If you've been diagnosed with an inflammatory condition, you may have been prescribed Humira, also known as adalimumab, to reduce inflammation and halt disease progression. Humira comes with a number of potential physical side effects, and you should maintain regular communication with your health care provider about how you're feeling. It's also important to be aware of your mental health while you're taking Humira. Stress and anxiety are a normal part of any medical diagnosis, especially chronic illness, but is there a proven medical connection between Humira and anxiety? Let's dive into the science to find out. 

What Does Humira Do? 

Adalimumab is one of a class of drugs known as TNF inhibitors. Tumor necrosis factor (TNF) is a proinflammatory cytokine, or signaling protein, that plays a role in normal immune response. In excess, though, TNF can cause an inflammatory cascade that may contribute to the development of autoimmune diseases such as rheumatoid arthritis. Humira and other TNF inhibitors block TNF from binding to its receptors on cells around the body, and keep it from stimulating further inflammation. Humira and other TNF alpha inhibitors are used to treat: 

• rheumatoid arthritis
• psoriatic arthritis
• psoriasis
• spondyloarthritis
• juvenile arthritis
• inflammatory bowel disease
• Crohn's disease
• ulcerative colitis  

(Source, Source, Source)

Why Take Humira?

If you have an inflammatory rheumatic disease, you might switch to or add a biological disease-modifying anti-rheumatic drug (bDMARD), such as Humira, if: 

• You have new symptoms, such as fatigue, stiffness, or swelling.
• The medication you’re on isn't working after several months.
• The side effects of current medication are intolerable or life-threatening. 
• Blood work is worrisome (for example, low white blood cell count or liver problems).
• Your rheumatoid arthritis is coming out of remission.
• There’s a change in your diagnosis, an additional diagnosis, or a new medication.

(Source)

Side Effects of Humira 

Humira’s common side effects, which tend to be mild and go away as your body adapts to the medication, include: 

• injection site reactions such as redness, itching, pain, bruising, swelling, or bleeding
• headache
• back pain
• stuffy nose and other signs of a common cold
• sinus pain
• stomach pain

(Source, Source)

There are more serious and rarer side effects associated with Humira, many of which can be influenced by current medical conditions, medical history, and family history. These include: 

• heart issues, such as arrhythmia, pericardial effusion, and tachycardia 
• lymphoma, basal, and squamous cell skin cancer 
• multiple sclerosis 
• infections, including fungal infections, urinary tract infections, and the reactivation of certain viruses, such as tuberculosis 
• liver injury and recurrence of hepatitis B 
• drug induced lupus
• pancytopenia, or reduced number of blood cells and platelets
• allergic reactions, such as shortness of breath, bruising, bleeding, paleness, rash, and hives 

(Source, Source, Source, Source, Source,  Source) 

Chronic Illness and Mental Health

Having a chronic illness increases the likelihood that you'll suffer from mental health issues such as anxiety, depression, and stress. Depression is common among those with autoimmune conditions such as:

• lupus
• rheumatoid arthritis
• psoriasis 

Anxiety and depression are comorbidities, which means that the conditions often exist in the same person. Those with chronic illnesses also often suffer from fears that their condition will recur or become worse. These fears can have a negative and lasting impact on your quality of life, and can also exacerbate the symptoms of your illness. (Source, Source, Source) 

Inflammation and Mental Health 

There’s science to support the relationship between inflammation and depression, specifically that depression is associated with chronic and low-grade inflammation, and that certain inflammatory conditions can trigger clinical depression. These conditions include: 

• chronic obstructive pulmonary disease
• cardiovascular disease 
• autoimmune disorders, such as systemic lupus erythematosus and rheumatoid arthritis 
• multiple sclerosis 
• Parkinson’s disease

Those with autoimmune conditions have higher levels of proinflammatory cytokines in their blood, which can affect mood and energy levels, causing fatigue as well as changes to appetite and disruption of sleep. 

Anxiety is associated with patients with rheumatic diseases, such as rheumatoid arthritis (RA), that affect the joints, tendons, muscles, and bones. Researchers have looked at whether anxiety and depression in RA could be related to the presence of various inflammatory markers. One theory is that chronic RA pain could cause the release of a neurotransmitter known as substance P, which indirectly stimulates the production of inflammatory cytokines. More research is needed to determine if there is a relationship between inflammation and anxiety. (Source, Source, Source, Source)

Anxiety and Humira 

Anxiety isn't listed as a side effect of adalimumab, but there are some reasons why you might experience anxiety while taking Humira. Let's take a look. 

Biologics and Mental Health 

A study published in 2022 found people with inflammatory rheumatic diseases who were started or restarted on bDMARDs such as adalimumab also often needed medication for depression and anxiety. This may be because bDMARDs are used when chronic, painful symptoms of rheumatic disease are not well-controlled, which can take a toll on mental health, or because having depression and/or anxiety can mean symptoms are experienced as more severe. (Source)

However, bDMARDs themselves are not believed to contribute to depression or anxiety. To the contrary, many people find their mental health improves with bDMARD treatment, whether that’s due to improvement in symptoms or to reduction of underlying inflammation. 

