Antidepressants are among medications sometimes prescribed to help manage multiple sclerosis (MS)-related symptoms such as depression, anxiety, and nerve pain. Some antidepressants may also help with certain bladder symptoms.

Some members of MyMSTeam report taking antidepressants to help manage their MS symptoms. “I take one for depression and another for pain,” one member shared. “I’m a mess without my antidepressants!”

“I got a new antidepressant several weeks ago, and I feel much less weepy, moody, and sad,” another said. A third member wrote, “Antidepressants help me keep my head above water.”

🗳️ Have you tried antidepressants to help manage multiple sclerosis (MS) symptoms?

Yes, and they helped.

Yes, but they didn’t help.

No, but I’m interested.

No, and I’m not interested.

Thanks! You've successfully submitted your vote.

Sign up to view the results!

Continue with Facebook

Continue with Google

Continue with Email

By joining, you accept our Terms of Use, and acknowledge our collection, sharing, and use of your data in accordance with our Health Data and Privacy policies.

Already a member? Log In

Antidepressants don’t work well for everyone with MS, and like all medications, they can cause side effects. There’s also no single best antidepressant for MS. This article will cover the benefits and risks of antidepressants for people with MS.

Benefits of Antidepressants for MS Symptoms

Along with treating MS with disease-modifying therapies, it’s important to manage MS symptoms, which often include depression and anxiety. Although managing these symptoms can be challenging, medications like antidepressants may help improve mood and provide other benefits.

When medications are prescribed for conditions or situations other than those approved by the U.S. Food and Drug Administration (FDA), this is called off-label use. Some uses of antidepressants to manage MS symptoms are considered off-label.

For people living with MS, antidepressants may be prescribed to help improve mood and relieve certain types of pain. Some antidepressants may also be used for other MS symptoms, although evidence for these uses is limited.

Boost Mood

Mood changes, including depression and anxiety, are common in people with MS. Mental health conditions can also worsen pain and negatively affect quality of life.

About 10 percent of people with MS may also experience pseudobulbar affect, a condition that causes sudden, uncontrollable episodes of laughing or crying. Certain antidepressants have been used to help relieve symptoms of pseudobulbar affect.

Relieve Neuropathic Pain

In MS, the immune system mistakenly attacks myelin, the protective coating around nerves in the central nervous system (CNS), which includes the brain and spinal cord. Nerve damage from MS may result in neuropathic pain, which can feel like stabbing, burning, squeezing, or electric shocks.

Certain antidepressants are potential options for relieving neuropathic pain. In studies related to MS, duloxetine and venlafaxine have shown promising results.

Ease Bladder Problems

According to the National Multiple Sclerosis Society, at least 80 percent of people with MS have bladder problems, the result of nerve damage in parts of the CNS that control the bladder. Some research suggests that duloxetine, an SNRI, may help with certain bladder symptoms. However, some antidepressants can make it harder to urinate or empty the bladder.

More research is needed, and it’s important to discuss your symptoms and treatment options with your healthcare provider.

Fight Fatigue

Fatigue — extreme tiredness or low energy — is among the most common MS symptoms and can greatly affect quality of life. A very small amount of evidence suggests bupropion may help some people with MS-related fatigue.

Bupropion is called an atypical antidepressant because it works differently from other types, such as SSRIs and SNRIs. Bupropion works in part by increasing the activity of dopamine and norepinephrine in the brain, which may help improve daytime energy for some people. Using bupropion specifically to treat MS-related fatigue is off-label, and there isn’t enough evidence to know how well it works.

Some antidepressants can cause or worsen fatigue. “My doctor just weaned me off my antidepressants because I was overly fatigued on them,” shared one MyMSTeam member. “Since I went off, I have felt like I have had more energy to do things.”

Risks of Antidepressants for People With MS

Like all medications, including those sold over the counter, antidepressants come with the risk of side effects. Some common side effects tend to be temporary and may improve over time.

Others, however, may overlap with and potentially worsen MS symptoms. Depending on the medication, side effects may include sexual problems, bladder or bowel problems, and an increased risk of falls or seizures.

Your neurology team can help you weigh the potential benefits and risks of antidepressants and discuss their side effects. They can also evaluate whether a new or worsening symptom may be related to MS, a medication, or another cause.

Risk of Fractures

People with MS have many risk factors for low bone density, which increases the likelihood of fractures (broken bones). Long-term use of some classes of antidepressants has also been linked to lower bone density and a higher risk of fractures.

SSRIs, for example, have been linked to bone loss. SSRIs and TCAs may also raise the risk of falls, which can lead to fractures.

Sexual Side Effects

Sexual dysfunction is common in people with MS, who may experience:

• Erectile dysfunction
• Vaginal dryness
• Pain during sex

Sexual dysfunction is also a common side effect of certain antidepressants, including some SSRIs, SNRIs, and TCAs. If you experience sexual side effects, your healthcare provider may consider adjusting your treatment or switching to an antidepressant that’s less likely to cause them, such as bupropion.

Bladder and Bowel Problems

Although the SNRI duloxetine shows potential for helping certain bladder problems related to MS, other antidepressants, such as TCAs, may make these symptoms worse. Some antidepressants can also cause or worsen constipation, which can already be a problem for people with MS.

Risk of Seizures

It’s estimated that up to 5 percent of people with MS may have seizures, according to the National Multiple Sclerosis Society. Some antidepressants can increase seizure risk.

Bupropion is generally not recommended for people with a seizure disorder. TCAs may also lower the seizure threshold, meaning they make seizures more likely.

Get Medical Guidance for Using Antidepressants

Some antidepressants are used off-label to help manage certain MS symptoms, such as nerve pain. Keep in mind that these specific uses aren’t FDA-approved.

Talk with your healthcare provider about whether an antidepressant might help manage your MS symptoms. They can help you choose one that may be safe and effective for you based on your symptoms, other medications you take, and your medical history.

Withdrawal Symptoms

If you’re taking an antidepressant and want to stop, talk with your healthcare provider first. Suddenly stopping an antidepressant may result in discontinuation symptoms, sometimes called withdrawal symptoms.

Some SSRIs, such as paroxetine, are more likely than others to cause these symptoms. Missing doses of certain antidepressants could lead to mood changes, balance problems, and unusual sensations, such as numbness or electric shock-like feelings. To help prevent discontinuation symptoms, your healthcare provider may slowly lower your dose before you stop taking the medication.