Depression – 8/18

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The information below is from the National Multiple Sclerosis Society.

“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.

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. If you would like additional, free, confidential screening for depression and other emotional changes, visit Mental Health America (mhascreening.org).

Scooterjon says… since my diagnosis 27 years ago I’ve had many ups and downs at  different times.  Sometimes in the same day.  Obviously, when I was working my ups and downs were less frequent.  I remember many times my Dad asking me over my 27 years of MS if I was depressed?  I would usually say “I feel down but not depressed”.  Now that I know what I know I was probably depressed way back in the mid 1990’s.  In my opinion, it’s hard to diagnose depression when you’re the depressed one!        

  • Reach an MS Navigator online or at 1-800-344-4867 for help, information or assistance finding a mental health professional in your area.
  • And, mention your symptoms to your doctor or nurse.

If you answered “no” to these questions but 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.  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.

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 and may be life-threatening.  Mention your symptoms to your doctor or nurse.

Scooterjon says… in 2016 this is what I told my neurologist about my daily life.  “Little things that I shouldn’t even concern myself with can now just rile me up, I’m not working, I feel just worthless, I’m bored stiff, I just watch TV all day, I’m easily pissed off (short), I yell at my wife too much, I’ve gained weight, my personal hygiene isn’t the best, I don’t want to work out at the health club anymore, I’m becoming more reclusive and lastly that I had no interest in sex!  Everything just seems askew!”

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.

 

  • 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.
  • Side effect of some medications such as corticosterooids 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.

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.

Scooterjon says… I got my MS diagnosis in 1991.  In 2004 I was told I had SPMS and finally in 2017 I was told I had PPMS.  My MS is progressing nicely!  lol  After I told my neurologist what my daily life was like she said to me very bluntly “you’re depressed!”  She didn’t say “you sound depressed”, “she didn’t say you could be depressed”, “she didn’t say you might be depressed”, she just looked at me and said “you’re depressed!”

Coping with life challenges with MS and/or with depression (if you’re experiencing it) can be difficult. Think about your overall wellness and try a thing or two — here are some ideas:

  • 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.

Clinical depression

It’s important to distinguish between mild everyday “blues” that we all experience from time to time from grief and clinical depression. The two questions to ask yourself above may help. Clinical depression is persistent and unremitting with symptoms lasting at least two weeks and sometimes up to several months. It’s a serious condition diagnosed by a mental health professional 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
  • 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.

People who are depressed often withdraw from activities.  The resulting lack of stimulation further reduces their quality of life creating a downward spiral.  Mention your symptoms to your doctor or nurse.

Scooterjon says… in 2016 my neurologist then prescribed an anti-depressant drug called Bupropion to help with my depression.  I take one tiny little pill when I get up in the morning.  I suppose I’ll take that for the rest of my life.  I don’t notice a big difference in myself but I admit it has mellowed me out some!  

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.  It also prevents 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. There is wide variability in response to antidepressant drugs.  It may be necessary to try different medications and doses before an effective medication or combination of medications is found.

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 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.
Scooterjon says… I personally have never thought of committing suicide because of my MS or anything else for that matter.  I occasionally talk suicide with my wife if we hear of someone taking their life!  The reason I wouldn’t commit suicide is because I’m too much of a chicken to kill myself and I don’t know where I’m going after this current rodeo is over!  lol