Depression and Multiple Sclerosis are inherently linked. Depression is not something that solely affects those of us with MS, and it is often underreported or undiagnosed.
While many individuals without MS experience depression and many individuals with MS may never experience it, more than 50% of individuals with MS will experience some form of depression during their lives. At any given time at least 17% of us will be depressed in one way or another. But there is hope, there is treatment, and there is possible prevention.
What Causes Depression?
- reaction to a chronic illness
- damage to the parts of the brain controlling emotions
When we are first diagnosed we have to come to terms with MS and learn to cope. The consequences of Multiple Sclerosis can affect almost every aspect of our lives. Some of us become weak, clumsy, constantly fatigued and may become frightened of going certain places or taking part in activities and hobbies that we used to love. Our energy is easily depleted. We may grieve at the uncertainty we will always face.
It’s only natural that the losses that come with Multiple Sclerosis could cause depression. Realistically, many of us will face the loss of ability, loss of mobility, loss of friends, an inability to work, and cognitive problems. Opportunities will be restricted by heat. We will learn which of our friends are not capable of maintaining a friendship with a sick person and we may face challenges in the relationships that survive. Some evidence suggests that relapses and increases in disability put us at an increased risk of depression. My darkest times have usually been during episodes of the MS Hug. But this is not the only possible cause of depression.
In addition to depression being a response to the symptoms and results of the disease, Multiple Sclerosis can also cause depression in a physiological way. As myelin and nerve fibers are damaged, parts of the brain are affected that may involve emotional control, behavior, and depression. Changes in the immune and neuroendocrine system may also trigger depression.
In a recent study using MRI, researchers discovered that the hippocampus is smaller in MS patients than in healthy adults. They also found a correlation between this and hyperactivity in the hypothalamic-pituitary-adrendal axis (HPA axis). The HPA axis is the part of the neuroendocrine system that manages stress. Cortisol, a stress hormone, is released in excessive amounts as a result of these physical conditions within the brain. These conditions in the brain are also consistently seen in individuals with chronic depression.
In addition to these causes, common medications for Multiple Sclerosis can also cause depression. Corticosteroids and interferons are specifically linked to depression. Steroids can cause periods of hyperactivity and euphoria, followed by a crash. When I began taking Rebif several years ago, my neurologist at the time required that I begin an antidepressant (Lexapro) along with the drug.
What Are Signs To Look For?
- loss of interest or pleasure in normal activities
- change in appetite
- change in sleeping patterns
- feelings of worthlessness or guilt
- problems with concentration
- persistent thoughts of death
- uncontrollable crying
- difficulty making decisions
- aches and pains
- digestive issues
- decreased libido
- sexual problems
Depression may sometimes lead to suicide. Individuals with Multiple Sclerosis are up to 7.5 times as likely as the general population to end their own life.
What To Do?
Individuals experiencing depression often withdraw from activities and social situations which further reduces their quality of life. Mild depressions may be brief, but other measures are necessary for help in properly treating depression. For example, psychotherapy and antidepressant medication are commonly used as treatment. Seek help when depression is negatively affecting your life or if you are considering suicide. Begin with your primary care physician and discuss your options. You may opt only for medication or you may be interested in ongoing therapy as well.
Common Medications For Depression:
An added benefit to many of the drugs used to treat depression is that they may relieve nerve pain associated with Multiple Sclerosis.
Fortunately, BG-12, which is expected to be widely prescribed upon FDA approval, is not known to cause depression. I am excited by the longterm prospects of this medication. Also, stem cell treatment is becoming increasingly common. With the possibility of remyelination and restoring ability this may also have a positive effect.
Sometimes changes in your life can also help to treat or prevent depressive episodes.
- listen to positive or calming music
- reach out to support groups in your area
- stay social – use the internet to meet new people
- stay active – preferably with regular exercise
- go to local ms events
- find a new hobby and dive into it!
- medical cannabis has been shown to alleviate depression as well as many symptoms of MS
How do you combat depression? How do you deal with stress?