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\n <\/figure>\n\u201cMajor depression is still, after decades, the most common reason patients do not have good outcomes to the treatment of their medical conditions,\u201d he told Healio. \u201cEven if major depression is diagnosed, it is usually undertreated. As a result, other physical symptoms are amplified, less tolerable and more disabling, not to mention less responsive to usual treatments.\u201d<\/p>\n
According to Clark, 60% of patients with depression report pain symptoms at the time of diagnosis.<\/p>\n
\u201cAfter 8 years, depression was the best predictor of persistence of chronic pain symptoms in general practice,\u201d he said.<\/p>\n
In addition, individuals diagnosed with depression carry a two-fold risk for myriad negative outcomes, including chronic daily headaches, atypical chest pain, musculoskeletal pain and low back pain.<\/p>\n
Although Clark maintained that treating depression is important, he encouraged rheumatologists to begin by managing the patient\u2019s disease. <\/p>\n
\u201cFix the broken parts to restore function,\u201d he said. <\/p>\n
However, even this recommendation comes with a warning. <\/p>\n
\u201cAll repairs cause damage,\u201d Clark said.<\/p>\n
Behavioral interventions are an essential component of managing mental health conditions, according to Clark.<\/p>\n
\u201cInterrupt unproductive habits by focusing the patient on their primary goals,\u201d Clark said. \u201cBut keep in mind, all demands to stop doing particular acts are stigmatizing and likely be met with some resistance.” <\/p>\n
And although Clark acknowledged that employing these strategies can be difficult, he encouraged rheumatologists to be persistent, as depression can continue to exacerbate physical outcomes. <\/p>\n
\u201cIt becomes more difficult to focus on an underlying disease process and prescribe the best treatments because the patient keeps complaining and demanding new treatment strategies,\u201d he said. <\/p>\n
With that in mind, Clark offered a starting point for clinicians to consider when managing a patient who may be experiencing depression in addition to their chronic disease. <\/p>\n
\u201cThe short answer or recommendation to a rheumatologist is ask yourself if the patient is doing well or making progress,\u201d he said. \u201cIf the answer is no, and you are failing to find an effective treatment, they are probably depressed until proven otherwise.\u201d<\/p>\n
For more information:<\/h2>\n
Michael <\/b>R. <\/b>Clark, MD, MPH, MBA,<\/b> can be reached at mrclark@jhmi.edu.<\/p>\n\n
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Sources\/Disclosures<\/h3>\n Source: <\/h2>\n
Clark MR. Perspectives on pain & depression: Linkages and management challenges. Presented at: Congress of Clinical Rheumatology East; April 30-May 3, 2026; Destin, Florida (hybrid meeting).<\/p>\n
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\n Disclosures: <\/strong>
\n Clark reports no relevant financial disclosures.
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