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Is it grief or something more?

These 2 questions might help you decide:

  1. During the past 2 weeks, have you often felt down, depressed or hopeless?
  2. During the past 2 weeks, have you had little interest or pleasure in doing things?

Get a free, confidential screening for depression and other emotional changes through Mental Health AmericaIf you answered “yes” to either or both of these questions, you may be experiencing depression, one of the most common symptoms of multiple sclerosis. To find out for sure, you can get a free, confidential screening for depression and other emotional changes through Mental Health America.

If you are depressed, you may:

  • Reach an MS Navigator online or at 1-800-344-4867 during standard business hours for help, information or assistance finding a mental health professional in your area.
  • Discuss your symptoms with your doctor or nurse.
  • If you're thinking about harming yourself or having a mental health emergency, call the National Crisis Hotline at 988.

If you answered “no” to these questions, but have low mood, you may be experiencing normal grief or other emotional changes. People with MS may experience losses — of the ability to work, to walk or to engage in certain leisure activities — and the process of mourning 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 focus primarily on their physical health and neglect their emotional health — which is an essential component of overall health and wellness. For more on maintaining good emotional health, see “What to Expect from Mental Healthcare: A Guide for People with MS.”

Overview of depression and MS

“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 MS. 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 and makes other symptoms — including fatigue, pain and cognitive changes — feel worse. It may also be life-threatening. Mention your symptoms to your healthcare provider.

While the nature of depression in MS is not fully understood, many factors seem to contribute to it, including:
  • Reaction to difficult life situations or stresses: It is easy to understand how a diagnosis of MS can bring on depression.
  • Major transition points: following diagnosis, during an exacerbation or when a major change in function or abilities occurs.
  • 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.
  • 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.
  • Side effects of some medications: corticosteroids and possibly interferon medications may trigger or worsen depression in susceptible individuals.
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Coping strategies for depression

Many wellness strategies can help you cope with mild depression and prevent more serious forms of depression. Think about your overall wellness, and try new strategies, such as:

  • Exercise daily.
  • Reduce stress in your life, and strive to manage inevitable stresses more calmly. Try breathing exercises and meditation.
  • Maintain your social networks. Call your friends. Join a support group. Spend time with family.
  • Stay in touch with your medical team.
  • Acknowledge your feelings. Get a notebook and write. Make a list of your stressors so you can stop thinking about them for a bit.
  • Stay away from addictive substances such as alcohol.

The Resilience Factor” details the benefits of wellness strategies and describes habits that help people thrive in the face of adversity. “What to Expect from Mental Healthcare: A Guide for People with MS” describes additional ways to maintain good mental health. 

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From a Loved One's Perspective: Depression

Two couples affected by MS discuss the ways that depression affects both the person living with MS and the carepartner.

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Clinical depression

It’s important to distinguish between mild, everyday “blues” — that we all experience from time to time — grief, and clinical depression. Asking yourself the 2 questions at the top of the page may help. Clinical depression is persistent and unremitting, with symptoms lasting at least 2 weeks and sometimes up to several months or more. It’s a serious condition, diagnosed by a mental health professional, that produces flare-ups known as major depressive episodes. Symptoms include:

  • Sadness and or irritability
  • Loss of interest or joy 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

Treatment

When depression occurs, it deserves the same careful assessment and treatment as any other symptom of MS.

Mention your symptoms to your healthcare provider. 

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 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.

Several antidepressant drugs are available for use under the supervision of a physician. Responses to antidepressant drugs may vary widely. You may need to try different medications and doses to find an effective medication, or combination of medications.

What to Expect from Mental Healthcare: A Guide for People with MS” can help you decide what kind of help you need and find providers, whether you have health insurance or not.

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Suicidal feelings

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 people with MS than the general population. If you are having thoughts of harming yourself or feel you are at risk of hurting yourself or someone else, call the National Crisis Hotline at 988 or 1-800-273-TALK (800-273-8255).

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