MS Symptom:

Depression

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Depression is common for people living with multiple sclerosis (MS). Around half of people diagnosed with MS will have a depressive episode at some stage – three times higher than for the general population. Identifying depression and seeking early treatment is key to successful management. 

With the right information and support, depression can be managed effectively to maintain a healthy and active lifestyle.

While everyone can feel sad, moody or low from time to time, some people experience these feelings intensely, for long periods of time and the feelings can prevent them from functioning normally. Depression is more than just a low mood – it’s a serious condition that affects your overall physical and mental health. Depression is diagnosed by a healthcare professional using a set of international guidelines.

Depression does not discriminate, indicate weakness, nor is something to hide. Depression can come and go, occur once, build up slowly or fast. It’s important to know that help is never far away. Talk to your family and/or friends to let them know how you’re feeling and seek help from your healthcare professional as soon as you can. 

Signs to look out for include: 

  • Persistently feeling sad or empty with a low mood 
  • Ongoing, reduced interest or pleasure in all or most activities, such as eating, socialising or engaging in your hobbies 
  • Changes in appetite and noticeable weight loss or weight gain 
  • Disturbed sleep or insomnia 
  • Increased fatigue (in addition to MS-related fatigue)
  • Feeling agitated, unmotivated, worthless or guilty
  • Reduced ability to concentrate, think or make decisions 
  • Negative thoughts 
  • Persistent thoughts of death or suicide

For many people, depression is a combination of a few factors:

  • An imbalance in brain chemistry leading to a drop in mood
  • Triggered by stressful or negative experiences, such as loss, financial worries or relationship strain
  • Genetic factors 

For people living with MS, there are additional factors that may lead to depression. 

Depression can be caused more directly by MS if the inflammatory lesions are in areas of the brain associated with mood, or due to MS-related changes in the immune and/or neuroendocrine (hormone) systems. Depression in MS can also be more indirect, such as coping with the challenges of living with MS, increased stress, and symptoms such as chronic pain and overwhelming fatigue. There is no clear link between how long someone has been living with MS or the level of disability they have and the risk of being depressed. Depression can occur at any time. 

Social support levels can also make a difference and vary between different people i.e., for someone socially isolated, depression can be more severe. How you adjust to living with MS and the kinds of strategies used to manage the condition can also play a part.

With the right help early on, depression can be controlled, managed, and even treated before it spirals out of control. Early intervention is critical to also ensure it doesn’t affect your MS management. 

If you are feeling depressed, speak to your neurologist, MS Nurse, GP, or health professional as soon as possible. Your healthcare team will also be able to help you review your MS management and medications and make any necessary adjustments. 

It’s important to know that there’s support and help available. You may want to reach out to a mental health helpline for more information or support, if you don’t feel comfortable disclosing your feelings to family or friends. You can find details for reputable services below.

In mild to moderate depression, self-management can form an important part of an overall approach to managing depression. This may include some key lifestyle changes such as:

  • Increased physical activity
  • Increased focus on health and wellbeing
  • Quit smoking
  • Reduce stress by ensuring you have time to ‘wind down’
  • Improve sleep hygiene
  • Mindfulness techniques such as meditation

Self-help support groups, phone counselling, online forums or mental health organisations may also help. Your doctor will regularly review your progress to ensure that your mood is improving.

There are several options to manage and treat depression. After speaking with your health professional, they will develop a tailored plan for you. Some options include talking to a psychologist or counsellor, engaging in cognitive behavioural therapy, and in more severe cases, medications in the form of antidepressants are available. 

Counselling and life coaching help you to think about and identify ways to overcome or manage problems. A deeper psychological approach may be needed for some people, such as learning Cognitive behavioural therapy (CBT) and other psychological approaches, which aim to help identify and overcome negative thoughts associated with depression, providing tools to help change thinking and actions.

Medications to treat depression may be used for moderate to severe cases, where previous treatments haven’t worked, or in conjunction with the measures described above. You usually start with the lowest possible dose, and it takes some time for the medication to take effect. Some people may start to feel better quickly, but it’s important not to stop taking your medication without talking to your doctor, as this can trigger a recurrence. If you experience side-effects or no benefit, the dose may be increased, or the treatment changed completely. 

In some rare cases, where there are persistent and repeated episodes of severe depression, or you are thought to be a major risk to people close to you, the standard treatments described above may prove ineffective. In these cases, you may be referred to specialist mental health services for a tailored treatment program.

General Information and Assistance

There is support available to help you manage your MS. 

Your neurologist, MS Nurse or GP should be the first contact for any new and/or persistent depression concerns, so they can perform a detailed assessment and tailor a management plan or referrals if needed.

Contact your state or territory MS organisation to access services such as MS Nurses, peer support and other resources. 

The following support services may be able to provide advice on depression, mental health, wellbeing and other lifestyle factors:

The following support services may be able to provide advice on anxiety, mental health, wellbeing and other lifestyle factors:

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