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Video Webcast — MS and Your Emotions Part 1

The National MS Society and Healthology developed the following video to help you learn more about positive ways to manage the emotional impact of MS.

Video Webcast — MS and Your Emotions Part 2

The National MS Society and Healthology developed the following video to help you learn more about positive ways to manage the emotional impact of MS.

Two questions to ask yourself

1) During the past two weeks, have you often felt down, depressed or hopeless?

2) 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 connect with an MS Navigator for help, information, or assistance finding a mental health professional in your area, call 1-800-344-4867 or fill out this form.

Overview of depression

“Depression” is a term commonly applied to a wide variety of emotional states. These may range from feeling down for a few hours on a given day to severe clinical depression that may last for several months. People with MS and their family members and friends should be aware that depression in its various forms is one of the most common symptoms of multiple sclerosis. In fact, studies have suggested that clinical depression, the severest form of depression, 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. 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; when depression occurs, it deserves the same careful assessment and treatment as any other symptom of MS. Left untreated, depression reduces quality of life, makes other symptoms -- including fatigue, pain, cognitive changes -- feel worse, and may be life-threatening.

While we still do not fully understand the nature of depression in MS, we have learned that many factors may contribute to it:

  • Depression may be a reaction to difficult life situations or stresses. It is easy to understand how a diagnosis of multiple sclerosis, a chronic condition with the potential for progressing to permanent disability, can bring on depression. People with MS are at greater risk of depression at major transition points -- following diagnosis, during an exacerbation or when a major change in function or abilities occurs.
  • Depression in MS is also 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, including depression.
  • Depression in MS is also associated with MS-related changes that occur in the immune and/or neuroendocrine systems. For example, there is some evidence that in persons with MS, changes in mood are accompanied by changes in certain immune parameters.
  • In contrast to what common sense might suggest, persons with MS who are more severely disabled are not necessarily more likely to be depressed. Depression can occur in any person with MS, at any point in the course of the disease.
  • 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.
  • Depression can also be 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.

Normal grieving

Depression is often hard to distinguish from grief. Persons with MS may experience losses — for example of the ability to work, to walk, or to engage in certain leisure activities. 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. Clinical depression is more 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 of a major depressive episode

  • 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
  • Fatigue
  • Feelings of worthlessness or guilt
  • Problems with thinking or concentration
  • Persistent thoughts of death or suicide

Treating depression

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. Although support groups may offer some help with milder types of depression, they are not effective in treating severe clinical depression. Psychotherapy and/or antidepressant medication are more effective in treating severe clinical depression.

Several antidepressant drugs are available, but they can be used only under the supervision of a physician. There is quite a bit of variability in response to antidepressant drugs and it may be necessary to try different medications and different doses before an effective medication, or combination of medications is found.

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