Depression & Multiple Sclerosis - Managing S pecific iSSueS
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Depression &
Multiple Sclerosis
M a naging specific issues
Aaron, diagnosed in 1995.The words depressed and depression The pull-up-your-socks syndrome
are used so casually in everyday
conversation that their meaning has While researchers look at complex
become murky. True depression is a changes in the brain and the immune
disorder that will affect from 5 to 20 system that may contribute to
percent of Americans during their depression, and measure the impact
lifetime. of antidepressant medication and
psychotherapy, many people still believe
Depression is not a fleeting emotion. severe depression can be overcome by
It is a persistent disturbance of mood will power. “There’s a strange feeling
with complex roots in an individual’s in this country that depression is
physiology and psychology, and it has a character flaw. It is not. There is
marked symptoms. People with MS treatment for depression, and it is
experience depression more than the curable,” said Dr. Randolph B. Schiffer,
general population or people with other a neurologist and psychiatrist who has
chronic illnesses. done research on the psychological
aspects of MS.
When “depression” and “MS” are
mentioned in the same breath, some
people say, “Of course you’d be depressed Cause or effect?
if you’d been diagnosed with MS,” or When Dr. David Michelson was a staff
“How would you feel if your ability to psychiatrist in the neuroendocrinology
walk just suffered a major setback?” Such branch of the National Institute of Mental
reactions assume that depression is a Health, he studied the interactions among
psychological and emotional response the body’s hormone system, immune
to MS. That is one explanation, but system, and central nervous system in
researchers are finding increasing evidence people with both depression and MS.
that depression is a symptom of MS as
well as a reaction to it.
1 | Depression & Multiple Sclerosis Managing Specific Issues | 2“There is some evidence to suggest that Is it sadness, grief, or true
the physiology of MS may predispose depression?
people to depression,” said Dr. Michelson.
“At the same time, people with MS carry Grief and sadness, both of which are
the burden of changes in daily life and common in MS, lift a little when
losses of function. But whether one something pleasant happens. Depression
becomes depressed in reaction to MS, stays in place. Things that would
or depression is a part of the biology normally give pleasure have no effect.
of MS, the fact to remember is there Symptoms of clinical depression are
are effective interventions.” listed on pages 5 and 6. They are quite
specific. But recognizing depression is
The interferons not always easy because some of the
physical and mental symptoms are
The beta-interferon medications carry
common to MS as well. The relationship
warning labels stating that they should
of fatigue, cognitive problems, and
be used with caution by anyone who is
depression can be confusing.
depressed or has a history of depression.
Although research has failed to show a “Symptoms such as fatigue or difficulty
strong link between depression and the concentrating, which are signs of
beta-interferon drugs used to treat MS, depression, are also signs of MS,” Dr.
these medications decrease levels of the Schiffer said. “Sometimes patients,
chemical serotonin in the brain — and families, and doctors are slow to
decreased serotonin can affect mood. recognize depression because it may
So if you are taking any interferon appear so gradually. One thing I’m sure
medication and experience emotional of is that depressive symptoms tend to
ups and downs, talk to your doctor. be at their worst when MS symptoms
are exacerbated.”
3 | Depression & Multiple Sclerosis Managing Specific Issues | 4Once depression is acknowledged, n Feeling sad or empty or being irritable
specialists agree — don’t wait; reach out or tearful most of the day.
for professional help. The quality-of-life n Loss of interest or pleasure in most
issues are serious. Depression can add activities.
to feelings of fatigue and significantly n Significant weight loss or gain or
worsen problems with thinking and a decrease or increase in appetite.
memory, so getting treatment for n Sleeping too much or inability to sleep.
depression may relieve other symptoms
n Physical restlessness or slowed
as well. And people who are seriously
movement observed by others.
depressed are at greater risk of suicide,
which is also more common in people n Ongoing fatigue or loss of energy.
with MS than in the general population. n Feeling personally worthless or guilty
without appropriate cause.
n Diminished ability to concentrate or
Symptoms of Depression make decisions.
n Recurrent thoughts of death or suicide,
The hallmark of these symptoms is
or planning suicide.
their persistence. They linger. They are
not the normal, transient “blues” that The symptoms not only persist over
everyone experiences in response to a time, but impair daily functioning.
sad or distressing event. According to One (or both) of the first two symptoms
the American Psychiatric Association is always present in a major depressive
in its Diagnostic and Statistical Manual episode.
of Mental Disorders, the symptoms of a The manual notes that symptoms
major depressive episode last at least 2 due to a medical condition such as
weeks. During that time, the person has MS, which might include fatigue or
5 or more of the following 9 symptoms diminished ability to concentrate,
on a daily, almost round-the-clock basis. should not be counted.
