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Almost half of MS patients will become depressed at some point. Why is that, how can you recognize depression, and what treatment options are most effective for people with multiple sclerosis?

Around half of all multiple sclerosis patients will become depressed at some point, while 20 percent are estimated to suffer from depression during any given year. Though depression is far from uncommon in the general population, these figures mean that MS sufferers are still at a much higher risk.

Why is this? How can you recognize the symptoms of depression when you have MS? And most importantly — what are your treatment options?

Why do so many people with multiple sclerosis become depressed?

MS is an unpredictable and debilitating disease. Eighty percent of patients will suffer from profound fatigue that limits their ability to participate in the things they want and need to, for instance, and many encounter problems with their gait, have muscle weakness, struggle with numbness and tingling in various parts of the body, and have muscle spasms. Bladder and bowel problems, vision changes, dizziness, and lightheadedness are also possible. Almost half of MS patients will live with chronic pain. 

When you live with a condition that severely impacts your quality of life, it's no wonder that you can become depressed. 

The reasons behind the high rate of depression in MS sufferers is more complex than that, however, as research reveals that brain lesions and the loss of the protective myelin that coats nerves are also implicated. Furthermore, interferon beta, often used in the treatment of multiple sclerosis, has been shown to have the potential to induce or worsen depression in some patients. 

Multiple sclerosis patients become depressed in such overwhelming numbers because of a combination of factors, then, and these include the symptoms they live with and the impact they have on life, biological changes in the body, and side effects from medications. 

Recognizing the symptoms of depression

The symptoms of major depressive disorder, as laid out in the diagnostic and statistical manual of mental disorders (DSM-5) and commonly accepted everywhere, can encompass, in short:

  • A depressed mood — this can manifest as crying, feeling sad, feeling low, numb, hopeless, and even irritated or angry. 
  • Losing interest in, or no longer deriving pleasure from, activities you previously found meaningful or enjoyable. 
  • Changes in sleep — these can include insomnia (not being able to get to sleep or stay asleep) as well as hypersomnia, or oversleeping.
  • Fatigue/loss of energy.
  • "Psychomotor retardation or agitation", which means a physical slowing down or speeding up that other people can observe. 
  • Losing appetite and weight, or an increased appetite combined with weight gain.
  • A negative self-image, which can include feeling inappropriate guilt or feeling worthless.
  • Lack of focus and having trouble making decisions.
  • Repeated thoughts about death or suicide, beyond simply fearing death. 
Because a good portion of these symptoms can easily be induced by MS itself, and the diagnosing healthcare provider has a duty to make sure the symptoms you're experiencing aren't caused by something other than depression, the diagnostic process has to be conducted carefully. To be considered clinically depressed, you should have either or both of the first two symptoms, and they should have been present for at least two weeks on most days or most of the day. The symptoms you're experiencing have to represent a significant change in functioning compared to your previous state. 

How is depression treated in multiple sclerosis patients?

Major depressive disorder is generally initially treated with talk therapy, antidepressants, or a combination of both. The same treatments that benefit depressed people who do not have MS can help you too, as a multiple sclerosis patient, but there are some special considerations:

  • Depression impacts not only your quality of life, but has also been shown to worsen MS symptoms and the course of your disease. It is, therefore, especially important that your depression is treated as soon as possible. 
  • One study showed that MS patients were 7.5 times more likely to commit suicide than the general population, again emphasizing just how important it is to receive timely treatment. 
  • While SSRI antidepressants are extremely popular right now, they may be less suitable for MS patients as they are known to have the potential to lead to sexual dysfunction, something that is already often part of the symptomatic picture of multiple sclerosis. This does not mean they should not be prescribed, but it is something the doctor should take into account.
  • Tricyclic antidepressants may, on the other hand, be a better choice for many depressed people with multiple sclerosis. 
  • Talk therapy can be extremely effective for depressed MS patients. While many depressed people benefit from psychotherapy that offers them insights into unprocessed past and present evens, however, people with MS benefit more if talk therapy includes a component that helps them uncover better ways to cope with their disease. 

In conclusion

If you have multiple sclerosis and have been feeling depressed, you are far from alone. Depression is far more common in people living with MS than others because of a combination of factors — physical limitations and pain, not being able to live your life in the way you want, biological changes, and sometimes side effects from medications you are taking. Depression worsens your MS symptoms, which can cause you to feel even more depressed. 

Treatment is, however, available, in the form of tailored antidepressant and talk therapy. The first step begins with you — tell your doctor that you have been feeling depressed, and a treatment plan will be set in motion. 

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