

  • Another common symptom of depression is trouble sleeping. Lack of sleep can make it more difficult to manage pain.

OA Pain May Trigger Depression

Studies show that depression is more common in people with OA than in the general population. In one study, CDC researchers found that nearly 18% of U.S. adults with arthritis also had depression.

Researchers believe that the relationship between depression and OA is a two-way street. While depression may worsen OA symptoms, OA may cause or worsen depression, too. One explanation: OA can be stressful if it causes chronic pain or problems. For some people, this stress may trigger a bout of depression.

Watch for Warning Signs

If you have knee OA, be sure you know how to recognize the warning signs for depression. Possible symptoms include:

  • Feelings of worthlessness

  • Irritability or restlessness

  • Lack of energy and tiredness

  • Long-lasting feelings of sadness, emptiness or hopelessness

  • Loss of appetite or overeating

  • Loss of interest in things you once enjoyed

  • Sleeping too little or too much

  • Trouble concentrating or making decisions

  • Unexplained aches, pains, or digestive problems

If you recognize these symptoms in yourself, talk with your doctor or a mental health professional. If you have thoughts of suicide, get help immediately. Call your doctor or therapist, go to the emergency room, or call the  National Suicide Prevention Lifeline at  800-273-TALK (800-273-8255).

Fight Pain and Depression

When you have depression and knee OA, it’s important to take care of both.

Treatments for OA may include medications, exercise, weight loss, braces, heat or cold, transcutaneous electrical nerve stimulation (TENS), and other approaches. Surgery may also be an option. With the right combination of treatments, you can greatly reduce the pain and stress of OA, and that can give your mood a lift.

Of course, depression needs attention, too. The sooner treatment for depression is started, the more effective it’s likely to be.

The good news is that some of the leading depression treatments also help control pain by reversing abnormal pain-signaling:

  • Cognitive-behavioral therapy is a proven treatment for depression. This form of psychotherapy teaches people strategies to manage and overcome unhealthy thoughts and behaviors. It can also teach skills for coping with chronic pain.

  • Many antidepressant drugs have both mood-boosting and pain-relieving effects.

  • Physical exercise is another effective mood booster. If you have knee OA, weight reduction can relieve joint discomfort. Exercise can also enhance your ability to manage pain and carry out your daily activities.

In the CDC study, only about half of arthritis patients who also had depression or anxiety sought help for their mental health condition. Choose to be in that group. By getting help for your emotional pain, you might find that you can reduce your knee pain, too. 

Key Takeaways

  • Osteoarthritis (OA) of the knee is linked with depression.

  • Depression magnifies the pain and disability of OA, while OA pain can sometimes trigger depression.

  • It’s important to recognize the symptoms of depression and seek medical help. Treatment is available for both depression and OA, and some treatments can even help both at once.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Aug 3, 2016

© 2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

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Medical References

  1. Kim KW, et al. Association between comorbid depression and osteoarthritis symptom severity in patients with knee osteoarthritis. J Bone Joint Surg Am. 2011 Mar 16;93(6):556-63. 
  2. Murphy LB, et al. Anxiety and depression among US adults with arthritis: prevalence and correlates. Arthritis Care and Research. 2012;64(7):968-76.
  3. Vitiello MV, et al. Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: the lifestyles randomized controlled trial. Journal of the American Geriatric Society. 2013;61(6):947-56.
  4. Agarwal P, et al. Depression treatment patterns among individuals with osteoarthritis: a cross sectional study. BMC Psychiatry. 2013;13(121).
  5. Parmelee PA, et al. The structure of affective symptomatology in older adults with osteoarthritis. International Journal of Geriatric Psychiatry. 2013;28(4):393-401.
  6. Depression Can Worsen Joint Pain. Arthritis Foundation. http://www.arthritis.org/living-with-arthritis/comorbidities/depression-and-arthritis/depression-knee-osteoarthritis-pain.php
  7. The Benefits of Physical Activity. Centers for Disease Control and Prevention. http://www.cdc.gov/physicalactivity/everyone/health/index.html
  8. Handout on Health: Osteoarthritis. National Institutes of Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp
  9. Depression: What You Need to Know. National Institutes of Health. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know-12-2015/index.shtml

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