Large Study Finds Predictors of Depression in Lupus

Huang X, Magder LS, Petri M. Predictors of incident depression in SLE.  Journal of Rheumatology (2014) 41:1823-1833. doi: 10.3899/jrheum.140111. Online Aug 15.

Results have been inconsistent from previous studies looking for predictors of depression in patients with systemic lupus erythematosus (SLE). Here, analysis of 1,609 patients from the Hopkins Lupus Cohort shows a higher risk for incident depression among patients if they have a recent diagnosis of SLE or a recent period of cutaneous activity, a history of longitudinal myelitis, or if they currently take high doses of steroids.

Patients were enrolled only if they had no previous history of depression. During a total follow-up of 9,487 person-years, the authors recorded 282 cases of incident depression - a rate of 17%, at the low end of the range of previously reported prevalences of depression in SLE (2% to 60%).

Compared to patients who don’t take prednisone, the Hopkins data show that the rate of incident depression is 2.3 times higher (P = 0.0002) among patients who take 20-39 mg/day and 3.1 times higher (P = 0.0001) among those taking at least 40 mg/day. Other independent predictors of depression included a recent SLE diagnosis, non-Asian ethnicity, disability, cutaneous activity, and longitudinal myelitis. After controlling for prednisone use, the researchers found that global disease activity (SELENA-SLEDAI) was not a significant predictor.

“Because these higher doses of prednisone are generally used in patients with SLE with higher disease activity, especially renal, central nervous system, and hematologic involvement, " the authors state, "our results reinforce the need for noncorticosteroid approaches to control SLE activity, to avoid inducing depression.”