Two questions to ask yourself
- During the past two weeks, have you often felt down, depressed or hopeless?
- During the past two weeks, have you had little interest or pleasure in doing things?
If you answered "yes" to either or both of these questions, you may be experiencing depression, one of the most common symptoms of MS. To reach an MS Navigator for help, information or assistance finding a mental health professional in your area, connect at 1-800-344-4867 or online. Mention your symptoms to your doctor or nurse. Read more about the Society's work on depression in MS.
If you answered "no" to these questions, but still feel you have low mood, you may be experiencing normal grieving or other emotional changes. People with MS may experience losses—for example of the ability to work, to walk or to engage in certain leisure activities—and the process of mourning for these losses may resemble depression. However, grief is generally time-limited and resolves on its own. Moreover, a person experiencing grief may at times be able to enjoy some of life’s activities.
In the face of MS, people may tend to focus primarily on their physical health and neglect their emotional health—which is an essential component of overall health and wellness.
“Depression” is a term commonly applied to a wide variety of emotional states ranging from feeling down for a few hours on a given day to severe clinical depression that may last for several months.
Depression in its various forms is one of the most common symptoms of multiple sclerosis. In fact, studies have suggested that clinical depression—the most severe form—is more frequent among people with MS than it is in the general population or in many other chronic illnesses. Depression is equally common in other immune-mediated, neuroinflammatory diseases (such as rheumatoid arthritis and inflammatory bowel disease) suggesting that inflammation is a contributing factor to depression in these conditions.
When depression occurs, it deserves the same careful assessment and treatment as any other symptom of MS.
- Depression can occur in any person with MS, at any point in the course of the disease. People with MS who are more severely disabled are not necessarily more likely to be depressed.
- Depression does not indicate weakness of character and should not be considered something shameful that needs to be hidden.
- A person cannot control or prevent depression with willpower or determination.
Left untreated, depression reduces quality of life, makes other symptoms—including fatigue
, cognitive changes
—feel worse, and may be life-threatening. Read more about the Society's work on depression in MS
. While we still do not fully understand the nature of depression in MS, we have learned that many factors may contribute to it:
- A reaction to difficult life situations or stresses: It is easy to understand how a diagnosis of MS can bring on depression.
- At major transition points: following diagnosis, during an exacerbation or when a major change in function or abilities occurs.
- A result of the MS disease process itself: When MS damages areas of the brain that are involved in emotional expression and control, a variety of behavioral changes can result.
- Associated with MS-related changes that occur in the immune and/or neuroendocrine systems: There is some evidence that changes in mood are accompanied by changes in certain immune parameters.
- A side effect of some medications, such as corticosteroids, which may be prescribed for the treatment of MS attacks. There is also some evidence that the interferon medications may trigger or worsen depression in susceptible individuals, although the research on this issue has yielded conflicting results.
Severe depression can be a life-threatening condition because it may include suicidal feelings. One study found that the risk of suicide was 7.5 times higher among persons with MS than the general population. If you are having thoughts about harming yourself or feel you are at risk of hurting yourself or someone else, call the National Crisis Hotline at 1-800-273-TALK (8255) or text "ANSWER" to 839863.
Clinical depression is persistent and unremitting, with symptoms lasting at least two weeks and sometimes up to several months. It’s important to distinguish between mild, everyday “blues” that we all experience from time to time, grief, and clinical depression. Clinical depression, which must be diagnosed by a mental health professional, is a serious condition that produces flare-ups known as major depressive episodes. Symptoms:
- Sadness and or irritability
- Loss of interest or pleasure in everyday activities
- Loss of appetite—or increase in appetite
- Sleep disturbances—either insomnia or excessive sleeping
- Agitation or slowing in behavior
- Feelings of worthlessness or guilt
- Problems with thinking or concentration
- Persistent thoughts of death or suicide
People who are depressed often want to withdraw from activities, and the resulting lack of stimulation further reduces their quality of life, creating a downward spiral. While supportive family and friends may help a person shake off mild depression, psychotherapy and/or antidepressant medication are generally needed to treat the condition adequately and prevent an even deeper depression that is harder to treat. Support groups may offer some help with milder types of depression, however they are not effective in treating severe clinical depression.
Mention your symptoms to your doctor or nurse.
Several antidepressant drugs are available for use under the supervision of a physician. There is wide variability in response to antidepressant drugs and it may be necessary to try different medications and doses before an effective medication, or combination of medications is found.