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Antidepressants for MS Symptoms: Benefits and Risks

Posted on November 01, 2022
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Ross Phan, PharmD

If you’re living with multiple sclerosis (MS), you’re likely familiar with disease-modifying therapies. Although these common MS treatments slow progression and reduce relapses, they don’t manage individual symptoms, so they’re often used along with other treatments. Antidepressants are among the medications sometimes prescribed to help with MS-related symptoms such as depression, anxiety, and neuropathic pain (a nerve problem).

Many MyMSTeam members report taking antidepressants to help manage MS symptoms. “I take one for depression, and another for pain,” shared one member. “I’m a mess without my antidepressants!” “I got a new antidepressant several weeks ago, and I feel much less weepy, moody, and sad,” said another. A third member wrote, “Antidepressants help me keep my head above water.”

Antidepressants don’t work well for everyone with MS, and — like all medications — they can cause side effects. This article will cover the benefits and risks of antidepressants for people with MS.

Benefits of Antidepressants for MS Symptoms

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

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

For people living with MS, doctors may prescribe antidepressants to help boost mood, relieve pain, fight fatigue, and more.

Boost Mood

Roughly 60 percent of people with MS experience mood changes, such as depression and anxiety. Problems with mental health may worsen a person’s pain and negatively affect quality of life. About 10 percent of people with MS may also experience pseudobulbar affect, a condition that causes crying spells and uncontrollable periods of laughing.

There are several classes of antidepressants, and each works in a particular way. Antidepressants commonly used for depression or anxiety in people with MS may include drugs known as selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs).

SSRIs include fluoxetine (Prozac) and sertraline (Zoloft), and SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor).

Both SSRIs and SNRIs might also relieve symptoms of pseudobulbar affect. Other antidepressants that might help this condition include mirtazapine (Remeron) and tricyclic antidepressants (TCAs), such as amitriptyline (Elavil).

Relieve Neuropathic Pain

In MS, the immune system mistakenly attacks the myelin that covers and protects nerves in your central nervous system (CNS), which includes the brain and spinal cord. Nerve damage from MS may result in neuropathic pain, which can feel like a stabbing, sharp, or burning sensation.

Antidepressants are potential options to relieve nerve 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 affect bladder control. Some study findings suggest that duloxetine may help relieve this MS symptom, but more research in this area is needed.

Fight Fatigue

Fatigue — extreme tiredness or low energy — is among the most common MS symptoms and may have severe effects on quality of life. People with MS who also have fatigue might benefit from bupropion (Wellbutrin), an atypical antidepressant. The drug is called atypical because it works differently from other types of antidepressants, like SSRIs and SNRIs.

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

Improve Brain Function

More than 50 percent of people with MS experience cognitive (brain) changes such as trouble remembering things, focusing, or problem-solving. Study findings show that vortioxetine (Trintellix) may help improve brain function, but additional research is necessary. Vortioxetine is an SSRI, but it also has other effects on serotonin, a brain chemical that boosts mood.

Risks of Antidepressants for People With MS

Like all medications, even those sold over the counter, antidepressants come with the risk of side effects. Some common side effects tend to be temporary, fading over time. Others, however, may overlap with — and worsen — MS symptoms. Antidepressants have side effects that could raise risks of fractures, sexual-related condtions, bladder and bowel problems, and seizures.

Raise Fracture Risk

People with MS have many risk factors for low bone density, which increases your likelihood of fractures (broken bones). Some classes of antidepressants may further raise this risk. SSRIs, for example, are linked to osteopenia (bone loss). SSRIs — along with TCAs — may also raise your risk of falls, which can lead to fractures.

Produce Sexual-Related Effects

Sexual dysfunction (problems with functioning) is very common in people with MS. Some have erectile dysfunction, and others may experience vaginal dryness and pain during sex. Sexual dysfunction is also a common side effect of certain antidepressants, such as SSRIs, SNRIs, and TCAs.

