Sjögren's disease and depression

Depression is a major and under-recognized comorbidity in Sjögren's disease, contributing to disease burden and impaired quality of life. This narrative review summarizes current evidence regarding the prevalence, pathophysiological mechanisms, clinical impact, assessment, and treatment of depression in patients with Sjögren's disease. Reported prevalence rates range widely from 3.2% to 78.6%, largely owing to methodological heterogeneity, although meta-analytic data demonstrate a significantly increased risk of depression in patients with Sjögren's disease than in healthy controls. Etiology is multifactorial, involving chronic pain, fatigue, dryness, psychosocial stressors, and immune-mediated mechanisms. Elevated inflammatory cytokines, altered serotonergic pathways, antibodies, gut dysbiosis, and neuroimaging abnormalities are the potential underlying links to depression. Furthermore, depression is associated with greater symptom burden, autonomic dysfunction, sleep disturbances, fatigue, reduced health-related quality of life, and impaired functional status. Patient-reported outcomes often correlate more closely with depression than with systemic disease activity. Although several screening instruments are available, their validation in patients with Sjögren's disease remains limited. Management requires a multidisciplinary approach integrating psychological interventions, lifestyle modification, and pharmacologic treatment. Selective serotonin reuptake inhibitors and other agents with low anticholinergic burden are preferred. Optimization of systemic disease control may provide additional benefits. Early recognition and comprehensive management of depression are essential to improve outcomes in patients with Sjögren's disease.