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Arthritis Doubles Risk of Depression and Anxiety

Do you feel like you’re constantly on a stress-induced roller coaster? Do fluctuating moods rule your days? Do you feel blue more often than you feel joy?  You’re not alone. Studies confirm that as many as 1 in 12 American adults struggle with depressed feelings each year - and isolation and inactivity can make it worse.

If you suffer with arthritis and joint pain your risk of depressed mood is even higher. Researchers say 19 percent of adults with arthritis report having frequent mental distress and 32 percent have a history of depression.

In addition, current stay-at-home and social distancing guidelines have exaggerated the isolation and inactivity associated with joint pain conditions. Fortunately, even during a pandemic, making small changes in your nutrition, activity, and friendships can significantly increase your overall happiness and lift your mood.

For persons 65 years of age or older, depression is often correlated with a decline in physical health. According to some expert estimates, up to 90 percent of patients with arthritis and other rheumatic diseases experience depression

Exercise and Activity

Moving your body always factors into the mood equation. Exercise is an all-natural treatment to fight depression. Studies clearly show that depressed mood and stress increase with inactivity and have found that as little as 30 minutes of exercise a day can help alleviate chronic sadness and low energy.

"Research has shown us that, for some individuals, exercise works as well as antidepressants, although exercise alone isn't always enough for someone with severe depression," explains Cory Calendine, MD, Orthopaedic surgeon, Bone and Joint Institute of Tennessee

Exercise decreases stress hormones such as cortisol and increases endorphins which naturally boost your mood. Adrenaline, serotonin, and dopamine are all healthy brain chemicals stimulated by exercise that work together to make you feel better. Simply put, exercise helps prevent depression, lowering risk by up to 40 percent and can improve depressive symptoms in people already feeling down. Just because you exercise doesn’t mean you won’t ever become depressed, but it certainly reduces the chances that you will.

A Duke University study found that 30 minutes of exercise three times a week may help treat depression in the elderly better than standard prescriptions.

Furthermore, compared with indoor activity, exercising in natural environments is associated with greater feelings of revitalization and energy, and decreased tension, confusion, anger, and depression. Joint pain, arthritis and pandemic restrictions are all barriers to regular outdoor activity, but keep in mind that even a small ‘dose’ of nature each day can further enhance your mood, self-esteem, and mental health. Your exercise routine doesn’t have to be intense or organized. Independent activities including walking, cycling, weight training, gardening, fishing, and swimming can all offer a boost of endorphins and mood.

Food and Nutrition

Dietary changes can make a dramatic impact on your mood. This may seem obvious, but the data is striking. There is strong epidemiological evidence that poor diet is associated with depression. The reverse has also been shown, namely that eating a healthy diet rich in fruit, vegetables, fish and lean meat is associated with reduced risk of depression. A Journal of Public Health Nutrition study revealed that people who ate junk food were 51 percent more likely to show signs of depression—and the more junk food the study participants ate, the more likely they were to be depressed.

Studies confirm that people who eat diets high in processed meat, sweet desserts, fried food, refined cereals and high-fat dairy products — are more likely to report symptoms of depression.

These are the basic guidelines for adjusting your diet to optimize mood:

  • Limit refined carbohydrates and processed food
  • Eat consistently throughout the day and don’t skip meals
  • Incorporate soluble fiber (25 to 30 grams a day from food) and protein
  • Consume foods high in essential nutrients (as described in the list below)

What Should You Eat?

The following foods can help lift your mood in two key ways. They deliver key nutrients that support brain chemistry to reduce the risk of depression and improve sleep quality. Second, they provide vitamins, minerals, and antioxidants that help build energy and your capacity to cope better with stress (all the way down to your body’s cellular metabolic pathways). So skip the quick energy and sugar fix that can result in feeling worse later, and strive to make these healthy, feel-good foods part of your nutrition routine.

