Ankylosing Spondylitis and Depression: What to Know

Medically Reviewed by Minesh Khatri, MD on August 01, 2022
Written by Kate Sweeney
5 min read

Difficult emotions are a normal part of living with ankylosing spondylitis (AS). As someone with this chronic inflammatory disease, you may experience symptoms ranging from pain in the neck, back, and buttocks to fatigue and eventual lack of mobility in your spine. All this may cause feelings of stress and unhappiness. But you can take steps to try to prevent these feelings from spiraling into depression.

Ankylosing spondylitis (AS), also known as radiographic axial spondylitis, is a type of arthritis that mostly affects the spine. It causes pain, swelling, and damage to both the spine and the sacroiliac joints. These are the joints that connect the bottom of the spine to the pelvis. AS usually starts in late adolescence or early adulthood.

Symptoms of ankylosing spondylitis

  • Pain in your low back, buttocks, and hips
  • Stiffness when you wake up
  • Pain, swelling, redness, and warmth in your toes, heels, ankles, knees, rib cage, upper spine, shoulders, and neck
  • Fatigue
  • Loss of appetite

In later stages, AS can also seriously decrease movement of your spine when bones in your spinal vertebrae gradually fuse. The parts of the spine where the sections of vertebrae fuse become stiff and inflexible. This spinal fusion can also stiffen the rib cage, reducing lung capacity. Later complications include eye inflammation called uveitis, compression fractures, and heart problems.

There is no cure for AS, but treatment can help to relieve pain, keep your spine straight, prevent joint and organ damage, aid mobility, and improve your quality of life.

AS has been found to raise the risk of depression. This is likely because its symptoms can so powerfully impact quality of life. And depression actually tends to make AS pain symptoms worse. If you’re not treated, it’s possible to fall into a cycle of AS pain causing depression, and that depression making your AS pain worse, which, in turn, increases your depression symptoms. It’s extremely important to look out for symptoms of depression if you have AS.

Symptoms of depression to look out for

  • Feeling low or sad
  • Negative thoughts
  • Less interested in doing things you normally enjoy
  • Hard time sleeping
  • Feeling tired or low on energy
  • Change in appetite
  • Hard time concentrating
  • Aches or pains, headaches, cramps, or problems with digestion without a clear cause that don’t get better with treatment.

The challenge can be that some of these symptoms of depression are also common symptoms of AS. To figure out whether your symptoms are a sign of depression, the best thing to do is to visit your primary care doctor and describe your symptoms. Your doctor will then ask you questions to find out which symptoms are caused by physical health issues and which are truly mental health symptoms. If there is no physical cause for some symptoms, then depression might be to blame. And because depression can make your AS symptoms worse, it's important to catch and treat it early on.

You can take steps to avoid the cycle of pain and depression AS can cause. A tailored approach that includes medications and other therapies is most effective in fighting AS symptoms early before they become serious. Such an approach can even lead to remission, a reduction in how intense your symptoms are. If you are having suicidal thoughts or are in crisis, contact the National Suicide and Crisis Lifeline by dialing 988.

A tailored approach might include:

Medications

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): These include over-the-counter drugs like ibuprofen and naproxen, plus prescription drugs like celecoxib, diclofenac, or indomethacin.
  • Analgesics: These are other pain relievers, including acetaminophen.
  • Disease-modifying antirheumatic drugs (DMARDs): If your AS only affects your back, your doctor may not prescribe most DMARDs. But they may prescribe sulfasalazine for other joints.
  • Biologics: These are a type of DMARD that can control your disease by targeting certain body processes and proteins that cause inflammation. Biologics include tumor necrosis factor (TNF) inhibitors and interleukin (IL-17) inhibitors.
  • Corticosteroids: You won’t get these for pain in your spine, but sometimes, doctors inject steroids into your knee or shoulder for pain relief.

Physical and occupational therapy

A physical therapist will help keep you moving and reduce your pain by teaching you how to strengthen your muscles. Occupational therapists can prescribe gadgets and devices to help make everyday life easier. These might include tools like a car door support handle, a bed ladder, a reacher, and other equipment that can help you live independently.

Lifestyle changes

  • Exercise. Joints can lose mobility or fuse if you don’t use them regularly. Exercise can also strengthen your core muscles and legs. A physical therapist can help set up a plan to help keep you moving. They might recommend walking, swimming, tai chi, or yoga.
  • Eat a good diet. Pile on the fish, fruits and vegetables, and whole grains. Limit your intake of red meat, sugar, and processed foods.
  • Stretch and practice good posture. Make sure you switch between sitting and standing while you work. And pace yourself on days when you’re having a lot of pain or are feeling especially tired.
  • Don’t smoke. Smoking can make your AS symptoms and joint damage worse and make any treatment less effective.
  • Get enough sleep. Not sleeping well can make your AS pain worse. To try to get the best sleep possible:
    • Make sure you are taking medicines as directed.
    • Exercise during the day.
    • Avoiding caffeine late in the day.
    • Limit your screen time before bed.
    • Still having difficulty sleeping? Talk with your doctor.

Putting self-care first

Managing your stress is important because stress itself can trigger your AS symptoms. It can help to identify your priorities each day as well as what can wait. Think about whether someone else can help with any of the tasks on your to-do list.

There are healthy ways you can manage stress simply by doing activities that calm you down.

  • Meditation. This can be as simple as sitting quietly with your feet on the floor and your eyes closed. Breathe slowly and deeply. You might imagine yourself in a place that relaxes you.
  • Yoga or tai chi
  • Get outside and enjoy nature.
  • Spend time with pets.
  • Listen to your favorite music.
  • Do something creative like writing, painting, pottery, or knitting.

This list is limited only by your imagination. Other ideas might include drinking a warm cup of herbal tea, taking a bath with bath salts and a bath pillow, or reading a good book.

There’s power in having someone in your corner. A recent study found having very little contact with other people can be linked to more serious disease and poor quality of life in people who have AS. There are a number of ways to consider reaching out:

  • Talk about your feelings with people in your life who are good listeners.
  • Join a support group. The Arthritis Foundation and the Spondylitis Association of America have in-person and virtual support and education groups where you can connect with other people living with AS.
  • Consider talk therapy. A kind of therapy called cognitive behavioral therapy (CBT) can be very effective in treating depression and anxiety. In CBT, you talk with a therapist to better understand how your thoughts, feelings, and behaviors affect one another. CBT usually involves trying to change thinking patterns that aren’t helpful. It can give you tools like problem-solving to deal with tough situations. You can also learn to calm your mind and body.