Battling the Blues: Multiple Sclerosis and Overcoming Depression

 

by Eve Pearce

Depression is, perhaps, one of the most commonly overlooked conditions for MS patients and their families, yet as many as 50% of all those with MS suffer from this debilitating condition at some point in their lives. It is vital to be clued in to the sometimes subtle signs of depression, particularly when one has MS, since the presence of this illness can indicate many important factors including the exacerbation of MS, the presence of an unrecognized condition that has not yet been diagnosed, or undesired side-effects of medication. Depression can likewise have serious outcomes when it goes undiagnosed for too long: it can increase the risk of suicide, affect relationships with loved ones and co-workers and lessen one’s interest in social activities and intimate relationships. Being wary of the warning signs of depression is crucial in order for patients to obtain the treatment they need, early. There are a myriad ways in which one can battle the blues. In this post, we highlight the warning signs, causes, and treatment options that can help sufferers battle the seemingly insurmountable obstacle that depression can pose.

Signs and Signals. You may have depression if you suffer from the following:

• A lack of interest in the things in life that formerly gave you pleasure (hobbies, social interaction, etc.)
• Frequent feelings of hopelessness and sadness
• Changes in appetite; noticeable weight gain or loss
• A lack of energy, fatigue
• Feelings of lack of worth, guilt
• Inability to concentrate or make decisions
• Frequent thoughts about death or suicide
• A low libido

What Causes Depression?

Depression can be caused by an array of factors, including neuro-chemical/hormonal imbalances, negative patterns of thinking and challenging life experiences. Additional causes in the case of MS sufferers can include:

• Difficulty adjusting to a recent diagnosis of MS.
• Feeling uncertain about the future.
• Experiencing an exacerbation of MS.
• Damage to the part of the brain that regulate emotions: The authors of the book, Comprehensive Nursing Care in Multiple Sclerosis (by June Halper and Nancy Joyce Holland) state that the high rate of depression in MS sufferers may indicate that it stems from damage to parts of the brain that regulate emotion.
• Chemical changes in the body and brain, which affect one’s mood.
• Fatigue: Feeling constantly tired wrests the energy required to do the things we might normally do to fight depression, such as meet with friends or attend an exercise class.
• Side-effects of medication: Steroids, in particular, can cause rapid ‘highs’ when first taken, followed by devastating ‘lows’. Changing medications can also cause mood changes.
• Often ignored and sometimes subtle factors, such as cold, dark weather, a lack of self-esteem or brusque changes to routine, can trigger depression.

In the case of MS patients, depression can be more difficult to diagnose, in particular because there are a host of shared symptoms between the two conditions, including insomnia, fatigue, restlessness, lethargy, cognitive difficulties and excessive drowsiness. The Goldman Consensus Group came to the conclusion that patients with MS should be routinely screened for depression using a questionnaire such as the Beck Inventory, which asks patients a series of questions to determine the presence and severity of depression.

Risk Factors for Depression

Women are almost twice as likely as men to suffering from depression, owing to a variety of factors, including hormonal changes during pregnancy, menopause etc.; the postpartum period is also particularly delicate, since between 9 – 16% of women in the US suffer from postpartum depression. Disabled mothers and those with significant family responsibilities (such as being a sole parent or the main carer of an elderly parent) are also at risk. Elderly patients are yet another group facing a greater risk of falling into depression; in addition to the challenges posed by MS, many of these patients also live in chronic pain or have recently undergone surgeries with slow, difficult rehabilitation processes. Many older people suffer from psychological issues like loneliness, an increased sense of purposelessness and fear. Others will have recently lost a loved one and are going through a painful bereavement process. Additional risk factors for depression include having parents who suffer/have suffered from depression, or having inadequate social/family support. A dependence on drugs or alcohol likewise exacerbates the symptoms of depression.

What Treatment Options are Available?

Since the causes of depression are varied in nature, treatment should always be individualized. The Goldman Consensus Group states that therapy, medication or integrated approaches may be ideal, depending on the patient’s individual choice and circumstances. It is vital to match your needs with the right professional, so make sure to ask potential therapists vital questions, including their experience in working with MS patients, their treatment approach, their views on medication, etc. Additionally, a good therapist should make you feel truly cared for and should enlighten you on important cognitive/behavioral coping strategies. These include commencing a regular exercise program, taking up stress-busting activities such as mediation and yoga, building your social circle, finding unconditional friendship by acquiring a pet, performing volunteer work and finally, maintaining your sense of humor. Simply facing each day with hope and excitement, can go a long way towards alleviating the symptoms of both depression and MS.

Eve Pearce is a freelance writer and full time mother. She took time out from her career as a nutritionist to look after her children and to develop her love for writing. Now she is able to combine all three. When not working or looking after all and sundry, she likes to get away and explore.