Deression in MS

DEPRESSION IN MS

We just had a discussion on the forum about Depression in MS.  This is another very important topic that all of us need to understand.  Depression and MS are close companions.  Many people with MS will deal with depression at one time or another during their lives.  We see depression from four main causes.  First, depression is a "primary effect" of Multiple Sclerosis just as vision problems, paresthesias, pain, weakness, spasticity, vertigo and many other things are.  Second, there is a depression known as the "depression of chronic illness."  And last, the stress of dealing with all that is involved with MS can cause a situational depression. Finally, many of the medications used in treating MS and its symptoms cause depression as a side effect.  The first cause is the most important to understand.

The damage to the brain in Multiple Sclerosis often causes depression, just as directly as it causes optic neuritis or other problems.  How this happens is not completely understood.  Many researchers believe that the overall slowing of nerve conductions in the brain is mostly responsible for the creation of depression.  We know it isn't just having a serious and incurable disease.  The incidence of depression in MS is higher than it is in other much more disabling diseases or even fatal diseases like ALS.  Even in the most well-adjusted person MS can cause major depressive episodes.  In people genetically predisposed to depression, with a history of severe depression, it is even more likely that they will be affected by this change in the working of the brain.  At all points, the treating physician must be watchful for the development of signs of depression.  Suicide is a seriously common side effect of this damage to the workings of the brain.  It occurs at least seven times more than in people without MS, including those with other chronic illnesses.  Families and friends of people with MS need to know about this problem that is peculiar to this disease.  The biggest warning signs of a high risk of suicide are social isolation, a family history of mental disease, and living alone.

Depression is so much a part of the disease that many experts in field are advocating using a previous and recent Major Depressive Episode as one of the Clinical Attacks need for diagnosis in the McDonald Criteria.  If a person is being worked up for MS and has had a Major Depressive Episode within the previous 2 years, that episode should be counted as an attack and as the clinical lesion (the abnormality on exam).

The second cause of depression in MS is the difficulty with the slowing metabolism of inactivity, chronic pain, chronic fatigue, and chronically not "feeling well."  This causes what is called the Depression of Chronic Illness.  It is hard to maintain an optimistic, cheerful activity when one feels bad in so many ways and for so long.  Some experts would not list this and would say this is part of the next cause, which is situational.

The third cause is similar to the one above.  It is the depression caused by living with the disease.  It is hard to cope with the many symptoms of this disease, along with the profound effects MS has on one's life.  Many people with MS are no longer the person they once were.  Their current state just doesn't match the image they have of themselves as a capable, independent and future-filled person.  Many lose their careers.  This is an expensive disease to have.  Not only are the treatments and meds often expensive, but sometimes a person loses their source of income.  This is an isolating disease to have.  Travel is more difficult and people with MS may become home-bound.  This reduces the time that we can spend with family and friends.  Social isolation is a potent cause of depression.  This disease is hard on relationships.  The spouse may suddenly have a caretaking role shoved upon them that they don't want, are not ready for, or are incapable of handling.  Friction can arise over financial  problems.  The person with MS may feel guilty over this change in roles.  The spouse may feel anger at the disease, at the affected loved one, or at the unfairness of it all.  There may be intense frustration at not being able to fix it or make things right.   We see marriages sometimes break up under the burden of MS.  And a major cause of disruption is the uncertainty of MS.  What will the future bring?  What will TODAY bring?  Can we plan for additional children, for a vacation this year, to go see the folks this weekend?  Never feeling as though anything is certain causes many people with MS to feel loss of control over the little and big things in their lives.

Finally, the medications used in MS may cause depression themselves.  The first to be aware of is the Interferon-beta drugs; Avonex, Rebif, and Betaserson.  Because of their action on the brain functions itself, which may include lowering the production of endorphins, depression must watched for carefully.  People with a signifcant history of depessive disease are not the best candidates for these meds.  Copaxone does not carry this effect to nearly the same degree, if at all.  Another category of meds that have a potential for causing depression as a side effect are the "benzodiazepines" such as Valium (diazepam), Xanax (aprazolam), Klonopin (clonazepam), Ativan (Lorazepam) and there are many others.

