Mood changes of various kinds are very common in MS including:
The Psychosocial Implications that apply to all mood changes are:
- Emotional issues tend to be underreported to the healthcare team, and undertreated when they are reported (with untreated or undertreated depression contributing to the high rate of suicide in MS).
- Mood changes can interfere with:
- Treatment adherence
- Role performance at home and work
- Interpersonal relationships
- Quality of life
Two-question assessment tool (Mohr, 2007):
- 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 your patient answers "yes" to either or both of these questions, she or he may be experiencing depression, one of the most common symptoms of MS. Your patient can access additional, free, confidential screening for depression and other emotional changes at Mental Health America (mhascreening.org). You can also refer your patient to an National MS Society MS Navigator at 1-800-344-4867 or online for additional information or assistance finding a local mental health professional.
If your patient answered "no" to these questions, but has low mood, she or he may be experiencing normal grieving or other emotional changes.
- Selective serotonin uptake inhibitors (SSRI’s): fluoxetine, paroxetine, sertraline, citalopram, escitalopram, fluvoxemine
- Serotonin and norepinephrine reuptake inhibitors (SNRI): venlafaxine, duloxetine, desvenlafaxine, levomilnacipran
- Aminoketone: bupropion
Current evidence on the efficacy and/or effectiveness of antidepressant medications for MS related depression is lacking. Additional study is needed (Patten and Marrie, 2017)
- Exercise and physical activity to support mood