Symptoms of Multiple Sclerosis: Depression

Depression—a condition marked by persistently low mood and a loss of interest or pleasure in daily activities—is common among people living with MS, adding significant burden to their well-being. It is challenging to detect depression in individuals with MS, as a distinction must be made between depression as a symptom of MS and as an individual syndrome. Two questions patients should ask themselves: During the past two weeks, have you often felt down, depressed, or hopeless? During the past two weeks, have you had little interest or pleasure in doing things? If they answer “yes” to either or both questions, they may be experiencing depression If they answer “no” to these questions, but have low mood, they may be experiencing normal grieving or other emotional changes. People with MS may experience losses—for example of the ability to work, to walk or to engage in certain leisure activities—and the process of mourning for these losses may resemble depression. However, grief is generally time-limited and resolves on its own. Moreover, a person experiencing grief may at times be able to enjoy some of life’s activities. In the face of MS, people may tend to focus primarily on their physical health and neglect their emotional health, which is an essential component of overall health and wellness. A study on “MS quality of life, depression, and fatigue improve after mindfulness training” is the largest of its kind in MS. This study showed health-related quality of life (HRQOL) is often much reduced among individuals with MS, and that the incidence of depression, fatigue and anxiety are high. The authors examined effects of a mindfulness-based intervention (MBI) compared to usual care (UC) upon HRQOL, depression, and fatigue among adults with relapsing-remitting or secondary progressive MS. An article was published by Dr. Anthony Feinstein and colleagues a while back looking into the link between MS and depression Upon evaluation of genetic data collected from people with MS, researchers concluded that the link between genetics and depression in MS remains unclear. Advancements in imaging technology have pointed to specific structural changes in the brain that may be associated with depression, however this information provides only a piece of the larger puzzle of how and why depression commonly arises in people with MS. Treatment of MS-related depression requires further investigation: antidepressants are modestly effective, but adverse effects can preclude adequate dosing; cognitive–behavioural therapy is also effective. Also, randomized trials must address whether combining treatments improves outcomes. Depression can occur in any person with MS, at any point in the course of the disease. People with MS who are more severely disabled are not necessarily more likely to be depressed. Depression does not indicate weakness of character and should not be considered something shameful that needs to be hidden. A person cannot control or prevent depression with willpower or determination. Left untreated, depression reduces quality of life, makes other symptoms—including fatigue, pain, cognitive changes—seem worse, and may be life-threatening. While the nature of depression in MS is not fully understood, many factors seem to contribute to it, including: Reaction to difficult life situations or stresses: It is easy to understand how a diagnosis of MS can bring on depression. Major transition points: following diagnosis, during an exacerbation or when a major change in function or abilities occurs. The MS disease process itself: When MS damages areas of the brain that are involved in emotional expression and control, a variety of behavioral changes can result. MS-related changes that occur in the immune and/or neuroendocrine systems: There is some evidence that changes in mood are accompanied by changes in certain immune parameters. Side effects of some medications: corticosteroids and possibly interferon medications may trigger or worsen depression in susceptible individuals. Coping strategies Coping with life challenges, with MS, and/or with depression (if you’re experiencing it) can be difficult. Think about your overall wellness and try a thing or two. Here are some ideas: Exercise daily. Reduce stress in your life and strive to manage inevitable stresses more calmly. Try breathing exercises and meditation. Maintain your social networks. Call your friends. Join a support group. Spend time with family. Stay in touch with your medical team. Acknowledge your feelings. Get a notebook and write. Make a list of your stressors so you can stop thinking about them for a bit. Stay away from addictive substances such as alcohol. Clinical depression It’s important to distinguish between mild, everyday “blues” (that we all experience from time to time) grief, and clinical depression. The two questions to ask yourself (from paragraph one, above) may help. Clinical depression is persistent and unremitting, with symptoms lasting at least two weeks and sometimes up to several months. It’s a serious condition, diagnosed by a mental health professional, that produces flare-ups known as major depressive episodes. Symptoms include: Sadness and or irritability Loss of interest or pleasure in everyday activities Loss of appetite—or increase in appetite Sleep disturbances—either insomnia or excessive sleeping Agitation or slowing in behavior Fatigue Feelings of worthlessness or guilt Problems with thinking or concentration Persistent thoughts of death or suicide Pharmacological treatments: When depression occurs, it deserves the same careful assessment and treatment as any other symptom of MS. People who are depressed often withdraw from activities; and the resulting lack of stimulation further reduces their quality of life, creating a downward spiral. Several antidepressant drugs (some are listed below) are available for use under the supervision of a physician. There is wide variability in response to antidepressant drugs and it may be necessary to try different medications and doses before an effective medication, or combination of medications is found. As always, checking with your pharmacist for any potential drug-drug interaction is highly recommended. Patients are also encouraged to engage pharmacist when selecting over the counter mood medications or herbs. Citalopram Duloxetine hydrochloride Velafaxine Paroxetine Fluoxetine Bupropion Sertraline Suicidal feelings Severe depression can be a life-threatening condition because it may include suicidal feelings. One study found that the risk of suicide was 7.5 times higher among persons with MS than the general population. If you are having thoughts about harming yourself or feel you are at risk of hurting yourself or someone else, call the National Crisis Hotline at 988 or 1-800-273-TALK (800-273-8255) in the USA or Talk suicide Canada 1-833-456-4566. For an emergency, call 911. References: 1. MS quality of life, depression, and fatigue improve after mindfulness training. P. Grossman P. Grossman, PhD, L. Kappos, MD, H. Gensicke, MD, M. D'Souza, MD, D.C. Mohr, PhD, I.K. Penner, PhD and C. Steiner, MS. Neurology. 2010;75:1141-1149. Resources: https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Depression https://www.nationalmssociety.org/Treating-MS/Medications https://mssociety.ca/research-news/article/canadian-researchers-explore-recent-evidence-on-depression-in-people-with-ms?gclid=Cj0KCQjw9ZGYBhCEARIsAEUXITXcKJLs7FrNTn4LFP1l0G4WiN9UeW-4-Q5jHKUP12pN5Hp0z9M3QzgaApyyEALw_wcB https://www.nature.com/articles/nrneurol.2014.139 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463050/ https://www.canada.ca/en/public-health/services/suicide-prevention/suicide-canada.html https://talksuicide.ca

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Symptoms of Multiple Sclerosis: Depression

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Nancy Banoub

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