  • Salmon — Full of heart and brain-healthy Omega-3 fatty acids, University of Maryland Medical Center researchers suggest that these nutrients can lift your mood, alleviate mild depression, and improve memory.
  • Dark Leafy Greens — These are high in folic acid, a nutrient known to alleviate depression and reduce fatigue. In addition, dark leafy greens are packed with magnesium. (Low magnesium levels can contribute to low levels of serotonin, a hormone that aids sleep and stabilizes your mood.)
  • Walnuts — Much like salmon and greens, walnuts are rich in antioxidants, serotonin-boosting omega-3 fatty acids, and magnesium, making them beneficial for your mental health.
  • Eggs — Eggs are high in protein, Vitamin D and B12. They are also a source of choline, a nutrient that supports the nervous system, which improves mood and helps produce important neurotransmitters.
  • Turkey and Chicken — Turkey and chicken contain tryptophan, an amino acid that helps in serotonin production. They also contain the amino acid tyrosine, a building block for dopamine and norepinephrine, brain chemicals that help even out your mood.
  • Vitamin C-Rich Foods — Vitamin C deficiency is associated with low energy, depressed mood, and irritability. Citrus fruits, such as oranges and grapefruit, provide an instant burst of vitamin C, and also fresh vegetables including red peppers, broccoli, and brussels sprouts.
  • Green Tea — An antioxidant powerhouse, green tea helps fend-off depression. It contains high levels of theanine, an amino acid that helps improve your response to stress.
  • Dark Chocolate — The polyphenols in cocoa (dark chocolate) can make you feel more calm and content.  Dark chocolate also stimulates the production of both endorphins and serotonin which support healthy mood.


Finally, you’ll want to take time for your social network. Several studies have established the link between having close friendships and a longer, healthier life. The landmark Framingham Heart Study points to evidence that happiness really is contagious among friends and relatives. At a time of social distancing and separation from friends and family, these factors are more relevant now than ever. In a study published in the Journal of the American Geriatrics Society, researchers found that osteoarthritis and joint pain further increased the risk of social isolation. Socializing and placing your trust in friends and family can be a powerful tool for lowering your risk for depression.

Social support, such as having someone to talk to has been cited as important for prevention and recovery from depression.

"Far and away the most prominent of these factors was frequency of confiding in others, but also visits with family and friends, all of which highlighted the important protective effect of social connection and social cohesion," says psychiatrist Jordan Smoller at Harvard Medical School.

It is more important than ever to surround yourself with positive people and stay engaged in relationships that lift your mood and protect against depression.


What factors are tied to depression, what factors lead to depression, and what factors are caused by depression are hard to tease apart, but when studied alone, some factors, like physical activity, diet, and relationships appear to have a big impact on mood and well-being. That said, current social distancing measures can make it hard for many of us to take full advantage of the advice that states we need more family time and exercise and less Netflix and Doritos to help avoid depressed moods - even when we know hitting that button to watch the next episode is not the best remedy. Regardless, science reassures us that daily efforts to eat healthier, increase activity and interact with friends can have a huge impact on our mood and quality of life.

If you or someone you love is experiencing depression and needs help now, call the National Suicide Prevention Hotline at 1-800-273-8255, or message the hotline.

Consult Cory Calendine, MD, Orthopedic Surgeon

Is joint pain and arthritis contributing to your anxiety and/or depression? Dr. Calendine and the medical team at the Bone and Joint Institute of Tennessee can individualize a treatment plan to address your symptoms and get you back in action. From nonsurgical treatment options to total joint replacement, there is hope for those suffering from debilitating arthritis symptoms. CONTACT our office today.

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Cory Calendine, MD is an Orthopaedic Surgeon and founding partner of the Bone and Joint Institute of Tennessee at Williamson County Hospital in Franklin, TN. Dr. Calendine is an expert in Joint Replacement, specializing in Hip and Knee Surgery. From diagnosis through treatment, the Orthopaedic Surgical experts at the Bone and Joint Institute use the latest techniques and technology to improve care for people with musculoskeletal problems. For more information, please contact our office or schedule your appointment today.  

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