Worsen Bladder and Bowel Problems

Although the SNRI duloxetine shows potential to help ease bladder problems related to MS, other antidepressants — like TCAs — may make these symptoms worse. These medications might also worsen bowel problems, including constipation, which also are common symptoms of MS.

Increase Chance of Seizures

It’s estimated that up to 5 percent of people with MS may have seizures, according to the National Multiple Sclerosis Society. If you have seizures, certain antidepressants, including bupropion and TCAs, may raise your seizure risk.

Get Medical Guidance for Using Antidepressants

Some studies show that antidepressants are possible off-label treatments for MS symptoms, such as to relieve nerve pain. Keep in mind, however, that these medications aren’t FDA-approved for these uses.

Talk with your health care provider about whether antidepressants might help manage your MS symptoms. They will help you choose an antidepressant likely to be safe and effective for you based on your MS symptoms, other medications you take, and your medical history.

Withdrawal Symptoms

If you’re taking antidepressants and want to stop, talk to your health care provider first. Suddenly stopping may result in withdrawal (discontinuation) symptoms.

Some SSRIs, like paroxetine (sold as Paxil), are more likely than others to have this effect. Missing a few doses of certain SSRIs could lead to mood changes, balance problems, and abnormal sensations, such as numbness or an electric shock-like feeling. To help prevent these side effects, your health care provider can slowly lower your dose to help you gradually stop the medication.

Talk With Others Who Understand

Living with certain MS symptoms can be challenging, but you don’t have to face them on your own. On MyMSTeam, the social network and online support group for people with MS and their loved ones, more than 193,000 members come together to ask questions, offer advice and support, and share stories with others who understand life with MS.

Are you currently taking an antidepressant? Do you believe it has helped with any of your MS symptoms? Has it worsened any MS symptoms? Share your experiences and tips in the comments below, or start a conversation on MyMSTeam.

References
  1. Disease-Modifying Therapies for MS — National Multiple Sclerosis Society
  2. MS Signs & Symptoms — National Multiple Sclerosis Society
  3. Antidepressants on Multiple Sclerosis: A Review of In Vitro and In Vivo Models — Frontiers in Immunology
  4. Practice Guideline Recommendations Summary: Disease-Modifying Therapies for Adults With Multiple Sclerosis — Neurology
  5. Mood Changes — National Multiple Sclerosis Society
  6. Pain & Itching — National Multiple Sclerosis Society
  7. Depression — National Multiple Sclerosis Society
  8. Neuropsychiatric Symptoms of Multiple Sclerosis — Psychiatric Times
  9. Multiple Sclerosis (MS) — Cleveland Clinic
  10. Central Nervous System — MedlinePlus
  11. Bladder Problems — National Multiple Sclerosis Society
  12. Trintellix — Vortioxetine Tablet, Film Coated — U.S. Food and Drug Administration
  13. Practice Guideline for the Treatment of Patients With Major Depressive Disorder — American Psychiatric Association
  14. Management of Multiple Sclerosis Symptoms Through Reductions in Sedentary Behaviour: Protocol for a Feasibility Study — BMJ Open
  15. Osteoporosis — National Institute of Arthritis and Musculoskeletal and Skin Diseases
  16. Sexual Problems — National Multiple Sclerosis Society
  17. Antidepressant Discontinuation Syndrome — American Family Physician
  18. Selecting a Selective Serotonin Reuptake Inhibitor: Clinically Important Distinguishing Features — Primary Care Companion to the Journal of Clinical Psychiatry
  19. Bone Loss and Fractures in Multiple Sclerosis: Focus on Epidemiologic and Physiopathological Feature — International Journal of General Medicine

All updates must be accompanied by text or a picture.
Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Ross Phan, PharmD is a MyHealthTeam writer with a doctorate in Pharmacy. She is also a founder of Off Script, a pharmacy consulting business. Learn more about her here.

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