So, it is clear that the possibility of depression is inherent in the disease of multiple sclerosis.  It is also a disease that can cause depression by creating severe stresses in the life and many of the meds used can predispose to depression.  How can we tell the difference?  Actually, we can't for the most part.  And it is not relevant to say that this depression is caused by the disease and that depression is cause by the stresses.  The treatment is mostly the same.  Every effort should be made to ease the stresses, relieve the symptoms and reduce meds that can cause the problem.  Depression is not shameful in MS, nor in any other setting.  It should be approached and treated just as any other symptom of a disease that encompasses almost every part of the body and life.

Quix

[Wobbly]

I havne't even read this and I know exactly how it feels..

[cjacks]

Quix

Wow ,   I'll have to read this tomorrow

Jo

[grannyhotwheels]

Can you have all 3?  I think I have all 3.

I'll be praying,
Carol

[Quixotic1]

Hey Hotlegs!!  So good to see you, but I wish you were feeling better.  Don't you know there is no pain in MS?

Yes, all three can easily be a part of a person's depression and It is hard to tease out how much of either.  

Quix

[biowham]

I've had two bouts of depression in the last few months, one in April and a more persistent one--I simply am having a very hard time shaking it--that began a few weeks ago. We have depressive tendencies in my family, but I've never been depressed like this before. Getting out of bed sometimes is just so hard, and I feel tired all the time, and just...depressed. It's weird, and I'm really considering asking for some antidepressants so I can just be my usual self.

Bio

[Lulu54]

Thanks so much for taking the time to give this excellent and thorough explanation.  My two cents here - depression is much easier to deal with when you share, even if it is here in the anonymous format of this forum rather than at home with your loved ones.  

Everyone,  please continue to be good to yourself and share the good and the bad with all of us.  It does make a difference!

My best,
Lulu

[Deb61]

Thanks for this clear explanation.  I get depressed when I'm fatigued.  Like a few weeks ago, I came home for work in a great mood, then a dark cloud moved over me later that evening, and I sank to a really, really low point.  When I woke up the next morning, the black cloud left and I was fine.  

I go through this many, many times.  I've tried medicines, but haven't found one yet that doesn't interact with my beta blocker or makes me feel incredibly bad.  The best way to control it for me is to just go to bed or to not get get myself overly tired.  

However, I also fly off the handle more easily than I used to, and I think it's mostly frustration from not being able to accomplish what I need or want to.  This is something that I've got to get a grip on.  I always apologize, but I don't like to treat the people I love this way.  

Thanks again, Quix.  We're lucky to have you.

Deb

[Quixotic1]

Bio - I understand what you mean about the depression being more overwhelming.  For me I think it is the depression (which I have been dealing with for more than 20 years) combined with the fatigue.

Lulu - You are sooo spot on about the sharing the low times with people here.  the inability to reach and connect with people goes back to the high risk of being socially isolated.  The worst thing to do is to withdraw and tough it out, yet that is often our first inclination.  The anonymity of the forum doesn't seem to  take away from the ability of the people here to let someone know that they aren't alone.

Yes, for all of us - share the bad with the good.  We will ALL be the better for it.  It helps people who are depressed to be able to support and help others, too.  The goodness flows both ways.

Deb - You describe something that is good to talk about.  That is the special irritability we can suffer with MS.  Irritability is a part of depression, but lack of control over the emotions is especially true with MS.  Emotions can be amazingly volatile.  Little things can set us off - totally out of proportion to the way you think you should respond.  Part of that is what is called the "pseudo-bulbar effect" where people may laugh or cry uncontrollably to minor events.

When I get overly fatigued I also have more trouble with the depression and with irritability.

