Depression in Sjögren Disease: Prevalence, Screening, and Treatment

Depression is common in Sjögren disease (SjD) but often goes unrecognized, adding to disease burden and eroding quality of life, according to a narrative review published in the Journal of International Medical Research. The authors argue that depression should be treated as an integral part of SjD rather than an incidental comorbidity, and they call for routine screening and multidisciplinary care.¹

SjD is a chronic systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands. Its prevalence ranges from 0.04% to 1%, and it occurs most often in women older than 40 years. Beyond ocular and oral dryness, patients frequently report anxiety, sleep disturbance, and cognitive symptoms, and they report more distress than patients with systemic lupus erythematosus or rheumatoid arthritis.

How Common Is Depression in Sjögren Disease?

Most studies report depression prevalence in SjD of 3.2% to 40%, although 1 study using a low Beck Depression Inventory cutoff reported 78.6%. The authors attribute the spread to differences in instruments, cutoffs, and patient populations. A 2018 meta-analysis of 12 studies including 1917 patients found that those with SjD had more than 5 times the odds of depression compared with controls (odds ratio [OR], 5.36; 95% CI, 4.05-7.09). A 2015 nationwide cohort study from Taiwan found an increased risk of incident depressive disorder after diagnosis (hazard ratio, 1.8; 95% CI, 1.4-2.3), and the authors recommend surveillance, especially during the first 5 years.

A separate 2026 retrospective, single-center study from China, published in World Journal of Psychiatry, adds context. Among 286 patients with Sjögren syndrome, 54.5% had a psychological disorder: 20.3% had depression alone, and 21.0% had comorbid depression and anxiety. Independent risk factors included peripheral neuropathy (OR, 3.42), a European Alliance of Associations for Rheumatology (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI) score of 12 or higher (OR, 2.67), and interstitial lung disease (OR, 2.15).² Its design limits comparison with cohorts in the review, several of which found depression tracked patient-reported symptoms more closely than ESSDAI scores.¹

What Drives Depression in Sjögren Disease?

The review describes a multifactorial etiology. Chronic pain, fatigue, and dryness act as persistent stressors, and approximately 30% of patients also have fibromyalgia. Proposed biological links include elevated interleukin 6 levels, cytokine-driven diversion of tryptophan away from serotonin synthesis, gut dysbiosis, white matter lesions, and anti-Ro52 antibodies. The authors caution that most of this evidence is cross-sectional and should be considered hypothesis-generating.

Among 639 patients, pain and depression together explained 48% of the variability in EuroQol-5 Dimension utility values. In a UK registry of 1046 patients, depression was 1 of several independent predictors of autonomic dysfunction, along with anxiety, dryness, and pain. The authors also describe depression as contributing to reduced treatment adherence, higher medical costs, and lost productivity.

Depression Screening Tools Lack Validation in Sjögren

The Patient Health Questionnaire-9 (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS) are the most widely used screening instruments, but none has been rigorously validated in SjD. Somatic items such as fatigue and sleep disturbance can inflate scores. The HADS depression subscale excludes somatic items, and a cutoff score of 10 or greater, drawn from general hospital populations, may be useful for screening.

Choosing Antidepressants That Won't Worsen Dryness

EULAR recommendations identify depression as a comorbidity to evaluate in patients with fatigue or pain. The authors recommend combining psychotherapy, such as cognitive behavioral therapy and mindfulness-based stress reduction, with lifestyle modification and pharmacotherapy. Selective serotonin reuptake inhibitors are considered first-line agents. Drugs with a high anticholinergic burden, including paroxetine and tricyclics, can worsen sicca symptoms; the authors advise avoiding paroxetine and reserving amitriptyline for refractory neuropathic pain.

Evidence that disease control improves mood is indirect. In a cohort of 1000 patients with various autoimmune diseases, 84 of whom had SjD, mean PHQ-9 scores were 6.78 with biologic disease-modifying antirheumatic drugs, 10.66 with conventional synthetic agents, and 9.05 with no systemic treatment. These cross-sectional data cannot separate treatment effects from patient differences, and the authors emphasize that immunosuppression should not be initiated for depression alone. Although the evidence remains largely observational, the authors concluded that "early recognition and comprehensive management of depression are essential" to improving outcomes in patients with SjD.

References

1. Galindo-Donaire JR, Vázquez-Hernández AE, Hernández-Molina G. Sjögren's disease and depression. J Int Med Res. 2026;54(10):1-11. doi:10.1177/03000605261494354
2. He GQ, Yu CY, Xu BY, et al. Incidence, risk factors, and correlation with organ involvement of psychological disorders in patients with Sjögren's syndrome. World J Psychiatry. 2026;16(7):120249. doi:10.5498/wjp.120249