Depression in systemic lupus erythematosus: a systematic review

Abstract

Depression is the most common psychological symptom in patients with systemic lupus erythematosus (SLE). A large fraction of these patients remains undiagnosed due to subclinical presentation or is missed in the routine workup of SLE. Many factors have been reported in the literature which can be used as predictor of depression in SLE. Lupus patients also have higher risk of suicidal tendencies than the general population. Pathogenesis of depression in SLE is multifactorial and involves complex interactions between cytokines, antibodies, genetic factors, etc. Approach to such patients consists of studies that establish diagnosis of SLE, distinguish between organic and functional etiologies, and exclude symptoms not due to SLE. Various hematological, cerebrospinal fluid investigations, electroencephalography, psychometric testing, as well as neuroimaging modalities are involved in diagnostic workup of lupus patients with depression. Patients with only psychological causes for depression are treated with antidepressants. While in case of organic disease, one treats with glucocorticoids, immunosuppressants, and antidepressants. Electroconvulsive therapy can be considered in very severe cases not responding to maximum therapy.