Depression
and multiple sclerosis (MS) often coexist and can contribute to each
other. The disease process of MS itself can produce depression, as can
the psychological impact of living with this chronic neurological
concern. Further, some of the symptoms of MS overlap with those of
depression, so it can be hard to know if you are experiencing worsening
of your MS or a bout of depression (either related or unrelated to your disease).
Depression can make it hard for you to function at your best, making the effects of your MS all the more difficult to manage, so it's important to be aware of these connections and to get help if you need it.
SYMPTOMS
Almost everybody feels sad from time to time. And there's no denying that living with MS may add to these feelings. But clinical depression is longer lasting and more severe than sadness and is often accompanied by other symptoms.
You should talk to your doctor if you experience any of the symptoms of depression. Given some of the overlap with MS, it's easy to chalk them up to your disease. But it's important that a professional determine exactly why you feel the way you do.
MOOD CHANGES: MS can manifest with mood changes as well as irritability and unexplained crying. If you feel sad, tearful, or irritable most of the time, and if these symptoms last for longer than two weeks, you could also be dealing with depression. With depression in MS, sudden bouts of crying can be triggered by difficulty with motor control and coordination.
APATHY: You may lose interest or pleasure in most of the things you previously liked to do or feel helpless. Apathy is also common in MS.
Appetite changes: Your appetite may decrease or increase. You may lose or gain 5 percent or more of your weight without trying to. MS typically does not affect appetite unless you also have depression.
SLEEP PROBLEMS: Depression can interfere with your sleep; you may have trouble sleeping and/or you may sleep too much. Sleep disturbances are not uncommon in MS.
Psychomotor changes: You may be agitated and restless, or you might move unusually slowly. This is not common with MS, which usually manifests with weak and uncoordinated movements, not with an overall slowing of movements or restlessness.
FATIGUE: You may feel tired and have little to no energy, one of the most common symptoms of MS. Exhaustion, rather than sleepiness, is more prominent if you are depressed and have MS.
FEELINGS of GUILT: You can feel worthless or excessively guilty about things you have done or not done. This is not a typical feature of MS.
COGNITIVE PROBLEMS: You can have trouble concentrating, organizing your thoughts, or making decisions on a regular basis. This clouded thinking is fairly common with MS.
SUICIDAL THOUGHTS: You feel you would be better off dead or have thoughts about killing yourself. MS does not typically cause suicidal thoughts unless you also have depression.
Depressive symptoms may precede an MS exacerbation, so they can be a clue that you need to get medical attention.
CAUSES:
Unfortunately, despite what is known about depression and how common it is, a stigma still exists. Many people feel better knowing that their depressive symptoms are caused by another disease (secondary depression), rather than by primary depression (when depression is the disease).
When you have MS, you may have primary or secondary depression or both. Regardless, depression is always caused by chemical and anatomical changes in the brain—and it is never your fault.
When you have MS, you may have primary or secondary depression or both.
When primary depression is at play, the depressive symptoms stem from a cause other than your MS, such as genetics, grief, drug use, or something else. MS, of course, could compound the impact of primary depression because of its similar symptoms.
With secondary depression related to MS, the demyelination and inflammation associated with the disease slow the communication between nerves in the brain, spinal cord, and optic nerve (which detects visual stimuli). This slowing causes mood changes, as well as the other symptoms of MS, including vision changes, fatigue, and cognitive difficulties.
Additionally, dealing with the disability and practical aspects of MS can bring your mood down. And some experts believe that stress and depression may exacerbate MS symptoms too.
Managing MS seems like an effective solution for this—and it is. But some of the disease-modifying therapies used for MS—such as the interferon therapies Avonex (interferon beta-1a) and Betaseron (interferon beta-1b)—can produce depression as a side effect as well.
DIAGNOSIS:
Depression is a clinical diagnosis. It typically lasts for over two weeks and/or recurs frequently.
Your doctor will ask if you experience sadness, tiredness, pessimism, problems sleeping, and feelings of guilt or hopelessness. You will also be asked whether you have had thoughts of committing suicide or if you have ever attempted to do so.
While many of these questions may be uncomfortable, it's important that you answer honestly.
There is no blood test or biomarker test that can accurately measure depression, but your doctor might give you a list of depression screening questions so you can discuss your answers together.
There are a number of screening tests, including the Beck Depression Inventory and the Rome Depression Inventory. Your doctor may use one of these to see whether your symptoms fit the criteria of a depression diagnosis. These tests can also be used in follow-ups to assess whether your symptoms change with treatment.
SCREENINGS Used to Help Diagnose Depression
If you have both MS and depression, your doctor may discuss tracking the symptoms of each condition to see if they correlate with one another. If there are trends—for example, if you get depressed during your MS exacerbations—you may need to take an antidepressant during those episodes.
Even if you have many of the symptoms of depression, your doctor may check your blood work to rule out health conditions that can mimic depression, such as thyroid disease or anemia.
