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Depression is a common symptom of multiple sclerosis (MS). As many as 50 percent of people with MS experience depression - that’s three times the rate in the general population. Along with fatigue, depression may be one of the the leading causes of decreased quality of life with MS, according to a 2019 study in Brain and Behavior.
What Is Depression, and How Is It Different From Feeling Sad?
Sadness is a temporary feeling in response to disappointments or losses. Depression, on the other hand, is a serious mood disorder that affects daily functioning and can last much longer. Left untreated, depression can make other MS symptoms such as fatigue worse, and even become life-threatening, according to the National MS Society.
According to the National Institute of Mental Health, you may have clinical depression if you’ve experienced at least five of the following symptoms for most of the day, nearly every day, for more than two weeks:
- Sadness, irritability, anxiety, or an “empty” feeling
- Loss of interest or pleasure in activities you usually enjoy
- Hopelessness or pessimism
- Changes in appetite
- Sleep problems
- Feelings of worthlessness or guilt
- Cognitive problems such as difficulties thinking or concentrating
- Persistent thoughts of death or suicide
Most people with MS will recognize that several of the symptoms associated with a depression diagnosis are also common MS symptoms, including fatigue and cognitive difficulties - also known as “brain fog.” Unfortunately, it may be hard to tell whether it’s MS or depression causing these symptoms, or if each condition is worsening the symptoms of the other.
Understanding the difference between depression and day-to-day sadness and “blues” can help people with MS get the proper diagnosis and treatment. If you think you might be clinically depressed, talk to your doctor.
What Does Depression Feel Like for MyMSTeam Members?
On MyMSTeam, members have an understanding and supportive community in which they often share their challenges with depression. Here are some members’ descriptions of how they experience depression:
- “When I have the blues, they pass right away. When I’m depressed it stays and I cry a lot.”
- “Feels like I’m sinking emotionally.”
- “It’s slow, creeps in, and affects every aspect of your life.”
- “It’s like a gray cloud that follows you, a cold, squeezing hand around your heart and soul. You feel helpless, sad, tired, constantly grieving, and can't put your finger on why. You can't just pull yourself out of it.”
While depression may affect people with MS in different ways, all share the experience of depression negatively affecting their quality of life and proving difficult to shake off.
What Causes Depression in People With MS?
Rates of depression are higher in other chronic illnesses too - not just MS. Everyone experiences sadness and stress from time to time, but living with MS and other chronic conditions can create an ongoing burden of disappointment and loss. Daily struggles with pain, loss of mobility, and concerns about MS disease progression can become overwhelming.
Inflammation, the immune process involved in MS, may also play a role in depression. A 2017 study in the journal Neurology found higher levels of inflammatory disease activity in the brains of people with MS who were depressed. In MS, inflammation also damages the myelin sheath protecting nerves that control behavior and mood. Researchers observed in the study that mood improved when inflammation was reduced or resolved.
Several disease-modifying treatments (DMTs) for MS list depression or worsening of depression as a potential side effect. In fact, a 2018 review in Multiple Sclerosis and Related Disorders found depression to be the most commonly reported adverse psychiatric effect for Natalizumab, Fingolimod, Dimethyl fumarate, Teriflunomide and Alemtuzumab - marketed respectively as Tysabri, Gilenya, Tecfidera, Aubagio, and Lemtrada.
While DMTs for multiple sclerosis can cause a wide array of potential side effects, they have been proven in clinical trials to be effective at reducing the rate of MS relapses, delaying the progression of disability, and limiting new inflammation in the brain and nervous system. If you suspect your depression may be connected to your MS medication, talk to your doctor. They will help you weigh the risks and benefits of your MS treatment.
Treating Depression in MS
The good news is that depression can be treated. The best place to start is by talking to your doctor. One treatment they may recommend is an antidepressant medication. Antidepressants may help in more than one way. Some antidepressants (such as Cymbalta) have been proven to help treat neuropathic (nerve-related) pain, which is common in MS. Some researchers think antidepressants may even provide the benefit of neuroprotection in MS, although more studies are needed.
Your doctor may also refer you to a mental health professional such as a psychologist or counselor. There are many types of psychotherapy, including traditional talk therapy and cognitive-behavioral therapy (CBT), that can help you work through difficult emotions and develop healthy coping mechanisms for stress.
There are also many lifestyle changes that can help manage depression and fatigue for overall health and wellness. They include:
Exercise. Moderate sessions of yoga, stretching, pool exercises, aerobics, and recumbent bicycling have been suggested to provide benefits for depression and fatigue in a number of small studies. Check with your doctor before starting any exercise program.
Stress reduction. A 2012 study found that people with MS who followed a stress management program experienced fewer symptoms of depression.
Mindfulness. A review of mindfulness based interventions (MBIs) - including mindfulness-based cognitive therapy (MBCT), mindful movement, breath awareness, mediation, qi gong, and tai chi - found evidence that they may help reduce stress and depression, prevent relapse, and improve overall quality of life with MS.
CoQ10. The antioxidant and anti-inflammatory properties of the supplement CoQ10 may hold promise for decreasing depression and fatigue in people with MS, according to a 2015 double-blinded study published in Nutritional Neuroscience.
MyMSTeam Members Share Ways They Manage Depression
By joining MyMSTeam, members gain a community of more than 140,000 people living with MS who understand their challenges, including depression. Members support each other and share ways they have found to manage their depression and live their best life with MS.
In their own words, MyMSTeam members share ways they manage depression:
- “My daily medication “cocktail” keeps me from feeling like I could climb in a hole and never come out.”
- “I had periods where I could not stop sobbing. Antidepressants have made a world of difference.”
- “My family doctor started me on an antidepressant and it really worked miracles.”
- “Chocolate-covered espresso beans are my go-to mood-lifting source.”
- “LOUD music, anything chocolate, calling another MSer, sleep.”
Do you live with MS and depression? What has worked to help you manage depression? Share below in the comments or join and post on MyMSTeam.
Here are a few question-and-answer discussions about depression:
Here are some conversations about depression:
Depression in MS can contribute significantly to fatigue. Learn more about fatigue and other factors like leg weakness and muscle weakness that can cause tiredness.
Laurie has been a health care writer, reporter, and editor for the past 14 years. Learn more about her here.