July 20, 2023 – Gout and Depression: Examining the Link
Gout, a form of arthritis, is known for causing severe pain, redness, and swelling in the joints and extremities. If left untreated, it can lead to various physical complications such as high blood pressure, heart attacks, diabetes, kidney problems, and obesity. However, recent research from the University of British Columbia has shed light on another challenging health issue associated with gout: depression.
In a study comprising 157,426 patients, researchers discovered a significant increase in the number of gout patients also diagnosed with depression. Out of every 1,000 person-years, approximately 13 patients had both gout and depression, compared to only 11 patients without gout but with depression. It is important to note that this number may actually be higher as men, who are more likely to have gout, are less likely to seek treatment for psychological symptoms and, hence, receive an official depression diagnosis.
Previous research by this team indicated that gout patients have a 29% higher risk of developing depression, based on the degree to which their condition is controlled. This is noteworthy because the psychological burden of intense physical pain should not be underestimated.
Multiple factors contribute to the connection between gout and depression. One hypothesis is that both conditions are linked to inflammation. Additionally, obesity and diet are shared risk factors in individuals with both gout and depression. Medications such as steroids, used to treat acute gout flares, can also contribute to or cause depressive symptoms.
The formation of uric acid crystals in the joints is a critical factor in understanding how gout develops. Uric acid, a waste product produced when the body breaks down purines, can lead to gout when it accumulates. Recent research from Korean scientists has explored how excessive uric acid levels in the blood can trigger low-grade inflammation.
Another potential link between gout and depression lies in the effect of high blood uric acid levels on brain neurotransmitters. This suggests a possible connection between gout and changes in mood associated with depression. However, it is essential to note that not all individuals with elevated uric acid levels develop gout, suggesting other shared genetic or metabolic associations between gout and depression.
Recognizing the Symptoms of Gout and Depression
Gout symptoms can include:
- Rapid onset of joint pain, commonly in the big toe but also in other joints
- Persistent pain that can last for days to weeks
- Restricted joint movement due to pain and swelling
Depression symptoms may include:
- Feelings of sadness, anxiety, hopelessness, or frustration
- Loss of interest in activities once enjoyed
- Fatigue, low energy, or slowed-down feeling
- Difficulty concentrating or remembering
- Changes in sleep, appetite, or weight
- Unexplained physical symptoms
- Suicidal thoughts
Effective Treatment Options
Regular doctor visits to monitor uric acid levels in the blood are beneficial for gout patients. The American Kidney Fund recommends maintaining uric acid levels below 6.0 milligrams per deciliter (mg/dl). Maintaining good kidney function is also essential, as increased urination during a gout flare can help eliminate excess uric acid.
In addition to managing uric acid levels, it is crucial for gout patients to stay vigilant about any changes in mood. If feelings of depression persist for more than two weeks or if thoughts of self-harm arise, patients should inform their doctor immediately.
Antidepressant medications can be prescribed alongside gout medication to improve quality of life. Adhering strictly to the prescribed gout medication regimen is crucial, as preventing gout flares may also reduce the incidence of depression episodes. Managing and addressing any cardiac risk factors is equally important.
Engaging in regular exercise, as recommended by a healthcare professional, limiting alcohol intake, and adopting a healthy diet can support heart health, prevent gout flares, and potentially address mood issues associated with gout. Processed foods, beer, and red meat have been identified as potential triggers for gout flares, reinforcing the significance of a balanced diet and overall healthy lifestyle.