For people with the neurodegenerative disease multiple sclerosis (MS), mental health is a major concern. Researchers estimate that depression occurs in up to 50% of people living with MS and is up to three times as common as in the overall population.
MS attacks the central nervous system (CNS), which consists of the brain and spinal cord. These attacks break down myelin, the protective cover that shields the nerve fibers in the CNS, and over time there can be loss of function.
Given that the brain is prominently involved in both MS and depression, what's the connection between the two?
It's a complicated relationship, Scott Patten, MD, PhD, of the University of Calgary in Canada, explained. "The causes of depression in MS include biological mechanisms, of course. But there are also the stressors, threats, and losses that can accompany living with an unpredictable disease."
The traditional risk factors for depression are less common among people with MS and depression, although it's not clear why, he said. These include:
- Age: People with both MS and depression are likely to be older at diagnosis than those who have depression alone.
- Gender: In the overall population, women are much more likely to have depression, but the sex breakdown is more equal among people with MS.
- Family history: Many people with depression in the general population have a family history of depression, but this is less common among people with both MS and depression.
Although the physical symptoms of MS -- which can include blurred vision, muscle weakness, and loss of coordination -- are challenging, many people with MS find the mental health challenges to be just as difficult.
A patient's mental health status can strongly influence their quality of life, regardless of the severity of their MS, Patten noted. "Patients who have support in their social environment, a problem-solving orientation, and a degree of optimism often rate their quality of life as very high, even if their physical MS symptoms are severe. But the patients who don't have those tools often rate their quality of life as poor, even if their physical MS symptoms are not that severe."
Talk to Your Doctor
This dichotomy means it's especially important to talk to your doctor regularly about any mental health concerns.
Scientists still have much to learn about the connection between MS and depression, but it appears that currently available depression treatments should work well for people who have both conditions. "Management of depression in MS specifically has not been well studied, but what we know aligns with general principles of depression management," Patten said. "The available evidence supports the effectiveness of standard treatment approaches, including both cognitive behavioral therapy (CBT) and antidepressant medications."
CBT and Antidepressants
CBT is what most people think of as talk therapy: you work one on one with a therapist who focuses on helping you change negative thought patterns. This process can help lift your mood and, in turn, ultimately change your actions and behaviors.
CBT is the most studied form of psychotherapy and has been the subject of literally thousands of clinical trials. It is typically goal-oriented and time-limited -- in effect teaching you to be your own therapist when negative thoughts arise.
When talk therapy isn't enough, many doctors prescribe antidepressants. These drugs work by increasing the ability of the brain's nerve cells to receive the naturally occurring neurotransmitters that help stabilize mood. These so-called chemical messengers include serotonin, norepinephrine, and dopamine.
Like CBT, antidepressants have been used and studied for decades. With dozens of antidepressants available in the U.S., it can take several attempts to find the right antidepressant for you.
A psychiatrist with expertise in treating people with MS may prescribe your antidepressant. Otherwise, your antidepressant prescription will come from your neurologist or primary care physician.
According to the Centers for Disease Control and Prevention, about 13% percent of adults in the U.S. take antidepressants. Dozens of studies have found that patients get the best results by using both CBT and antidepressants to treat their depression.
Self-Care for Depression
The National Institute of Mental Health suggests several self-care strategies for living with depression:
- Healthy eating: Choose plenty of fruits and vegetables and limit your intake of high-fat or high-sodium foods. Drinking lots of water throughout the day can help improve energy and focus. You may find that limiting caffeine and alcohol also helps.
- Explore meditation and relaxing activities: Learn what relaxes you most, whether that's listening to music, using a meditation or mindfulness app, getting out into nature, or anything else that makes you feel calm and centered.
- Build your support system: Surround yourself with people you trust and who offer emotional support and practical help as needed.
- Incorporate gratitude and a positive focus into your life: Some people write down things they're grateful for each day. This practice can help you identify and redirect negative or unhelpful thoughts.
- Say no when you need to: Life with MS may have shown you that you can't take on too much. That means a former "must do" has now become a "maybe later" on your to-do list. Take pride in your accomplishments.
Two other common suggestions for depression self-care can be difficult for people with MS: getting regular exercise and improving sleep habits. "Telling someone with MS to walk briskly for an hour or join a gym to combat depression isn't always helpful," Patten noted. "And severely disordered sleep is a fact of life for many people with MS, even without depression."
Patten's advice: Try to find ways to be more active that fit with your illness, and keep talking with your doctor about any mental health challenges you encounter.
The exact circumstances of how MS and depression affect your life can change over time, but your doctor should always be in your corner, offering advice and treatments and cheering you on.
Read previous installments in this series:
For Your Patients: What to Expect After a Multiple Sclerosis Diagnosis
For Your Patients: What Are the Different Types of MS?
"Medical Journeys" is a set of clinical resources reviewed by doctors, meant for physicians and other healthcare professionals as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.