People with rheumatoid arthritis are more likely to feel depressed than their peers. But you can keep a positive view by prioritizing activities you enjoy, getting enough sleep, and seeking therapy as needed.

Research suggests that nearly one in five people with rheumatoid arthritis also experience depression. Receiving a rheumatoid arthritis diagnosis can foster feelings of anger coupled with grief. And if you focus too much on what you may have to give up, it can cause more resentment and sadness. Fortunately, strategies such as seeking counseling, managing fatigue, improving sleep, and finding ways to continue enjoyable activities can all help you stay upbeat with rheumatoid arthritis.

Crystal Rivers, who lives in Tempe, Ariz., found out she had rheumatoid arthritis (RA) in 2012. When pain that began in one finger spread throughout both hands, she sought a diagnosis.

A yoga instructor for eight years, Rivers said she had worked hard to make healthy choices because autoimmune diseases, including rheumatoid arthritis, run in her family. So when, despite her healthy lifestyle choices, she was given the RA diagnosis, she went through a period of grief, anger, and denial. At first she kept teaching yoga and going about her busy life as a graduate student. When a severe flare restricted her mobility though, she had to give up her role in the yoga community she loved.

Rivers also faced the challenge of telling people about her RA. Though others might reach out immediately to their social circle, Rivers said she's basically a private person and needed to process her diagnosis and what it meant for her and her husband before she could tell anyone else. Friends and family were supportive when they found out, but she had to deal with some unexpected responses from colleagues who were less than supportive. Since then, she said, she's learned to distinguish between people who are unintentionally hurtful, but really want to learn more about RA, and those whose views are too rigid for conversation.

Acknowledging that everyone’s experience of rheumatoid arthritis is different is the best first step when talking to other people, Rivers said. Despite those obstacles, she remains hopeful. Alex Zautra, PhD, a professor of clinical psychology at Arizona State University in Tempe, said that's a common characteristic of people with RA: “They are among the most hopeful people I have seen."

RA: Positive Steps

Maintaining a sense of hopefulness and optimism can help when managing RA, Dr. Zautra said. When you're having a hard time maintaining that perspective because rheumatoid arthritis and depression seem overwhelming, try these strategies for staying positive:

Protect your pleasures. “Maintain pleasurable and valued activities,” said psychologist Thomas Harrell, PhD, a psychology professor and director of the Fatigue Management Institute at the School of Psychology at Florida Tech in Melbourne. “There’s a tendency to do what has to be done, and give up the valued activities that make life worthwhile.” If you’re tempted to cut back on fun so you can get work done, consider which of the necessary activities you can delegate to someone else or get some help with, so that you can conserve energy for things that bring you pleasure.

Build community. “Don’t go it alone,” advised Zautra, who studies resilience in the context of chronic disease and has found that social support plays a key role. "One of the calamities associated with RA is that people feel disfigured, they don’t feel right inside, they don’t feel like they look right outside, they feel ashamed of themselves." Because of this, reaching out might be the exact opposite of what you feel like doing, but he suggested doing it anyway. Rivers said that friends and family, many of whom have an autoimmune disease, were invaluable to her as she grieved and ultimately accepted her diagnosis.

Get more sleep. Getting a good night's sleep with RA and chronic pain is challenging, but essential. Research in the journal Sleep confirms that people with RA feel more pain and are in a bluer mood after a bad night’s sleep. “Poor sleep increases depression, pain, and feelings of fatigue,” said Dr. Harrell. Work on sleep strategies, your “sleep hygiene,” such as turning off the TV and video games about an hour before you want to go to sleep, keeping your room slightly cool and dark, sticking with a set bedtime and wake-up time every day, and cutting back on caffeine, alcohol, and cigarettes — all of which can negatively affect sleep. If you’ve tried to make these sleep-friendly lifestyle changes but are still losing sleep, talk to your doctor about specialized testing with a sleep study to find out if you have other sleep disorders. Also, Rivers said, some pain medications can add to sleep problems, so ask about a change in meds if you suspect this unwanted effect.

Manage fatigue wisely. “RA-related fatigue is not responsive to rest in the same way as activity-related fatigue,” Harrell noted, whose article in Nursing Research underscores the fact that fatigue significantly contributes to feelings of depression and dissatisfaction with life. “Continue with measured activities despite fatigue, and don’t spend additional time in bed due to the feelings of fatigue.” Fatigue with RA can become a vicious cycle in tandem with depression. You feel fatigued, so you skip an activity you enjoy in favor of resting. Instead of feeling more energized though, you remain fatigued and also feel resentful and sad about having to limit your life. It’s counterintuitive, but Harrell suggested prioritizing activities you enjoy even if you may take a bit longer to do them or spacing them out further in your schedule.

Try cognitive behavioral therapy. “Although you can’t control RA, you can influence how you respond to RA symptoms,” Harrell pointed out. Cognitive behavioral therapy is an approach that will help you identify and change thought patterns that could be undermining your efforts.

Try yoga. A study comparing twice-a-week Iyengar yoga sessions for young women with RA to life as usual showed that six weeks of yoga appeared to improve fatigue, mood, and quality of life in the participants. From her perspective as a yoga teacher of eight years and an RA patient, Rivers said these study results strike a chord with her because this particular style of yoga uses props to support good alignment and also teaches breathing techniques. She now practices a gentle version of yoga, even though she can no longer do some of the poses she once did.

Try water-based exercise. Exercise is helpful for keeping your mood positive and maintaining your health, and water workouts make exercise easier to do. "I am very lucky to have access to a pool," said Rivers. "I’ve realized I can do stuff in the water without pressure on my joints.”

Just breathe. Rivers spent years teaching breathing to yoga students. Yet, she said, intentional breathing was one of the first things she forgot about when she was faced with her diagnosis and unexpected pain. Once she reminded herself to breathe, she found that she had more control over her response to pain and RA.

Try mindfulness meditation. Though any style of meditation could be helpful, Zautra said, he and his team teach mindfulness meditation techniques. “One thing we teach in our mindfulness interventions is that pain is not all you feel,” he said. Paying attention to all the current elements of your life, the things that bring you joy as well as your pain, can help. “Any meditation will ask a person to see more fully the complexity of their own mind and to understand themselves and the sentiments of others," he said. "When you have a chronic and painful condition, you need to take the time to see life fully.” You can find meditation guidelines online, although some find it more motivating to learn one on one or in a class.

Laugh a little. “Some people probably think I am taking this too lightly, but that’s definitely a family trait,” Rivers said. Although she’s been angry and sad over her diagnosis, she also tries to look for the light side. For example, on days when RA has thrown an unpredictable flare her way, she prefers to see RA as a dance partner stepping on her toes instead of a war zone — "although I’ve definitely had some war images in my head!” she said. This allows her to laugh a bit, breathe more easily, and get back on track with RA management.

Remember that you’re more than your RA. “Your illness doesn’t have to define you,” Harrell said, who suggested reminding yourself of that fact fairly often. “The more actively you manage your symptoms, the more confidence you will feel in embracing life despite your RA.” If you’re going through a period of feeling like RA is consuming your whole life, make some lists of things that have nothing to do with RA: everything you are — a good sister, good friend, good volunteer; everything you enjoy — food, family, fun; and everything you do well — hobbies, work, tasks.

If you try all of these steps and still find that you have symptoms of depression that won’t go away, such as feeling hopeless, that life isn’t worth living, or that your loved ones might be better off without you, seek RA counseling from a therapist, Harrell urged. Look for a practitioner who has experience with chronic illnesses and who will help you work through feelings of despair.