TREATMENT
The somewhat chicken-and-egg-like relationship between MS and depression is at the root of proper treatment.
Taking care of your MS with the right disease-modifying therapy and treatment for your exacerbations can prevent depression if your MS exacerbations trigger depression. And while treating depression does not change the overall course of MS, addressing it can make the effects of your MS limiting by improving your ability to function at your best.
Whether your depressive symptoms are caused by your MS or not, antidepressants and counseling/psychotherapy can help. The most effective treatment for depression in MS is a combination of both.
MEDICATIONS
The most common types of antidepressants you may be prescribed if you have MS and depression are:
-Selective serotonin reuptake inhibitors (SSRIs):
SSRIs are the most widely prescribed antidepressants and include Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), Paxil (paroxetine), and Lexapro (escitalopram).
-Selective serotonin and norepinephrine reuptake inhibitors (SSNRIs):
Effexor (venlafaxine) and Cymbalta (duloxetine hydrochloride) are two SSNRIs sometimes used to treat depression.
-Tricyclic antidepressants:
The tricyclic antidepressants, such as Elavil (amitriptyline) and Pamelor (nortriptyline), tend to have side effects like drowsiness, constipation or difficulty passing urine. This can make your MS symptoms feel worse. Therefore, they are not usually used as a first-line treatment for depression in MS. However, for treatment-resistant depression, they may be used alone or in combination with other medications.
How your doctor chooses your antidepressant is based on a number of factors, including side effects of the medication, how often it's taken, your most notable or bothersome depressive symptoms, cost, and your preference.
It's important to be aware that antidepressants can take six to eight weeks to reach their full effect.
You should expect to have regular appointments with your doctor so that your level of improvement and side effects can be closely monitored. You may need dosage adjustments, especially in the early stages of your treatment.
PSYCHOTHERAPY
You can talk with your therapist about recognizing the factors that trigger your depression, and you may learn strategies that can help you change your perspective.
While depression is not caused by mindset, adjustments in your way of thinking can reduce some of its symptoms and effects.
Understanding Psychotherapy
There are so many different potential effects of MS that no one experiences all of them. You might not experience any of the emotional effects, such as stress and depression, or they can be a major problem for you.
Knowing what to expect from MS can help you recognize symptoms before they worsen. Sometimes, taking medication or getting counseling at the earliest sign of an MS complication can prevent it from reaching a more severe stage.
***If you are having thoughts of committing suicide, seek emergency medical attention or call the National Suicide Prevention Hotline at 1-800-273-8255.
You can also call the National Crisis Hotline at 1-800-273-TALK or text "ANSWER" to 839863.
Depression can make it hard for you to function at your best, making the effects of your MS all the more difficult to manage, so it's important to be aware of these connections and to get help if you need it.
SYMPTOMS
Almost everybody feels sad from time to time. And there's no denying that living with MS may add to these feelings. But clinical depression is longer lasting and more severe than sadness and is often accompanied by other symptoms.
You should talk to your doctor if you experience any of the symptoms of depression. Given some of the overlap with MS, it's easy to chalk them up to your disease. But it's important that a professional determine exactly why you feel the way you do.
MOOD CHANGES: MS can manifest with mood changes as well as irritability and unexplained crying. If you feel sad, tearful, or irritable most of the time, and if these symptoms last for longer than two weeks, you could also be dealing with depression. With depression in MS, sudden bouts of crying can be triggered by difficulty with motor control and coordination.
APATHY: You may lose interest or pleasure in most of the things you previously liked to do or feel helpless. Apathy is also common in MS.
Appetite changes: Your appetite may decrease or increase. You may lose or gain 5 percent or more of your weight without trying to. MS typically does not affect appetite unless you also have depression.
SLEEP PROBLEMS: Depression can interfere with your sleep; you may have trouble sleeping and/or you may sleep too much. Sleep disturbances are not uncommon in MS.
Psychomotor changes: You may be agitated and restless, or you might move unusually slowly. This is not common with MS, which usually manifests with weak and uncoordinated movements, not with an overall slowing of movements or restlessness.
FATIGUE: You may feel tired and have little to no energy, one of the most common symptoms of MS. Exhaustion, rather than sleepiness, is more prominent if you are depressed and have MS.
FEELINGS of GUILT: You can feel worthless or excessively guilty about things you have done or not done. This is not a typical feature of MS.
COGNITIVE PROBLEMS: You can have trouble concentrating, organizing your thoughts, or making decisions on a regular basis. This clouded thinking is fairly common with MS.
SUICIDAL THOUGHTS: You feel you would be better off dead or have thoughts about killing yourself. MS does not typically cause suicidal thoughts unless you also have depression.
Depressive symptoms may precede an MS exacerbation, so they can be a clue that you need to get medical attention.
CAUSES:
Unfortunately, despite what is known about depression and how common it is, a stigma still exists. Many people feel better knowing that their depressive symptoms are caused by another disease (secondary depression), rather than by primary depression (when depression is the disease).