5 | Depression & Multiple Sclerosis Managing Specific Issues | 6OK, I need help Side effects are no longer a major
obstacle. The older antidepressants
To find help, Dr. Schiffer advises asking were notorious for causing dry mouth,
your neurologist or general medical urinary hesitancy, constipation, blurred
doctor first. vision, fatigue, drowsiness, weight gain,
The Society office nearest you can sexual dysfunction, and other unpleasant
give you referrals to mental health symptoms. They are now rarely used.
professionals who understand MS. The newer agents are generally well
Call 1-800-344-4867. tolerated and have fewer unwanted
effects. However, all side effects should
Drug therapy be discussed with your doctor. Often,
Many types of antidepressants are the drug or the dosage can be altered
available, but none are magic bullets. to provide the best effect with the
Most work gradually. They may bring fewest problems.
some improvement after several days,
but the drug’s full effect may not Talk therapy
appear for several weeks. If there are no Very few physicians believe that
improvements after six weeks, the doctor medication alone cures depression.
may increase the dose, add another “Most combine drug therapy with some
medication, or prescribe a different drug. form of counseling,” said Dr. Sarah L.
“It’s very important to target selected Minden, a psychiatrist who treats people
symptoms and to follow them closely with MS at Brigham and Women’s
to see if the medication is helping,” said Hospital and Harvard Medical School.
Dr. Andrew H. Miller, a psychiatrist at
Emory University School of Medicine
in Atlanta, Georgia.
7 | Depression & Multiple Sclerosis Managing Specific Issues | 8Psychiatrists, who are MDs, can A good relationship
prescribe medication as well as provide
counseling. Certified psychiatric nurse “No matter what form talk therapy
practitioners are also able to prescribe takes, a good ‘fit’ between you and
medications. Talk therapy can also be your therapist is essential. You should
obtained from certified social workers, feel that you can bring up any topic,”
psychologists, psychiatric nurses, advised Dr. Michelson.
licensed professional counselors, or “Treatment is very relationship-sensitive,”
other qualified non-physicians, who Dr. Schiffer explained. “What’s important
will seek evaluations by a psychiatrist is that you see somebody who believes in
to guide the selection and monitoring what he or she is doing, someone with
of medication if it is indicated. whom you can have a good relationship.”
Talk therapy takes several forms. It may This may mean a period of shopping
be time-limited and address a current around. Obviously, not every qualified
crisis. It may be supportive and focus therapist is right for everyone. “Don’t
on finding ways to cope. Or, it may give up on the concept of treatment
involve in-depth exploration with the just because you don’t ‘click’ with
goal of helping a person develop greater the first therapist you meet,” Dr.
self-awareness. The form depends on the Schiffer said. “When a comfortable
individual’s needs, and these may change relationship is developed, it can help
over time or with the stage of illness. you understand your emotions and
gain more control over your life.”
Therapy can be supplemented by
participating in a self-help group,
but keep in mind that support group
participation, by itself, is not sufficient
for treating depression. Ask your Society
chapter about self-help group programs
in your area for people with MS.
9 | Depression & Multiple Sclerosis Managing Specific Issues | 10Exercise and mood “What makes a person depressed seems
to relate to a host of factors,” Dr.
The evidence is growing that exercise Minden explained. “These include
has a positive impact on mood as well genetics, individual coping styles,
as on a person’s physical well-being. An past and present experiences, and the
exercise regimen that is tailored to a kinds of social supports a person has.
person’s abilities and limitations can But while we don’t yet know how
significantly improve mood and quality depression originates, we do know
of life in people living with MS. how to treat it.” People should not
hesitate to get help if they need it.
Disability and depression —
a false link
“Some people who are profoundly
disabled are not depressed — while
others are very depressed but not
physically disabled at all,” Dr. Minden
said. Research has shown no clear
or consistent relationship between
depression and an individual’s degree
of disability or length of time with MS.
In fact, one large study showed that
depressed mood was related to both a
higher level of (self-reported) disability
and a shorter time since diagnosis.
11 | Depression & Multiple Sclerosis Managing Specific Issues | 12Notes The National Multiple Sclerosis Society is
proud to be a source of information about
multiple sclerosis. Our comments are based
on professional advice, published experience
and expert opinion, but do not represent
individual therapeutic recommendations or
prescriptions. For specific information and
advice, consult your physician.
Early and ongoing treatment with an FDA-
approved therapy can make a difference for
people with multiple sclerosis. Learn about
your options by talking to your health care
professional and contacting the National
MS Society at nationalMSsociety.org or
1-800-344-4867.
The Society publishes many other pamphlets
and articles about various aspects of MS.
Visit nationalMSsociety.org/brochures
to download them, or call your chapter at
1-800-344-4867 to have copies mailed
to you.
Some of our popular pamphlets
include:
n Multiple Sclerosis and Your Emotions
n Taming Stress in MS
n MS and the Mind
Also explore our educational videos at
nationalMSsociety.org/mslearnonline,
and look under “Symptom Management.”
Managing Specific Issues | 13MS stops people from moving. We exist to make sure it doesn’t. Join the Movement®. nationalmssociety.org For Information: 1 800 FIGHT MS (1 800 344 4867) © 2011 National MS Society. All rights reserved. ER6003 11/11
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