title: Anxiety, depression and suicidal ideation in patients with rheumatoid arthritis in use of methotrexate, hydroxychloroquine, leflunomide and biological drugs.
abstract: OBJECTIVE
  This paper aims to investigate the prevalence of anxiety, depression and suicidal ideation in patients with rheumatoid arthritis taking different drugs to control the disease.
  
  
  METHODS
  The study included 105 patients with rheumatoid arthritis who were treated with methotrexate, leflunomide, hydroxychloroquine and biological drugs. All patients were assessed using the Mini International Neuropsychiatric Interview, the Beck Scale for Suicide Ideation and the Hospital Anxiety and Depression Scale.
  
  
  RESULTS
  Difference was statistically significant (p < 0.001) for both depression and anxiety as to suicidal ideation among groups of patients according to the medication used. Furthermore, the value reached by those patients taking biological drugs was alarming with higher scores for all measures, including suicide ideation. The patients using methotrexate and leflunomide reported lower scores on suicidal ideation than those using hydroxychloroquine and biological drugs. Patients using leflunomide showed less mental health impairment than other groups.
  
  
  CONCLUSIONS
  Greater scores for depression, as a comorbidity of rheumatoid arthritis, increase the rate of suicidal ideation and depression also can worsen general pain, hardships, treatment denial, and prognosis, as well as cause a faster reduction in quality of life. Patients taking biologic DMARDs (drugs known as disease-modifying drugs) had the highest rates of depression, anxiety and suicidal ideation among all patients studied. The current analysis showed that psychiatric aspects such as depression, anxiety and even suicide ideation, may differ between groups of patients with arthritis according to the drug used, serving as an alert to the importance of considering also this factors in therapeutic decisions.
authors.affiliation: National Institute for Science and Technology - Translational Medicine (INCT-TM); Laboratory of Panic and Respiration, Institute of Psychiatry, UFRJ, INCT-TM. Electronic address: pinho.natalia@yahoo.com.br.
authors.forename: Natalia
authors.initials: N
authors.lastname: Pinho de Oliveira Ribeiro
authors.forename: Alexandre
authors.initials: A
authors.lastname: Rafael de Mello Schier
authors.forename: Ana Claudia
authors.initials: AC
authors.lastname: Ornelas
authors.forename: Christina Maria
authors.initials: CM
authors.lastname: Pinho de Oliveira
authors.forename: Antonio Egidio
authors.initials: AE
authors.lastname: Nardi
authors.forename: Adriana Cardoso
authors.initials: AC
authors.lastname: Silva
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001007:Anxiety / Q000139:chemically induced / Q000453:epidemiology / Q000523:psychology*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000139:chemically induced / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000494:pharmacology / Q000627:therapeutic use; D007555:Isoxazoles / Q000494:pharmacology / Q000627:therapeutic use; D000077339:Leflunomide; D008297:Male; D008727:Methotrexate / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D059020:Suicidal Ideation
chemical_list: D018501:Antirheumatic Agents; D007555:Isoxazoles; D006886:Hydroxychloroquine; D000077339:Leflunomide; D008727:Methotrexate