COVID-19 

In a study of patients with rheumatoid arthritis who were taking adalimumab and other synthetic and biologic DMARDS during COVID-19, the incidence of depression and anxiety were slightly higher than that of the general population. According to the World Health Organization, overall rates of anxiety and depression increased by 25% worldwide during COVID, and one study found levels of fear and anxiety were higher for people who were female, divorced or widowed, or middle-aged with chronic diseases. Since Humira is an immunosuppressant, and those with weakened immune systems are of particular risk of being hospitalized for COVID-19, the combination of a global pandemic and physical vulnerability could cause or increase anxiety. (Source, Source, Source) 

Depression, Anxiety, and TNF 

A 2021 study published in the journal Rheumatology found that people with axial spondyloarthritis (a type of arthritis that affects the spine) who had depression or anxiety responded poorly to treatment with TNF inhibitors, compared with those who had few if any mental health concerns. It’s very common to have both depression and anxiety at the same time, but the study also looked at participants with just one or the other and found anxiety was more likely than depression to cause a patient to discontinue TNF treatment. The researchers concluded that treating depression and anxiety before starting treatment with a TNF would likely improve patient outcomes. (Source, Source) 

Can Humira Have a Positive Effect on Mental Health?

Relieving the symptoms of chronic illness is crucial when it comes to improving and maintaining mental health. Patients with inflammatory bowel disease (IBD) experience anxiety and depression at up to 3 times the rate of the general population, and those with depression and anxiety are likely to have more symptoms of the disease. When an anti-inflammatory drug like adalimumab is effective, it works to improve both IBD symptoms and anxiety and depression. Additionally, anti-TNF therapy has been shown to reduce fatigue and emotional stress. 

While finding the right medication to alleviate your symptoms is vital, drugs alone may not be enough to relieve anxiety and depression. This is especially true if you live with a chronic illness, such as IBD or RA, that is connected to mental health concerns. Fortunately, there’s more you can do to support your mental health while living with an autoimmune condition. (Source, Source)

Managing Your Mental Health While on Humira 

We've established that chronic illness and mental health challenges often occur together, but conditions such as anxiety and depression often go undiagnosed when a health care provider is focused on alleviating physical symptoms. Taking care of yourself when you have depression and/or anxiety is challenging, and it can be even more so when you're living with chronic illness. Here are some tips for how to manage. 

Talk to Your Provider 

Anxiety, depression, and all aspects of mental health remain deeply stigmatized, and you might feel some shame at the thought of bringing concerns about your psychological health to your provider’s attention. Being open with how you’re feeling and how your thoughts are affecting your well-being and daily life is an essential step to healing your body and mind. Keep a list of any symptoms you’re concerned about, and share it with your provider. 

Exercise (as You Are Able) 

Aerobic exercise such as swimming, walking, and even gardening has a positive impact on your mood and has been proven to reduce anxiety and depression. Unfortunately, it can be difficult to exercise when you’re anxious, especially if you have a chronic illness that impacts your mobility. Ask your health care provider to recommend exercises you can incorporate into your daily routine, as well as how to modify them when you’re not feeling like going all out. (Source)

Consider Including and Avoiding Certain Foods

Eating when you’re depressed or anxious is difficult, and that’s compounded when you’re in physical pain. It’s a good idea to have nourishing foods such as fruits, vegetables, nuts, seeds, and yogurt prepared ahead of time and available so you can eat well even if you don’t feel up to being active. Hydration is also super important, so be sure to keep water close by your bed or the space where you're resting.

Additionally, adding anti-inflammatory foods into your diet and cutting down on certain other foods can help alleviate your psychological and physical symptoms. 

Anti-inflammatory foods include: 

• nuts
• green, leafy vegetables such as kale and collards
• fatty fish such as salmon, tuna, and sardines
• colorful fruits such as strawberries, blueberries, and cherries

(Source)

Consider avoiding foods that aggravate inflammation and symptoms of anxiety, such as: 

• sweetened sodas, juices, and iced teas
• food additives 
• refined carbohydrates, such as bread, pasta, and breakfast cereal
• processed and packaged meats, meals, and snacks
• dairy products
• Caffeine stimulates your central nervous system, and can cause effects that feel a lot like anxiety and even panic attacks. It may also interfere with sleep, which can exacerbate depression and anxiety and can make anxiety medications less effective. (Source, Source)
• Alcohol can also worsen your anxiety symptoms, and regular consumption can interfere with neurotransmitters in the brain that regulate function and behavior. Alcohol may also reduce the efficacy of antianxiety and antidepressant medication, as well as medication you might take for autoimmune conditions. (Source, Source)

The Bottom Line 

While Humira treats conditions such as IBD and rheumatoid arthritis that are tied to anxiety and depression, it doesn’t cause anxiety. Rather, when it’s applied successfully, it has been shown to alleviate not only symptoms of autoimmune conditions but also of anxiety and depression. It is vital that your provider address any mental health concerns you have along with your ongoing autoimmune symptoms, as they may be related to the stress of living with chronic illness. 

You don’t have to do all this alone. In fact, trying to juggle taking care of your mental health when you're coping with a chronic illness and attempting to live your life can be overwhelming. It’s important to have people on your side, ready to listen and encourage you. WellTheory’s Care Team, including our Nutritional Therapy Practitioners, can support you through making changes, evaluating next steps, and finding a community of others who share your experiences.

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