When you have MS, you may have primary or secondary depression or both. Regardless, depression is always caused by chemical and anatomical changes in the brain—and it is never your fault.
When you have MS, you may have primary or secondary depression or both.
When primary depression is at play, the depressive symptoms stem from a cause other than your MS, such as genetics, grief, drug use, or something else. MS, of course, could compound the impact of primary depression because of its similar symptoms.
With secondary depression related to MS, the demyelination and inflammation associated with the disease slow the communication between nerves in the brain, spinal cord, and optic nerve (which detects visual stimuli). This slowing causes mood changes, as well as the other symptoms of MS, including vision changes, fatigue, and cognitive difficulties.
Additionally, dealing with the disability and practical aspects of MS can bring your mood down. And some experts believe that stress and depression may exacerbate MS symptoms too.
Managing MS seems like an effective solution for this—and it is. But some of the disease-modifying therapies used for MS—such as the interferon therapies Avonex (interferon beta-1a) and Betaseron (interferon beta-1b)—can produce depression as a side effect as well.
DIAGNOSIS:
Depression is a clinical diagnosis. It typically lasts for over two weeks and/or recurs frequently.
Your doctor will ask if you experience sadness, tiredness, pessimism, problems sleeping, and feelings of guilt or hopelessness. You will also be asked whether you have had thoughts of committing suicide or if you have ever attempted to do so.
While many of these questions may be uncomfortable, it's important that you answer honestly.
There is no blood test or biomarker test that can accurately measure depression, but your doctor might give you a list of depression screening questions so you can discuss your answers together.
There are a number of screening tests, including the Beck Depression Inventory and the Rome Depression Inventory. Your doctor may use one of these to see whether your symptoms fit the criteria of a depression diagnosis. These tests can also be used in follow-ups to assess whether your symptoms change with treatment.
SCREENINGS Used to Help Diagnose Depression
If you have both MS and depression, your doctor may discuss tracking the symptoms of each condition to see if they correlate with one another. If there are trends—for example, if you get depressed during your MS exacerbations—you may need to take an antidepressant during those episodes.
Even if you have many of the symptoms of depression, your doctor may check your blood work to rule out health conditions that can mimic depression, such as thyroid disease or anemia.
TREATMENT
The somewhat chicken-and-egg-like relationship between MS and depression is at the root of proper treatment.
Taking care of your MS with the right disease-modifying therapy and treatment for your exacerbations can prevent depression if your MS exacerbations trigger depression. And while treating depression does not change the overall course of MS, addressing it can make the effects of your MS limiting by improving your ability to function at your best.
Whether your depressive symptoms are caused by your MS or not, antidepressants and counseling/psychotherapy can help. The most effective treatment for depression in MS is a combination of both.
MEDICATIONS
The most common types of antidepressants you may be prescribed if you have MS and depression are:
-Selective serotonin reuptake inhibitors (SSRIs):
SSRIs are the most widely prescribed antidepressants and include Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), Paxil (paroxetine), and Lexapro (escitalopram).
-Selective serotonin and norepinephrine reuptake inhibitors (SSNRIs):
Effexor (venlafaxine) and Cymbalta (duloxetine hydrochloride) are two SSNRIs sometimes used to treat depression.
-Tricyclic antidepressants:
The tricyclic antidepressants, such as Elavil (amitriptyline) and Pamelor (nortriptyline), tend to have side effects like drowsiness, constipation or difficulty passing urine. This can make your MS symptoms feel worse. Therefore, they are not usually used as a first-line treatment for depression in MS. However, for treatment-resistant depression, they may be used alone or in combination with other medications.
How your doctor chooses your antidepressant is based on a number of factors, including side effects of the medication, how often it's taken, your most notable or bothersome depressive symptoms, cost, and your preference.
It's important to be aware that antidepressants can take six to eight weeks to reach their full effect.
You should expect to have regular appointments with your doctor so that your level of improvement and side effects can be closely monitored. You may need dosage adjustments, especially in the early stages of your treatment.
PSYCHOTHERAPY
You can talk with your therapist about recognizing the factors that trigger your depression, and you may learn strategies that can help you change your perspective.
While depression is not caused by mindset, adjustments in your way of thinking can reduce some of its symptoms and effects.
Understanding Psychotherapy
There are so many different potential effects of MS that no one experiences all of them. You might not experience any of the emotional effects, such as stress and depression, or they can be a major problem for you.
Knowing what to expect from MS can help you recognize symptoms before they worsen. Sometimes, taking medication or getting counseling at the earliest sign of an MS complication can prevent it from reaching a more severe stage.
***If you are having thoughts of committing suicide, seek emergency medical attention or call the National Suicide Prevention Hotline at 1-800-273-8255.
You can also call the National Crisis Hotline at 1-800-273-TALK or text "ANSWER" to 839863.
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