Depression is a common symptom of multiple sclerosis (MS). As many as 50 percent of people with MS experience depression — that’s three times the rate in the general population. Along with fatigue, depression may be one of the leading causes of decreased quality of life with MS, according to a 2019 study in Brain and Behavior.

MyMSTeam recently interviewed Dr. Alissa Willis, chair of the department of neurology at University of Mississippi Medical Center. According to Dr. Willis, depression is often overlooked as a common symptom experienced by people living with MS.

“Many people who don't have MS primarily think about the physical symptoms that go with MS,” Dr. Willis said. “But people with MS know that there are many invisible symptoms, and depression falls into that category.”

How Is Depression Different From Feeling Sad?

Sadness is a temporary feeling in response to disappointments or losses. Depression, on the other hand, is a serious mood disorder that affects daily functioning and can last much longer. Left untreated, depression can make other MS symptoms worse, and even become life-threatening, according to the National Multiple Sclerosis Society.

Dr. Willis said that when someone receives a diagnosis of MS, they can exhibit symptoms that look very much like depression, such as fatigue and sleep disturbances. However, after a period of time, the person will overcome the initial shock of the diagnosis and some of these symptoms may begin to abate. If they don’t, Dr. Willis explained it may be an indication that the person has depression.

“When someone gets a new diagnosis of MS, there's understandably an adjustment period with feelings of loss and sadness and sometimes loss of interest in normal activities,” Dr. Willis said. “When that continues beyond a few months, that is very abnormal, and it's concerning to me as a neurologist that there's something more going on there.”

How can you tell if you’re depressed? According to the National Institute of Mental Health, you may have clinical depression if you’ve experienced at least five of the following symptoms for most of the day, nearly every day, for more than two weeks:

• Sadness, irritability, anxiety, or an “empty” feeling
• Loss of interest or pleasure in activities you usually enjoy
• Hopelessness or pessimism
• Changes in appetite
• Sleep problems
• Fatigue
• Feelings of worthlessness or guilt
• Cognitive problems, such as difficulty thinking or concentrating
• Persistent thoughts of death or suicide

Most people with MS will recognize that several of the symptoms associated with a depression diagnosis are also common MS symptoms, including fatigue and cognitive difficulties — also known as “brain fog.” Unfortunately, it may be hard to tell whether it’s MS or depression causing these symptoms, or if each condition is worsening the symptoms of the other.

Understanding the difference between depression and day-to-day sadness and “blues” can help people with MS get the proper diagnosis and treatment. If you think you might be clinically depressed, talk to your doctor.

What Does Depression Feel Like for MyMSTeam Members?

On MyMSTeam, members have an understanding and supportive community in which they often share their challenges with depression. Here are some members’ descriptions of how they experience depression:

• “When I have the blues, they pass right away. When I’m depressed, it stays and I cry a lot.”
• “Feels like I’m sinking emotionally.”
• “It’s slow, creeps in, and affects every aspect of your life.”
• “It’s like a gray cloud that follows you, a cold, squeezing hand around your heart and soul. You feel helpless, sad, tired, constantly grieving, and can't put your finger on why. You can't just pull yourself out of it.”

While depression may affect people with MS in different ways, all share the experience of depression negatively affecting their quality of life and proving difficult to shake off.

What Causes Depression in People With MS?

Rates of depression are higher for people with other chronic illnesses too — not just MS. Everyone experiences sadness and stress from time to time, but living with MS and other chronic conditions can create an ongoing burden of disappointment and loss. Daily struggles with pain, loss of mobility, and concerns about MS disease progression can become overwhelming.

Dr. Willis cautioned against chalking up the depression to everyday sadness or stress. Rather, she explained, there’s a neurological reason behind it.

“People with MS don't develop depression because they can't deal with what they have,” Dr. Willis said. “When you have a disorder that affects your brain, it affects the processing of neurotransmitters that influence your mood, things like serotonin, norepinephrine, and dopamine.”

