Ehlers-Danlos Syndrome and Depression: Why They Often Overlap and How Psychiatry Can Help

If you live with hypermobile Ehlers-Danlos syndrome or a hypermobility spectrum disorder, you already know how much it can take out of you. Pain, fatigue, poor sleep and years of searching for answers can wear down anyone's mood. If you're wondering about the link between Ehlers-Danlos and depression, you're not imagining it, and you deserve care that takes both your body and your mental health seriously.

Key takeaways

• Research has observed that anxiety, depression, ADHD and autism appear more often in people with hypermobility conditions than in the general population.
• Chronic pain, fatigue, dysautonomia such as POTS, and long, frustrating diagnostic journeys can all contribute to depression and anxiety.
• Depression alongside Ehlers-Danlos is real and treatable. It isn't a sign that your physical symptoms are "all in your head."
• Coordinated care with rheumatology, genetics, cardiology and your other specialists helps your treatment fit together.
• People with hypermobility conditions may be more sensitive to medication side effects, so a careful, gradual approach often works best.

If you're struggling right now: If you have thoughts of harming yourself, call or text 988 to reach the Suicide and Crisis Lifeline. Call 911 in an emergency, or text HOME to 741741. You can find more options on our crisis resources page.

What are hEDS and hypermobility spectrum disorders?

Ehlers-Danlos syndromes are a group of genetic conditions that affect connective tissue, the material that supports skin, joints, blood vessels and organs. There are several types. You can read an overview of them on MedlinePlus Genetics.

Hypermobile EDS (hEDS) is the most common type. Unlike many other types, it doesn't yet have a known genetic test, so it's diagnosed based on clinical criteria, such as joint hypermobility, skin and tissue features, and family history.

People who have symptomatic joint hypermobility but don't meet the full criteria for hEDS may be diagnosed with a hypermobility spectrum disorder (HSD). The symptoms and daily challenges can be just as real.

The link between Ehlers-Danlos and depression

Researchers have noticed for years that mental health conditions seem to show up more often in people with joint hypermobility. Anxiety has been studied the most, and depression, ADHD and autism have also been reported more frequently in people with hEDS and HSD.

Scientists are still working to understand why. Part of the link likely comes from what it's like to live with a chronic condition. Some researchers are also exploring whether shared biology, such as differences in the nervous system or in how the body senses internal signals, plays a role.

If you or your child has hEDS and also struggles with attention or social differences, our post on ADHD vs. autism explains how those two conditions compare.

What can contribute to depression and anxiety with hEDS

Depression rarely has a single cause. With hEDS and HSD, several factors often stack up.

Chronic pain

Ongoing joint and muscle pain can disrupt sleep, limit activity and make it hard to enjoy things. Pain and depression also tend to feed each other. Pain can lower mood, and low mood can make pain feel worse.

Fatigue

Many people with hEDS describe deep, persistent tiredness that rest doesn't fix. Fatigue overlaps with symptoms of depression, which can make it hard to tell where one ends and the other begins.

Dysautonomia and POTS

Dysautonomia means the autonomic nervous system, which controls things like heart rate and blood pressure, isn't regulating well. Postural orthostatic tachycardia syndrome (POTS) is a common example in people with hEDS.

POTS can cause a racing heart, dizziness, shakiness and brain fog when standing. Those symptoms can feel a lot like anxiety or panic, and they can also limit daily life in ways that affect mood.

Medical gaslighting and long diagnostic journeys

Many people with hEDS spend years seeing different doctors before getting a diagnosis. Along the way, some are told their symptoms are stress, anxiety or exaggeration. Being dismissed again and again can leave you feeling hopeless, isolated or wary of doctors.

That history matters. A psychiatric provider who understands it can help you feel heard, not dismissed. Treating depression or anxiety doesn't mean your physical symptoms aren't real. Both deserve care.

Why integrated care matters

hEDS affects many body systems, so people often see several specialists. When those providers don't talk to each other, treatments can conflict or important details get missed.

Integrated care means your providers share information and plan together. Depending on your needs, that may include:

• Rheumatology to evaluate joint symptoms and rule out other conditions
• Genetics to confirm the type of EDS and rule out types that need specific monitoring
• Cardiology to evaluate POTS, heart rate and blood pressure concerns
• Your primary care doctor to keep the overall picture in view

A psychiatric provider can be part of this team. With your permission, we can coordinate with your other providers so medications and plans work together. Our integrative psychiatry approach also looks at sleep, nutrition and lab work, such as iron, vitamin B12 and vitamin D, that can affect energy and mood.

Medication considerations with hEDS

Medication can be a helpful part of treating depression and anxiety, including for people with hEDS. A few general considerations often shape the plan.

• Sensitivity to side effects. Many people with hypermobility conditions report being sensitive to medications. Starting at a low dose and increasing slowly is a common approach.
• Orthostatic effects. Some medications can lower blood pressure or cause dizziness when standing, which may worsen POTS symptoms. Examples include some older antidepressants, some antipsychotics, and certain blood pressure medications sometimes used in psychiatry.
• Heart rate and blood pressure. Some medications, such as stimulants used for ADHD and some antidepressants, can raise heart rate or blood pressure. That may matter if you have POTS.
• Bruising and bleeding. Some people with hEDS bruise easily. SSRIs and SNRIs can slightly raise bleeding risk, especially when taken with NSAIDs like ibuprofen.
• Interactions. If you take medications for POTS, pain or digestive symptoms, your prescriber will check how they interact.

Antidepressants carry an FDA boxed warning about a possible increase in suicidal thoughts and behaviors in children, teens and young adults, especially early in treatment or after dose changes. Your provider will talk with you about what to watch for.

Always talk with your prescriber before starting, stopping or changing any medication.

How psychiatry can help

A psychiatric provider can help you sort out which symptoms point to depression or anxiety, which come from hEDS or POTS, and where they overlap. From there, you can build a plan together.

That plan may include a careful diagnosis, medication when appropriate, attention to sleep and nutrition, and coordination with your other specialists. When skills-based support for coping with chronic illness would help, we can refer you to a trained mental health professional. To learn more about how we approach mood care in general, see our guide to depression treatment in Chicago.

The National Institute of Mental Health also offers general information about depression symptoms and treatment.

Frequently asked questions

Does having Ehlers-Danlos cause depression?

Not directly, and not everyone with EDS develops depression. But hEDS is associated with higher rates of depression and anxiety, likely due to a mix of chronic symptoms, life stress and possibly shared biology.

Can POTS symptoms be mistaken for anxiety?

Yes. A racing heart, shakiness and dizziness can look like anxiety or panic. A careful evaluation, often with input from cardiology, helps tell them apart. Some people have both.

Are antidepressants safe for people with hEDS?

Many people with hEDS take antidepressants safely. Your provider will consider your other conditions, medications and sensitivity to side effects when choosing one, and will usually start low and go slow.

Should my psychiatrist know about my hEDS diagnosis?

Yes. Sharing your full medical history, including hEDS, HSD or POTS, helps your provider choose medications wisely and understand your symptoms in context.

Care that sees the whole picture

Living with hEDS is hard enough without feeling dismissed. At Musec Medical, our psychiatrist and psychiatric physician assistants take a whole-person approach, in person in Chicago and by telehealth anywhere in Illinois. Learn more about integrative psychiatry or get started today.