Living with MS has it’s own unique challenges. With unpredictable symptoms, and changes to your everyday life, it’s essential that you get the right care and have a strong support system in place. As much as coping mechanisms and medical treatment can help, all of this change can often amount to feelings of sadness. Perhaps you may question “why me”, or are simply overwhelmed by the amount you have had to adapt. These feelings are natural, but they may also indicate a wider problem.
For those with MS, depression does not often get the attention it deserves in routine medical consultations, as precedence is taken by the monitoring of physical changes within the body. Depression, however occurs more frequently in MS sufferers than in the general population1, or people living with other chronic medical conditions. For MS patients and their carers, it’s important to understand the link between MS and depression, and know what signs and symptoms to look out for. Like MS, depression is a serious medical condition, but is something that can be treated.
Am I just sad, or is it depression?
Depression should be distinguished from similar emotional states like sadness. Sadness is a normal emotion that is experienced by everyone from time to time, usually as a reaction to a painful or unpleasant event. People are usually aware that they feel sad2, and the sadness does not last long or dramatically affect their functioning. Depression, however, is diagnosed by a prolonged occurrence of a combination of symptoms, nearly every day for more than two weeks, with a significant effect on daily functioning. Those suffering from depression will most likely have a low mood on most days, and will have lost interest in activities that used to be enjoyable. Depression also causes certain physical changes including alterations in sleep, appetite, weight, and energy. Mental and psychological symptoms of depression3 include difficulty concentrating or making decisions, and feelings of worthlessness, guilt, and hopelessness. Confidence and self-esteem
are reduced, and depression can result in very negative thoughts including thoughts about self-harm and death.
Symptoms of depression can creep up on people, to the point where they may not realise that they are depressed. To complicate matters, symptoms like fatigue and altered sleeping patterns may occur due to MS or depression4, so it can be tricky to tell which condition is the culprit. People suffering from depression often isolate themselves5, withdrawing from their loved ones when they need them the most.
What causes depression in people living with MS?
There are several causes for depression in people living with MS . Much of the research on the subject has involved flawed clinical studies, and the need for further research6 is widely acknowledged in the medical community7. Nevertheless, it is clear that a number of factors may
lead to depression in the setting of MS, including physical and chemical changes in the nervous system, medication side effects , and emotional aspects related to living with a chronic condition.
The reaction to the diagnosis of MS, or an exacerbation in the disease course can result in changes to a sufferer’s lifestyle, routine, and general function, which can then lead on to depression8. People are faced with uncertainty about their health, unpredictable MS symptoms, and physiological difficulties such as urinary problems . Studies have shown9 that one’s feelings and coping skills are more important factors in the likelihood of depression, than the degree of disability.
The psychological difficulties are, however, only part of the problem. MS also causes physical and chemical changes in the nervous system that have been linked to depression. Scientists have demonstrated that depression in MS can be linked to structural changes in the brain10. MS may result in loss of the protective layer around nerves in the brain that regulate mood. In addition to nerve damage, MS causes chemical changes in the brain11 involving inflammatory molecules that are linked to depression.
Doctors and scientists have also studied the link between medications used to treat MS and depression. For example, it is known that steroids may cause depression as a side effect. Previously, there has been concern12 over the link between depression and the treatment interferon β , which has been claimed to reduce the risk of relapse and slow the progress on the disease13. Although, more recent studies have shown that this link is questionable. In reality, side effects of medication probably play a minor role in the likelihood of an MS sufferer being diagnosed with depression14. That said, it is advisable to monitor for signs and symptoms of depression associated with the medication one is taking, especially if there is a change in medication type or dosage.
How is depression treated?
By far the most important step to successful treatment is recognition of the symptoms. People with MS and those who care for them should always be on the lookout for signs of depression,
and should discuss these with the treating healthcare professional. Your doctor or psychiatrist will assess the need for medication, and may prescribe an antidepressant to help manage your condition Psychotherapy forms an important part of management, so finding an experienced therapist should be seen as a priority. Discussing your feelings with a therapist, journaling, making gratitude lists, and designing a stress management program are all very helpful activities when it comes to treating depression15. Remember that 50% of people with MS will become depressed at some point in life, but as social worker and MS patient Allison Shadday noted16, “Fortunately, depression is treatable. Once the illness is recognised and addressed, individuals with depression can rediscover the delights and pleasures of life”.
If you need any more information relating to depression and multiple sclerosis, please do have a read through our Learn section. Or, you can give us a call. We'd be more than happy to put you straight through to one of our Bard nurses for a chat.
1 Bradshaw J, Rose A Cognition, Depression and Fatigue in Multiple Sclerosis Sept/Oct 2008 8 (4)
2 NHS Guidelines http://www.nhs.uk/conditions/stressanxietydepression/pages/lowmoodanddepression.aspx[Accessed: 6/07/2016]
3 Feinstein A. Multiple sclerosis and depression. Mult Scler. 2011 Nov;17(11):127681.
4 Siegert RJ, Abernethy DA. Depression in multiple sclerosis: a review. J Neurol Neurosurg Psychiatry. 2005Apr;76(4):46975.
5 Expert advice on how to sidestep pitfalls that often accompany depression.http://www.webmd.com/depression/features/depressiontrapsandpitfalls [Accessed: 06/07/2016]
6 Siegert RJ, Abernethy DA. Depression in multiple sclerosis: a review. J Neurol Neurosurg Psychiatry. 2005Apr;76(4):46975.
7 Feinstein A. Multiple sclerosis and depression. Mult Scler. 2011 Nov;17(11):127681.
8 Bradshaw J, Rose A Cognition, Depression and Fatigue in Multiple Sclerosis Sept/Oct 2008 8 (4)
9 Siegert RJ, Abernethy DA. Depression in multiple sclerosis: a review. J Neurol Neurosurg Psychiatry. 2005Apr;76(4):46975.
10 Feinstein A. Multiple sclerosis and depression. Mult Scler. 2011 Nov;17(11):127681.
11 Feinstein A. Multiple sclerosis and depression. Mult Scler. 2011 Nov;17(11):127681.
12 Feinstein A. Multiple sclerosis and depression. Mult Scler. 2011 Nov;17(11):127681.
13 LysengWilliamson KA, Murdoch D Spotlight on Subcutaneous Recombinant Interferonβ 1a (Rebif®) inRelapsingRemitting Multiple Sclerosis BioDrugs, 2005, 19 (5) 323
14 Siegert RJ, Abernethy DA. Depression in multiple sclerosis: a review. J Neurol Neurosurg Psychiatry. 2005Apr;76(4):46975.