Coping With Depression

Ankylosing Spondylitis commonly leads to significant impairment in functionality as well as chronic pain which can negatively impact a person's quality of life.  Therefore, it is no little surprise that a recent study published in 2016 in The Journal of Rheumatology found that patients with AS are at an increased risk for depression, anxiety disorders and sleep disorders (1).
The level of depression and anxiety correlates with more severe disease activity.
So what can be done to combat the tendency for depression?  Talk openly to your doctor about your depression and the mental/emotional impact that your disease burden is having in your life.  Your medical provider might suggest pharmaceutical intervention, which is a personal choice you will have to make.  Whether or not you try medication, below you can find 10 strategies that have proved helpful for many and might just give you the edge you need.
1.   You Are Not Alone.   Coping with a chronic illness such as Ankylosing Spondylitis can easily make an individual feel isolated.  Remind yourself that YOU ARE NOT ALONE!  Millions of people around the world are also coping with AS and experiencing symptoms similar to your own.  Just telling yourself that you are not alone may not be enough.  Join Online communities such as this one - ASCNA.   Sign up for the newsletter.  Submit your AS story.  Read the stories of others.  Learn strategies that have helped others.  Education is empowering.  By taking a hold of the steering wheel and hijacking your life by implementing some of the suggested strategies, you will feel a measure of control that perhaps was missing before. 
2.  Focus Your Attention Off of Yourself.  Simply put, find someone to help.   Every person in your realm of influence (family members, friends, neighbors, etc) are struggling in one way or another with something in their life....a sickness different than your own, the ravages of old age, financial struggles, job struggles, stress, insecurities, depression, family problems, etc.  Find a way that you can help.  Start with your own family.   Ask sincere questions.  Listen.  Extend yourself.  Show love.  Show interest.  Find a way to show an act of kindness, some practical help of some kind, or encouraging uplifting words.  Invite friends, neighbors, work mates, etc, over for coffee or tea, given them a card or little gift, tell them how special they are to you.  By lifting others up and seeing the effect of your kindness, your focus will be taken away from yourself and you will find that really it was a gift to yourself. 
Another potent way that you can focus attention off yourself is by focusing on the bigger picture.  Some people obtain this by means of prayer- communication with a higher being, a Creator.  Other people obtain this by spending time with nature.  Take the time to look up at the clouds and their vastness.  Notice the peace and beauty of the bright blue skies.  Take a walk and focus on the sounds of the wildlife, the smells of the outdoors, the colors.  If you are blessed to live near an ocean or near mountains, visit them and feel their power.  Or perhaps you have tall trees, living statues of art, nearby that sway with every breath of the wind.  Focus on the bigger picture.  See the energy around you, the beauty of nature, and the lives of others all around. You are NOT alone!
3.  Get Busy!  Do something productive EVERY day.  Even on days when you are in more pain than normal, or experiencing more fatigue than average, find something productive to accomplish in that day.  It may be as simple as washing a load of laundry,  cooking a healthy meal for yourself and/or your family, paying some bills that are due, responding to emails that you have been meaning to get to, backing up files on your computer, calling to check on a friend, writing out a grocery list, dusting some furniture or vacuuming a rug, etc.   Be sure to include stretching and/or exercising of some sort every day among your activities.  
4.  Find Something You Love To Do.  Learn to play a musical instrument.  Find music that you love to listen to.  Write poetry.  Make scrapbooks from old family photos.  Learn to knit or crochet.  Enjoy photography or playing chess.  Buy a recumbent bicycle and enjoy bike riding without the risk of falling that comes with a standard bicycle, or the strain on your neck and back without the support that a recumbent bike offers.  Perhaps you can express yourself somehow through art: take up painting, or ceramics.  Experiment in the kitchen with cooking your own creations that are starch-free and safe.  Find a book that you cannot put down.  Try new things and find something that you love to do.  Already have something you love to do?  Maybe you could expand your horizons and try out something new.
