Depression and MS often occur together
About one in 10 Americans has depression during any given year, but depression occurs even more often among people with MS. By some estimates, roughly half of all people with MS will experience depression at some point in their lives.
Why do depression and MS seem to go hand-in-hand? There are a number of reasons, including MS itself, which can be a painful, fatiguing and disabling condition that's challenging to manage. However, people living with other painful chronic conditions do not suffer from depression at the same rates as those living with MS.
Many of the drugs that are used to treat MS have also been linked to depression. Steroids, benzodiazepines, and baclofen (Kemstro), for example, have been known to contribute to depression. There's also some anecdotal evidence that interferon may cause symptoms of depression, though clinical studies haven't been able to confirm this association.
Brain scans of people with MS, using MRI and computed tomography (CT) scanning technologies, have found that lesions and atrophy in the left anterior and parietal regions of the brain are associated with depression. Though further study is needed, many experts believe this may help to explain the strong link between depression and MS.
Symptoms of Depression in MS
Depression and MS share some common symptoms, such as fatigue and cognitive difficulties, so it can be difficult to diagnose depression. If several of the following symptoms are present for two weeks or more, talk to a doctor or mental health professional to see if depression may be the cause:
- Depressed mood for most of the day
- Loss of interest or pleasure in most or all activities
- Significant change in weight or appetite
- Insomnia or excessive sleepiness
- Agitation or lethargy
- Fatigue and loss of energy
- Feelings of worthlessness, low self-esteem or guilt
- Difficulty concentrating or indecisiveness
- Recurrent thoughts of death or suicide
These debilitating symptoms can have an effect on treatment for MS, which usually requires taking medication and engaging in other therapeutic activities. Following a medication regimen, participating in regular exercise and attending support group meetings, for example, are all more difficult when a person is depressed.
Treatment for Depression in MS
Treating depression in MS often starts with a primary care physician, though some advocates recommend also seeing a psychiatrist who can monitor the progress of your treatment for depression.
Most cases of depression are treated with an antidepressant, such as a selective serotonin reuptake inhibitor (SSRI) or a selective norepinephrine reuptake inhibitor (SNRI). These drugs may take up to six weeks to have an effect on depression. Your doctor will track your progress and advise you if any changes in doses or medication are warranted.
Many mental health professionals have found that antidepressants work best in conjunction with therapy such as cognitive-behavioral therapy (CBT). If you're interested in working with a therapist, the Multiple Sclerosis Association of America recommends asking a prospective therapist the following questions:
- Do you have experience working with MS patients?
- What is your success rate in treating depression?
- What is your psychological treatment approach?
- Do you work closely with physicians?
- How do you feel about using medications to treat depression?
- Are your services covered by my insurance?
The most important thing to remember, whether you or someone you know has MS, is that with proper diagnosis, support and treatment, the symptoms of depression can be alleviated, leading to a better quality of life for people with MS.
Bradshaw, Jane et al. Cognition, Depression and Fatigue in Multiple Sclerosis. Advances in Clinical Neuroscience & Rehabilitation, Vol. 8, No. 4. Sept/Nov 2008.
Koch MW, Glazenborg A, Uyttenboogaart M, Mostert J, De Keyser J. Pharmacologic treatment of depression in multiple sclerosis. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD007295.
Multiple Sclerosis Association of America: Understanding and Treating Depression in Multiple Sclerosis. 2007.
Siegert, RJ et al. Depression in multiple sclerosis: a review. Journal of Neurology, Neurosurgery and Psychiatry 2005;76:469–475.