Gout and Depression: Is There a Link?

Although gout – first identified in 2640 BC – was among the earliest diseases identified as a clinical entity,¹ much remains unknown about the condition. In recent years, researchers have examined a potential link between the inflammatory arthritis and mood disorders such as depression. We review recent clinical evidence on the subject.

Gout and Depression

A number of notable studies on gout and depression have been published over the past few years. One such study, published in Medicine in 2015, concluded that gout significantly increases the risk of depressive disorders. Researchers sampled data from the National Health Insurance Research Database on 34,050 patients with gout and 68,100 controls. They found that patients with gout had a 1.18-fold higher risk of depression.²

However, that same year, a study in the Scandinavian Journal of Rheumatology found no association between the two. Investigators matched 1689 patients with gout with 6756 patients without the condition. They found an incidence rate of depression of 10.8 per 1000 person-years for individuals with gout and 10 per 1000 person-years for matched controls. “This study provides new evidence of a lack of an association between common mental health problems and gout,” the researchers concluded.³

A year later, a study in Joint Bone Spine revealed that patients who experience frequent gout attacks are likely to experience depressive symptoms, whether or not they take allopurinol. The researchers examined 1184 participants aged ≥18 years with gout that was managed in the primary care setting in the United Kingdom. Prevalence of depression in these patients was 12.6%, and an association was observed between gout attack frequency and depression.⁴

In 2017, researchers published a systematic review and meta-analysis involving 7 studies and 411,745 participants in the International Journal of Psychiatry. A pooled analysis revealed that patients with gout are nearly 20% more likely to experience depression.⁵

In 2018, researchers established a “substantial prevalence” of depression among patients with gout. They found that patients with gout were nearly 10% more likely to experience depression compared with the general population. Their findings were presented at the 2018 ACR/ARHP Annual Meeting.⁶

Bottom Line

Most recent clinical findings suggest an association between gout and depression. However, as some of the investigators in these studies noted, further research is needed to determine causality and identify potential targets for intervention.

References

1. Nuki G, Simkin PA. A concise history of gout and hyperuricemia and their treatment. Arthritis Res Ther. 2006;8(Suppl 1):S1.
2. Changchien T-C, Yen Y-C, Lin C-L, Lin M-C, Liang J-A, Kao C-H. High risk of depressive disorders in patients with gout: a nationwide population-based cohort study. Medicine. 2015;94(52):e2401.
3. Prior JA, Ogollah R, Muller S, Chandratre P, Roddy E, Mallen CD. Gout, anxiety, and depression in primary care: a matched retrospective cohort study. Scand J Rheumatol. 2015;44(3):257-258.
4. Prior JA, Mallen CD, Chandratre P, Muller S, Richardson J, Roddy E. Gout characteristics associate with depression, but not anxiety, in primary care: baseline findings from a prospective cohort study. Joint Bone Spine. 2016;83(5):553-558.
5. Lin S, Zhang H, Ma A. Association of gout and depression: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2018;33(3):441-448.
6. Howren A, Zusman EZ, Rai SK, Shojania K, De Vera MA. Prevalence, incidence, determinants, and impacts of depression and anxiety in gout: a systematic review. Arthritis Rheumatol. 2018;70(suppl 10);1129.