5.  Don't Make it Worse!   When it comes to living with AS, there are certain elements that are beyond your control.   But on the other side of the coin, there are a number of things which you CAN control.   Eat right.  If you are following the low or no starch diet to help manage the symptoms of your Ankylosing Spondylitis,  then stick to it and do not cheat.   If you don't comply to the diet, then it doesn't work.  As your pain flares up, it makes it more difficult to battle depression.   So do what you can to keep your pain levels down.  Exercise and stretch.  This is within your control, and neglecting to move will only make your pain and stiffness worse.    Get enough sleep.  Go to bed at a reasonable time and allow yourself 8 hours of sleep.  Sometimes you may even need more than that.  If you are sleep deprived, it will only add to your fatigue and make depression more difficulty to control. Drink enough water.  Do not overdo activity levels.  While it is beneficial to keep moving and active, pushing yourself too hard or overextending yourself may flare up symptoms.  Also, despite the urge to isolate yourself when you are battling depression, it is the worse thing you could do.  It will make your situation worse.  Rather, force yourself to be around others.
6.  Be Thankful!  It is easy to become consumed by dark clouds when depression takes over. 
Have you ever flown in an airplane on an overcast, dark and cloudy day?  What happened when your airplane rose above the thick layer of dark clouds?  As it broke through the clouds, the sunshine above the clouds was almost blinding as it streamed in the windows of the airplane.  Yes, the fact is,  IT IS ALWAYS A SUNNY DAY!  It's just that sometimes the clouds block that sunshine.  But the sunshine is still there!     
When we are fighting feelings of depression, we need to remind ourselves of the sunshine.  There is always, always something to be thankful for.  Don't let the clouds block your view of the wonderful things you have in your life to be appreciative of.   Focus on all that you are grateful for.  
7.  Find The Humor.  Laughter is medicine.    Do something every day that makes you laugh.  Watch your favorite episode of I Love Lucy or Jerry Lewis.  Read some funnies.  Don't underestimate the importance of laughter.  The book "Anatomy of an illness as Perceived by the Patient" (later made into a movie) was about Norman Cousins, a man who came down with Ankylosing Spondylitis.  He treated his condition and apparently cured it, with very high doses of Vitamin C, combined with a program that induced laughter.  He would watch Candid Camera and other various comic films to get in a good 10 minute bout of laughter every day, sometimes more than once a day.  He found that 10 minutes of good laughter allowed him 2 hours of good uninterrupted sleep.  Laughter also combats depression because it releases endorphins.  
8.  Accept Help.  Being modest means recognizing our limitations.  What does it take in order to be modest and make such an admission?  Honesty.  We must be honest with ourselves and admit that we would benefit from help.  There is nothing shameful about recognizing that we have limits.  Everyone has limits.  There is also no shame in honestly admitting that we are experiencing a problem such as depression or anxiety that is not resolving on its own and seek the help of a therapist.  It is no more shameful than admitting we have a sinus infection that is not going away and taking an antibiotic.  Asking for help and speaking to a therapist is an act of bravery as well as modesty.  It is a healthy endeavor that can help you discover the source of your pain to alleviate its impact on your life and to combat your critical inner voice.
9.  Learn From Others.  Watch inspiring videos and read life experiences of others who have conquered depression despite their pain, or despite a debilitating health condition or challenge.
10.  Recognize Your Value.  Life is a miracle no matter how you look at it.  YOU are a miracle.  That makes you special.  You have a life force, an energy, a power.  Your AS does not change that fact.  Every breath that you breath in, every beat of your heart, every neuron firing in your brain, is an amazing miracle.  You exist, from once nothingness, to a living, sentient, conscious aware being... one that can think, feel emotions, invent, discover and affect others.  Yes, life is a miracle and life has value.  YOU have value.  Don't listen to any inner voices that try to tell you otherwise.
1. Shen CC, Hu LY, Yang AC, Kuo BI, Chiang YY, Tsai SJ. Risk of psychiatric disorders following ankylosing spondylitis: a nationwide population-based retrospective cohort study. J Rheumatol. 2016;43(3):625-631.