Inflammation, the immune process involved in MS, may also play a role in depression. A 2017 study in the journal Neurology found higher levels of inflammatory disease activity in the brains of people with MS who were depressed. In MS, inflammation also damages the myelin sheath protecting nerves that control behavior and mood. Researchers observed in the study that mood improved when inflammation was reduced or resolved.

Some MS treatments can also lead to depression. Several disease-modifying treatments (DMTs) for MS list depression or worsening of depression as a potential side effect. In fact, a 2018 review in Multiple Sclerosis and Related Disorders found depression to be the most commonly reported adverse psychiatric effect for the medications marketed as Tysabri (Natalizumab), Gilenya (Fingolimod), Tecfidera (Dimethyl fumarate), Aubagio (Teriflunomide), and Lemtrada (Alemtuzumab).

While DMTs for multiple sclerosis can cause a wide array of potential side effects, they have been proven in clinical trials to be effective at reducing the rate of MS relapses, delaying the progression of disability, and limiting new inflammation in the brain and nervous system. If you suspect your depression may be connected to your MS medication, talk to your doctor. They will help you weigh the risks and benefits of your MS treatment.

Treating Depression in MS

Once a doctor diagnoses both MS and depression, there are steps that need to be taken. The first is to determine the severity of the case. Someone who is severely depressed and thinking about self-harm will need different treatment from the person who’s depressed but functioning, without having intrusive thoughts.

Whatever the case, the good news is that depression can be treated. The best place to start is by talking to your doctor. One treatment they may recommend is an antidepressant medication. Antidepressants may help in more than one way. Some antidepressants, such as Cymbalta (Duloxetine), also help treat neuropathic (nerve-related) pain — which is common in MS. Some researchers think antidepressants may even provide the benefit of neuroprotection in MS, although more studies are needed.

Your doctor may also refer you to a mental health professional, such as a psychologist or counselor. There are many types of psychotherapy, including traditional talk therapy and cognitive behavioral therapy, that can help you work through difficult emotions and develop healthy coping mechanisms for stress. Dr. Willis said that while antidepressants can be an effective clinical tool, good communication with your doctor and regular meetings with a therapist are also indispensable components of treating depression for many people.

“Talk to me, talk to a psychiatrist or a therapist,” Dr. Willis said. “Make sure that the person with severe depression is first of all safe. … The answer to that is not from medicines. It's seeing someone frequently and talking about what's going on.”

Dr. Willis added that another crucial component of treating depression is healthy living, including exercise and changes to one’s diet. “We spend a lot of time talking about medicines in MS, specifically disease-modifying therapies, but being well overall, being healthy overall, helps a person with MS do better,” she said. “They usually feel better, and they function better, and it is something that helps control the MS.”

There are many lifestyle changes that can help manage depression and fatigue for overall health and wellness.

Exercise

Moderate sessions of yoga, stretching, pool exercises, aerobics, and recumbent bicycling have been suggested to provide benefits for depression and fatigue in a number of small studies. Check with your doctor before starting any exercise program.

Stress Reduction

A 2012 study found that people with MS who followed a stress management program experienced fewer symptoms of depression.

Mindfulness

A 2014 systematic review of mindfulness-based interventions for MS — including mindfulness-based cognitive therapy, mindful movement, breath awareness, meditation, qi gong, and tai chi — found evidence that they may help reduce stress and depression. They may also prevent relapse and improve overall quality of life with MS.

Coenzyme Q10

The antioxidant and anti-inflammatory properties of the supplement coenzyme Q10 (also called coQ10) may hold promise for decreasing depression and fatigue in people with MS, according to a 2015 double-blind study published in Nutritional Neuroscience.

Find Your Team

By joining MyMSTeam, members gain a community of more than 143,000 people living with MS who understand its challenges, including depression. Members support each other and share ways they have found to manage their depression and live their best life with MS.

Do you live with MS and depression? What has worked to help you manage depression? Share below in the comments or join and post on MyMSTeam.