In the March issue of Harper’s Bazaar, Selena Gomez reveals that her top priority in 2018 is to focus on her well-being. “I’ve had a lot of issues with depression and anxiety, and I’ve been very vocal about it,” she said, “but it’s not something I feel I’ll ever overcome.”1

“I think it’s a battle I’m gonna have to face for the rest of my life, and I’m okay with that because I know that I’m choosing myself over anything else,” she continued. “I’m starting my year off with that thought. I want to make sure I’m healthy. If that’s good, everything else will fall into place.”

Last summer Gomez revealed that she underwent a kidney transplant due to complications from the auto-immune disease lupus.2  Soon after, Gomez opened up about to The Today Show about her longtime battle with pain, anxiety and depression, which she said stemmed from her lupus.3

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In January, citing emotional difficulties related to the transplant and family issues, Gomez checked into a treatment facility in New York City for two weeks to tackle anxiety and depression, according to The Blast.4

At the facility, Gomez underwent therapy, ate healthy meals and took pilates and meditation sessions. “She felt like she needed to get away and focus on herself with no distractions,” a source close to Gomez told PEOPLE. “She came back feeling very empowered.”5

This was Gomez’s second in-patient treatment for her emotional health.

A year ago, Gomez revealed to Vogue in its April 2017 issue that after she canceled her tour in the summer of 2016, she entered a treatment facility in Tennessee for help with depression, anxiety and panic attacks.

She also told Vogue that sees her therapist five days a week, and “is a profound believer in Dialectical Behavior Therapy.”

The treatment, first developed for patients with borderline personality disorder, is now used to treat other conditions including depression by cultivating mindfulness, teaching communication skills and developing the cognitive tools to regulate emotions.6

“DBT has completely changed my life,” she told Vogue. “I wish more people would talk about therapy.”

Lupus is an autoimmune condition in which the immune system creates antibodies that attack healthy cells in the body. It can have symptoms including fatigue, weight loss and two or more painful joints, with pain lasting for many weeks.7

According to The Johns Hopkins Lupus Center, depression and anxiety are found in almost one-third of all people with lupus.8

It can be caused by the disease itself, by medications used to treat the disease, or by inadequate coping mechanisms.9

But it’s actually quite rare to enter a facility due to lupus-related mental distress, says rheumatologist and lupus researcher Dr. H. Michael Belmont, a professor of medicine at NYU Langone Health.10

(Belmont notes he has not interviewed, examined or seen the chart of Gomez, and is speaking generically.)

“I’ve treated 3,000 lupus patients,” he says, “and maybe a half dozen at some point had the equivalent of a mental complication that is as Selena described.”

How Gomez handled her lupus diagnosis could have been a factor in triggering her emotions, says Belmont.

“People with chronic diseases, such as cancer, multiple sclerosis, cystic fibrosis, disfiguring skin diseases, they can become anxious and depressed because no one likes that feeling,” Belmont says.

“She was a high functioning famous entertainer and when you become ill it changes the quality of your life,” he continues.

“I think she had a serious illness that compromised her quality of life, changed her morale and ability to function and be on the stage and that in a more indirect way led to anxiety and panic attacks or whatever she described to the public.”

Gomez’s distress could be a result of persistent emotional stressors, says David Cosio, PhD, a psychologist and pain specialist.11 “Depression also has a relationship with anxiety,” he says, noting that this synergy could contribute to physical symptoms such as headaches, stomach pains, and the “inflammatory picture” of lupus.

With pain a hallmark of lupus sufferers, does depression and anxiety typically trigger pain or is it the other way around?

“It’s the classic chicken and egg problem to determine the direction of causation between pain and mood disorders,” Cosio says.

As for keeping anxiety and depression at bay, Cosio says that a variety of cognitive and behavioral treatment (CBTs) approaches have been studied for chronic pain and anxiety, including breathing control, muscle relaxation, exposure therapy, and hypnosis.

He adds that four major classes of medications—selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants (TCAs), and benzodiazepines—also may be helpful in the treatment of anxiety disorders.

“However, ” he says, “when treating anxiety in people who suffer from chronic pain, prescribing a benzodiazepine and an opioid concurrently generally is discouraged.”

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Last Updated: Feb 22, 2018