Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease where the immune system mistakenly attacks healthy tissues, causing widespread inflammation. This inflammation can affect virtually any organ system, including the central nervous system. Mood swings, depression, and anxiety are recognized manifestations of lupus, stemming from direct biological attack on the brain, medication side effects, and the psychological burden of chronic illness.
Understanding Neuropsychiatric Manifestations
When lupus directly affects the brain or nervous system, the resulting conditions are collectively termed Neuropsychiatric Systemic Lupus Erythematosus (NP-SLE). Mood disorders, including severe depression, anxiety, and rapid mood changes, are among the most frequent psychiatric symptoms seen in NP-SLE. Up to 90% of people with lupus experience some form of neuropsychiatric symptom, with mood swings affecting over 20%.
The direct involvement of lupus in the central nervous system is a primary biological cause of mood instability. This process involves the immune system generating autoantibodies that may cross the blood-brain barrier. Once these antibodies enter the brain, they can directly attack nerve cells or other supporting cells, leading to inflammation and cellular damage.
Inflammation within the brain is further fueled by the release of pro-inflammatory cytokines. These cytokines can disrupt normal brain chemistry and function, contributing to symptoms like psychosis, cognitive dysfunction, and profound depression. Lupus can also cause vasculitis, the inflammation of small blood vessels, restricting blood flow and oxygen to brain tissues. The presence of active lupus disease, indicated by systemic inflammation, correlates significantly with the severity of depression.
Other Contributing Factors to Mood Instability
Mood swings are not always a sign of a direct lupus flare in the brain; they can also be an indirect result of the treatments used to manage the disease. Corticosteroids, such as prednisone, are frequently prescribed to quickly reduce inflammation during lupus flares and are known to cause psychiatric side effects. These medications mimic the stress hormone cortisol and can significantly affect the brain’s hormonal balance.
Side effects of corticosteroids often include irritability, agitation, anxiety, and noticeable mood swings, sometimes presenting as euphoria followed by depression. The severity of these emotional changes is typically dose-dependent; higher doses used during acute flares are more likely to induce pronounced psychological effects. For some individuals, this effect can manifest rapidly after starting the medication.
Beyond the physiological impacts of the disease and its treatment, the experience of having a chronic, unpredictable illness contributes significantly to mood instability. Lupus is characterized by periods of flares and remission, creating constant uncertainty and anxiety about the future. Chronic symptoms like persistent fatigue, widespread pain, and cognitive issues—often called “lupus fog”—can severely limit a person’s ability to work or socialize, leading to isolation and grief. Studies show that about one-quarter of lupus patients experience major depression, and one-third struggle with anxiety.
Seeking Help and Management Strategies
Managing mood swings or other emotional changes begins with an open conversation with your rheumatologist. It is necessary to determine if the mood changes are a direct symptom of active NP-SLE, a side effect of medication like prednisone, or a psychological reaction to the chronic illness. Addressing the underlying lupus activity, often by adjusting immunosuppressive treatment, can frequently alleviate mood symptoms if they are disease-driven.
If a corticosteroid is suspected, the doctor may attempt to reduce the dose or switch to a different therapeutic agent to minimize side effects. Formal screening for anxiety and depression is important, as these conditions are common in the lupus population and require specific intervention. Mental health specialists, such as psychologists and psychiatrists, play an important role in comprehensive care.
Treatment often involves psychotherapy, with cognitive behavioral therapy (CBT) being an effective method for managing negative thought patterns and developing coping strategies for chronic illness. Pharmacological options, including anti-depressants or anti-anxiety medications, can also be used to improve mood, energy levels, and emotional balance. Non-pharmacological strategies complement medical treatment and include:
- Prioritizing sleep hygiene.
- Engaging in low-impact physical activity like yoga.
- Practicing stress-reduction techniques such as mindfulness.
- Journaling.