Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Is depression linked with AS?

Hi, jroc:

I don't know about the link I provided, but calcium deficiency has been implicated in depression (and also calcium over consumption).

Years of suffering with AS have left my bones quite weak from demineralization and this is due, as were my kidney stones, to a lack of calcium. It is, however, easy for me to believe that some group did not find serum calcium low--because in AS this is usually HIGH--while it is in the process of being expelled from our bones!

I usually have some good contrary data to cite, but for now I will suggest this is my own opinion, for what it is worth: Calcium deficiency is rampant amongst those of us with AS and there are over 200 diseases related to the calcium problem and I have had some, but precious scant feedback from members successfully treating depression with calcium supplementation; I would agree that it is probably not that easy and inflammation plays a role but it is related probably through OPGL (OsteoProteGerin Ligand).

HEALTH,
John

That view doesn't seem to be supported by the scientific literature. As per the study I previously cited, bone mineral density of subjects with AS is decreased, in spite of normal calcium homeostasis and bone remodeling indices. As you mention, the role of inflammation and other factors such as OPG are supported by many studies.

"About 74% of AS patients have reduced BMD and this change reflects disease activity. Serum sRANKL levels and sRANKL/OPG ratios are up-regulated in patients with AS and have relationship with BMD and radiological changes. These results suggest that the imbalance between RANKL and OPG might be involved in the pathogenesis and clinical courses of osteoporosis in AS." - http://rheumatology.oxfordjournals.org/content/45/10/1197.short

"A role for inflammatory cytokines has received support from several studies. Inflammation of the entheses and synovium may result in increased release of proinflammatory cytokines, whose deleterious effects on bone metabolism have been established. Tumor necrosis factor alpha (TNFα), interleukin-1, and interleukin-6, which play a pivotal role in inflammation, as well as nitric oxide, induce bone metabolism imbalances in animals and humans [35]. Thus, in several studies, significant correlations were found between bone turnover markers (pyridinoline, deoxypyridinoline, C- and N-telopeptide crosslinks, and osteocalcin) and the levels of proinflammatory cytokines or their markers (erythrocyte sedimentation rate and C-reactive protein) used in clinical practice [36]." (Osteoperosis & Ankylosing Spondylitis - http://www.sciencedirect.com/science/article/pii/S1297319X03001878)

And when inflammation is reduced, bone density increases. "TNFα has been shown to increase bone resorption and decrease bone formation. This study, in which inhibition of TNFα resulted in a decrease in systemic inflammation, and in an increase in bone density, adds some evidence in favour of the hypothesis of bone loss mainly due to systemic inflammation through direct effects of TNF on bone."

So if you can stop the inflammatory process it appears that you can stop bone loss. "In two longitudinal studies a decrease in BMD was seen only in patients with SpA with persistent active disease." - http://ard.bmj.com/content/62/4/347.abstract

The scientific literature appears to support the idea that inflammation and not calcium deficiency plays a key role in both depression and bone demineralisation associated with AS. Reducing inflammation through medications, diet or lifestyle are likely to improve these parameters.

Hey Seb,

I was where you are at once... I got myself to hospital and got help. Was not close to family at the time, so thought best to get somewhere safe.

We need you around here, so get help if needed.

I am glad I found help when I needed it many years ago.

Take care,

Tim

Hey, jroc:



I think the problem is yet more complex.

But I do agree that inflammation does play a key role in depression.

The problem I have with measuring serum calcium is how much attention is paid to bioavailable calcium ions versus complexed calcium: Consider You can measure calcium in the blood, but do not know where it came from or where it is going; is more of it on its way OUT having come from bone or on its way IN from supplementation or food sources.

When I was trying to decide upon the best supplementation approach, calcium was of primary interest and I found various sources that promoted the idea that this mineral should be taken on an empty (acid) stomach (to properly ionize it) and also not taken with green vegetables (due to forming oxylate compounds) or grains, either for a similar reason.

But my opinion on depression linked to calcium only comes out of feedback from others, and not from any direct personal experience. There are many reasons a person with AS should supplement with calcium. But even better reasons to get out of inflammation altogether; thanks for the articles.

HEALTH,
John

Seb,

The horrible thoughts you have creeping into your head are a sign of a physical ailment that just happens to be called depression - this needs attention by a doctor.

Symptoms, such as thoughts of harming yourself or others, are serious and are a sign of a chemical imbalance. There is a physical link between AS and clinical depression. This is not mind over matter. These symptoms are worth a consultation with your doctor for an examination and assessment. You should not have to suffer feeling like this... life is too short not to be having fun and enjoying your days!

I know AS can be scary at times... but look how well so many kickers are doing! Having kids, working in fulfilling careers.. AS may be a battle for sure but please don't think that you have to accept that you will become hunched and disabled. Many with AS will never face that degree of severity. You will have all sorts of treatments that should help to prevent you from the worst outcome. Work with your doctors, make a plan, and see how much better you can feel.

Please see your doctor and tell them you are not willing to continue with these rotten thoughts - they should be able to help!

I am worried for you, Seb!
mig

i have to second what mig has said. please do talk to a doctor about this. i agree with everything mig just said. i'm glad you are using us as a sounding board, but this really does sound like something that a doctor needs to help you with.

Hi Seb,

I'm sorry to hear that this is such a tough time for you right now. I don't know much about whether or not AS is linked with depression and the physiology of it, but regardless of what might or might not be causing it, it's still very real. (Thanks to all for the info explaining the link ... very interesting).

It sounds like you're in a time of great transition ... relationships, school, adjusting to having AS. That's a lot to deal with and I think some degree of depression often goes with uncertainty. You mentioned that your having a hard time accepting the impact that this disease might have on your life and your goals. Hopefully you'll find some great treatments that really work for you and will be able to reach all of your goals regardless ... but the thought that something out of your control is threatening that is definitely enough to be depressed about.

If you do decide to talk to someone about it, there are counselors who specialize in dealing with chronic illness and in this type of situation I think someone working with grief and loss might be a good fit too. Even though your feeling good now, you're grieving the loss of the picture of what you hoped your future would look like pre-AS.

No shame in wanting extra help in getting through these rough patches. One thing I've gained from this site is that you never have to feel alone with what your going through. I hope you're not feeling so lost today ... we're all rooting for you!