Depression and MS By J. Lamar Freed, Psy.D. Updated 11/12/2004

Everyone gets the blues. That is how the song has it, and the songwriter is probably right. Even if you are an emotional rock, you are likely to know what someone means when they say, "I'm kind of down today" or "I'm a little depressed."

Certainly, if you have Multiple Sclerosis (MS) there is a good chance that you have experienced the pain of those days when the world looks bleak and you lack motivation and hope.   Sometimes this can turn into depression.

Clinical depression goes beyond a few bad days.  Technically defined one must have a number of these symptoms::         - depressed (or irritable) mood most of the day nearly every day         - diminished interest in pleasure and activities         - significant weight loss or gain         -  insomnia or hypersomnia         - agitation or, alternately, sluggishness or complaints of fatigue         -  feelings of worthlessness or excessive or inappropriate guilt         - diminished ability to think, or an inability to make decisions         - recurrent thoughts of death or interest in/plans for suicide

Galling to some is that many people who have eventually received a diagnosis of MS have first been diagnosed as depressed. Others have expressed anger and resentment that they have had to "pass" evaluations by psychologists or psychiatrists in order to rule out depression as the primary cause of their symptoms. But when you compare MS fatigue to major deression (see box), it is easy to see why this so frequently happens.

Having MS can cause depression

While MS is not depression, its consequences can certainly make people depressed. Depression can result from the personal and social losses that come with MS symptoms. Weakness, clumsiness, reduced mobility, restricted movement -- all these things can cause depression. We value our capacity to move with energy and ease very highly.  Sometimes these changes cause other losses, like jobs,  well-loved activities, hobbies, even friends, companions, or spouses who turn out to be less loyal and caring then we had hoped. Losing any one of these things can trigger depressed days that can escalate into a major depression. Even the threat of these kinds of losses is enough to depress many of the newly diagnosed.

MS is not depression

MS can easily be seen as depression. It is not. It is a demyelinating illness that affects the ability of our neurons to communicate with other neurons in our nervous system. It makes us unnaturally tired, sedentary, slow, sometimes giving us the daily lassitude of the severely depressed.  MS can make us lose weight.  It can make us sleep too much or too little.  It can make decisions take longer or cause memory slowing or even some memory loss.  Indeed, people with MS have a higher rate of suicide than the general population, though this is not independent of the depression we are also more likely to get.

MS can be a physiological cause of depression

Complicating this is that depression in MS can come from a neurological source. The demyelination of certain areas of the brain can cause a change of mood that is directly related to the neurological function of these areas. Demyelination in these key areas can be the direct cause of mood changes ranging from depression to anger to euphoria. These emotional experiences sometimes may seem to make little sense to the person with MS, as though the emotions come out of context and as overreaction.

Fifty percent of people with MS have symptoms of major or minor depression.

MS medications can cause depression

Depression can also be caused by some medications used to treat MS. The medications Betaseron and Avonex have been associated with depressions in a small minority of people taking them. It is not as well known that there are a similarly small number of people who get depressed as a result of taking other medications used for MS or for conditions related to MS and its symptoms.

You don't need MS to get depressed

Depression can also be a unique hereditary disease, unrelated to a diagnosis of MS. As one person once put it, "Just because you have MS doesn't mean you won't get sick." As with colds and flu, which can devastate someone with MS, an independent episode of major depression will make a significant impact on the course of MS and how a person with MS experiences its symptoms.

Fatigue can look like depression

Finally, the fatiguing aspects of MS can give one feelings identical or close to the feelings of someone in the midst of a bout of major depression. Poor self esteem, hopelessness, demoralization, and even self destructive feelings can come to someone with MS when fatigue settles in, only to be alleviated by a good night's sleep or maybe several good days of rest.

Depression can be treated

Treatments for depression:      -Interpersonal Psychotherapy      -Cognitive Psychotherapy      -Couples or Family Therapy      -Medication

Treating depression in any of its forms is almost invariably helpful. The nice thing about depression, unlike MS, is that we have a large range of very effective things that can be done to treat it. There are many medications that work to lift depression, and there are many ways psychotherapy or counseling can alleviate the worst symptoms of depression.

For most depressions, psychotherapy can be very helpful. It can be of significant help for the person with MS in accepting and adjusting to his or her new condition. Psychotherapy facilitates normal mourning, it helps develop and strengthen coping skills, and it examines and often corrects malfunctioning thinking. Many depressions respond to psychotherapy alone, sometimes quickly, sometimes more slowly.

Barriers to treatment:      -Personal prejudice      -Psychologists who don't know MS      -Costs

Family, couples and group therapies are also often very helpful. MS is an illness that affects more than one person. It also makes a significant impact on family and friends. Acknowledging and discussing the impact on marriages and family life can go a long way in preventing or repairing the painful feelings that descend on a family hit with this disease.

Medication is likely to be needed when a depression has direct physiological roots. It is very likely to help when MS lesions interfere with those areas of the brain that relate to mood. It is also indicated when the depression seems unrelated to environmental factors, or when psychotherapy alone does not seem to be helping. It is particularly important when the depression has gotten sufficiently severe that self destructive acts are contemplated or if sleep is so disturbed as to prevent normal functioning during the day.

Some Medications for Depression:      Paxil            Remeron      Prozac         Wellbutrin      Effexor        Lexapro

Depression is rarely easy. It is often devastating, and it should always be taken seriously. No one who is depressed should be deprived of treatment. Yet, there are many barriers to getting treatment for psychological disorders.  These barriers, including personal prejudices, psychologists or other treatment professionals who don't fully understand MS, and the expense of treatment can be overcome with effort and the effort usually pays off.

Even if a transient fatigue depression is all someone with MS gets, it is likely that everyone with MS knows depression. Understanding the range of depressed symptoms is likely to help one cope when these symptoms do arrive. Marshaling one's resources to cope with depression should include all of the help that is available. While depression may be inevitable with MS, it does not have to be unmanageable.