Mental Health and MS: Depression Causes
Six years ago today I had an odd dream. It was of my grandmother coming into my bedroom to talk. I mumbled something (in the dream) about wanting to sleep a little longer and she laughed, saying that it was fine.
This was a Monday morning after Hurricane Isabel swept through the East Coast and Washington DC area. I was home alone when the power went out on the previous Friday morning which would ruin the mound of food I had just stocked our new freezer with. The power did not return until late Sunday evening.
I received a phone call later in the morning on Monday. My grandmother had passed away that morning. This turned out to be only the 2nd of too many devastating events which occurred during the most hellacious week I’ve ever experienced before or since. Hurricane. Death. Funeral (in Oklahoma). Family Violence. Police. Hospital. Panic Attacks (mine). Xanax. Delayed, then Cancelled Flights. Stuck in St.Louis. Missed Flights leaving DC for Indiana. Doctoral Oral Exams on following Monday.
After recovering, slightly, from all of the above, I knew I NEEDED HELP!!! As a result of the hellacious week, I had many reasons to be depressed. I found a therapist with whom I would develop a great working relationship, which certainly helped years later when I was being diagnosed with MS.
Causes of Depression
1. Disease Response
Experiencing a period of depression and uncertainty following the diagnosis of MS is not uncommon. It takes time to adjust to a “new reality” and grieve the loss of what was, or the loss of a planned future. I have observed that the first year post-diagnosis seems to be the most difficult one emotionally. However, most patients do eventually adjust to altered circumstances, even the ones which come from new disabilities, loss of employment or loss of relationships.
To be honest, I must admit that I’ve experienced the same post-diagnosis depression during each exacerbation. All of the uncertainties and fears come rushing back with each gain of unstable ground. If staying in a place of “emotion-centered” thoughts and avoiding constructive problem-solving skills, I become depressed more easily during and following a relapse. It takes time to come back around to acceptance.
Also, low self-esteem (due to poor body image, loss of abilities, activities, friends, etc ) can lead to feelings of worthlessness and guilt, which can certainly lead to depression. But do not give up hope; there are strategies which can help.
2. Physiological Changes
Damage to the central nervous system can impact mood directly. One theory is that lesions which cause damage to the right frontal and temporal lobes of the brain can cause depression. These are areas of the brain which regulate emotion.
Chemical changes which occur within the brain (and body) can affect mood. I am fascinated with the association of interferon-gamma (IFN-gamma) and Th1-type cytokines (pro-inflammatory proteins) in depression experiencing during an exacerbation. This could further explain why I (and patients like me) experience increased depression when active inflammation is occurring in the body.
Fatigue takes away our energy, including the emotional energy to fight depression and the physical energy to do the things which might normally detour depression. When MS fatigue has settled in, the last things we feel like doing are exercising, socializing, or maintaining good nutrition and sleep habits. It is a vicious cycle as neglecting these things will increase the amount of depression we experience.
4. Medication Side-Effects
Probably the MS treatment which most commonly affects mood would be steroids prescribed for acute exacerbations. Steroids will put you on an emotional rollercoaster quicker than anything else I can think of. If you routinely experience increased irritability (ie. you have to fight enormously hard to keep from biting off the heads of even the sweetest dear ones around you), then your neurologist may prescribe a low-dose anti-anxiety medication (ie. Xanax) to help you through the cycle.
Some of the disease-modifying medications we use can help to contribute to depression levels through the depletion of serotonin levels. Beta interferons (ie. Avonex, Betaseron, Rebif) are known to increase depression in some (not all) patients. Other medications used for symptom-control can also have an effect. Examples include baclofen for spasticity, benzodiazepines for vertigo or spasticity, or other sedating drugs.
Please keep in mind that we each are unique and our bodies respond in different ways to treatment. My experience is certain to be different than yours. Also, when changing medications, one might initially experience a mood changes as your body gets used to the new chemicals being introduced.
5. Other Causes
Multiple sclerosis is not the only medical or physical condition which may cause depression. Be sure to talk with your doctor who may want to test hormone, thyroid, and blood-glucose levels, or test for urinary tract or other infections.
Changes in the seasons can cause depression, often called Seasonal Affective Disorder (SAD) or “winter blues.” Oddly enough, I’ve experienced SAD during the summer months if I’ve not been able to get outside and get fresh sunlight due to unbearable heat and humidity. And changes in routine can be the culprit in some cases of depression.
Wow. There certainly are many, many possible causes of depression in MS patients. It’s amazing that we’re all not depressed, all of the time.
To give the topic enough space and attention, I will save discussion of treatment options for next week. I have appreciated the comments which add to the discussion of each post. There is such great power when we help each other through shared questions, shared stories, shared experience, and shared recommendations. Thank you for sharing in the discussion.
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