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Depression and Multiple Sclerosis Overview

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Updated December 04, 2008

Depression and multiple sclerosis have a complicated relationship, since one can aggravate the other. Also, depression has many of the same symptoms as MS, making it hard to tell which disorder is to blame.

For example, MS can make us sleep more or less. It can also cause us to be confused and have a hard time making decisions. It can bring unnatural fatigue and slow us way, way, way down. We may feel guilty that we couldn't finish an assignment at work or live up to a promise to go camping with our children. The combination of these symptoms can make it more difficult to do some of the things we like to do, especially physical activities and sports. Because of this overlap of symptoms, many people with MS initially get misdiagnosed as simply depressed, and many people with confirmed MS have depression that goes undiagnosed.

Here is some clarity from me: If you have MS and feel very sad or have no interest in things around you, you need to seek help. Start with your doctor (see Diagnosing and Treating Depression in MS Patients) or call your local MS Society Chapter for recommendations for a psychiatrist. It is important to see a doctor used to dealing with people with MS, as the depression criteria need to be interpreted and applied correctly, and the right medications prescribed (or changed, if they are contributing to the problem).

Whether you meet all of the necessary criteria for depression outlined below or not, or if you think some of them are just part of having MS - it doesn't matter. Leave the diagnosis and treatment to a professional. It is important that you get help to feel better. Depression is very treatable. We all have enough to deal with and depression can affect the course of our illness, because it can impact how well (or poorly) we take care of ourselves.

What Does It Feel Like?

According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), the diagnostic manual of the American Psychiatric Association which contains the criteria used by mental health professionals to diagnose patients, you are clinically depressed if you meet the criteria below.

You have had an episode of depression lasting at least two weeks with at least five of the following symptoms, representing a change in function:

  • Sadness: You are depressed, sad, or tearful most of the time. This can be noticed by you, but it is also important if others notice it.
  • Loss of Interest: You have lost interest or pleasure in most of the things you previously liked to do.
  • Appetite Change: Your appetite is much less or much greater than usual. You have lost or gained weight (more than 5% in a month) without trying to diet or gain.
  • Sleep Problems: You have a lot of trouble sleeping or sleep too much every day.
  • Psychomotor Agitation or Retardation: You are so agitated and restless or slowed down that other people notice.
  • Fatigue: You are tired and have no energy.
  • Feelings of Guilt: You feel worthless or excessively guilty about things you have done or not done.
  • Cognitive Problems: You have trouble concentrating, organizing your thoughts or making decisions on a daily basis.
  • Suicidal Thoughts: You feel you would be better off dead or have thoughts about killing yourself.

In addition, these criteria must be met:

  • These symptoms are severe enough to upset your daily routine, seriously impair your work or interfere with your relationships.
  • The depression does not have a specific cause like alcohol, drugs, medication side effect or physical illness. (This is confusing, because MS does cause depression, and it can be a side effect of some of the MS disease-modifying therapies or other medications. It is important to see a physician who is used to treating depression in MS, so that the criteria can be appropriately interpreted and applied.)
  • Your depression is not just a normal reaction to the death of a loved one.
You may also feel or experience: uncontrollable crying, irritability, unexplained aches and pains, stomachaches and digestive problems, decreased sex drive or headaches.

What Causes Depression?

Depression in multiple sclerosis can be the result of several things alone or in combination:
  • Reactive or Situational Depression: Depression can be a reaction to being diagnosed with MS, as well as the onset of new symptoms which limit the ability to do things or cause discomfort. It can also come from the reactions of friends or spouses. Depression can also be caused by the fear of the unknown, as you ask yourself questions concerning your future ability to be able to live the life that you planned.
  • Organic Depression: Depression may also be the result of demyelination of key areas of the brain, although studies have failed to pinpoint which areas these are. It can also be unrelated to MS, especially if there is a history of depression in your family. An estimated 15% of the general population will experience a depressive episode in their lifetimes.
  • Medication Side Effect: Depression may also develop as a side effect to certain drugs used to treat MS, such as Betaseron and Avonex. Also, steroids can cause periods of hyperactivity and euphoria, followed by a "letdown" period.

How Common Is It?

Fifty percent of people with MS have symptoms of major or minor depression at some point in their lives. It is estimated that 14% of people with MS are depressed at any time.

How Severe Can It Get?

Untreated depression can lead to suicide. Studies show that people with MS are between two and 7.5 times as likely to commit suicide as the general population.

Sources:

ADAM Medical Encyclopedia. Depression.

American Psychiatric Association 2000. (DSM-IV-TR) Diagnostic and statistical manual of mental disorders, 4th edition, text revision. Washington, DC: American Psychiatric Press, Inc.

Feinstein A. Multiple sclerosis, depression, and suicide. BMJ. 1997 Sep 20;315(7110):691-2.

Goldman Consensus statement on depression in multiple sclerosis. Multiple Sclerosis. 2005; 11, 328-337.

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