Quix

[Sunnytoday]

A wonderful post....
I had a dr.in NY wonder if I was getting anxious with all my strange symptoms, and my first impulse was to say "No!" becuase I had been placed on Anti-D's this summer and pushed out the door " your' just depressed" and at that time in the summer I wasn't anywhere near depressed and that was the LAST thing I wanted now. BUT, i realized afterwards that this week really did a number on me and yes, I'm rather up and down emotionally right now. I don't know what to do with myself, frankly. I think it will settle out eventually but I do understand more and can empathize a bit more with those dealing with depression from an illness.
~Sunnytoday~

[Rena705]

Thank you Quix for posting this exceptional explanation of depression.  After having to build up the nerve to admit that I was diagnosed with depression and that they want me to seek professional help...this should explain to people what it is I am dealing with and how serious it can be!  

Again...you are a WISE old owl and I sincerely appreciate you going to the effort of writing this explanation.

Hugs from swiss cheese brain,
Rena

[SaraRN]

Wow, that's such a great post. I read it out loud to my husband to help him understand what  we are going through as a result of my MS and other autoimmune conditions I'm suffering from. It's all so interesting to me, as a patient and as my background as a nurse.  So many of us were pushed away early on in our diagnostic process by doctors who did not fully understand the symptoms of MS themselves. I met some really ignorant neurologists in the last 12 years. In fact, a nationally known MS specialist at UCSF in the late 90's held up my MRI scans to the window, gazed at the numerous lesions in my brain and spinal cord then turned to me and said, "Well, I can tell you right now that what you really need is to lose about 20 pounds and go on antidepressants!".  

I was shocked, to say the least! At the time I was desperately seeking answers because I was in prerequisites for the Registered Nursing program at a local college and had just been accepted to the program the following year. I had one doctor tell me to quit, one say that it could be MS or spinal cord tumors, and I chose to go to UCSF for a 2nd opinion, to be sure, and I left there feeling totally abused and tossed aside. It was a horrible experience. But back then I couldn't find a neurologist who agreed that MS could cause pain either yet years later the MS Society came out with a pamphlet called "Ms & Pain"!!! ha! ;-)  I have often felt like my own research resulted in me being more knowledgeable than my doctors, unfortunately, even the MS specialists. It can leave you feeling alone and discouraged for sure!  But, I came to realize that just like in any other career there are people who are good at their job and people who suck at it. I have met some of each!  The one who said it might be spinal cord tumors also said, "But we can't biopsy the spinal cord until autopsy". Nice, huh? He is not known for his bedside manor!  The one at UCSF turned to me as I was crying after his abuse and said, "Was there something else you needed because I need this room for another patient" after he literally sat there doing his dictation about me into his recorder.  I have never met anyone in my life that awful, why would someone like that go into such a field? And how on earth did he become so well known for greatness, I sure didn't see it!  I wasn't shocked to learn later that he was no longer in that position!

Anyway, it's so nice knowing that the depression and other issues of MS are becoming more easily understood even though we have a way to go yet. I'm going through a pretty bad depression right now. I pushed myself to finish school, graduated as a RN in 2001, even showed up to labs at times with an IV in my arm. But now, I'm weaker, more fatigued, and have a cluster of other autoimmune problems and some docs now believe I may also have Lupus. I've been off work for 2 years. I didn't get to be a nurse as long as I hoped but at least I got to do it. The depression, fatigue, and pain have become debilitating in the last 2 years. My sweet husband puts up with it all so beautifully but I do feel guilty a lot for what it does to our lives.  

I hope everyone out there is feeling well and having a good day. If not, well, it's nice to know we aren't alone in this fight!

[essdipity]

Hello, Sara. You've put this most interesting post at the end of a long and old thread, as I'm sure you realize. I know your principal reason was to thank Quix for her wonderful analysis of depression in MS.

You may not know that this same information can be found in slightly different form in our Health Pages (yellow icon, upper right). There's a great deal of other very helpful info there as well. I invite you to take a look.

I hope you'll stay with us, and suggest you start a new post telling us about yourself. Others here will welcome you and will be glad to get to know you.

ess