Mental health problems do not affect
three or four out of every five persons
but one out of one.
~ William C. Menninger (1899-1966)
May is Mental Health Month and Depression is the mental health problem I am talking about today. It is not unusual for someone who has Multiple Sclerosis to be depressed.
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods. True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended period of time.
Multiple sclerosis is a neurological condition that often progresses into disability. New symptoms and long-lasting symptoms all leave the MSer feeling helpless, hopeless and depressed. All of this is equivalent to the loss of a loved one or a life that cannot be recovered. It often involves the five-step grief process of denial, anger, bargaining, depression and acceptance. Many of us with MS go through that five-step process with every new symptom and, therefore, depression is sometimes a part of our lives. Sadly, some of us are stuck in the depression stage. MSers are said to be three times more likely to develop depression than the general population.
Characteristic of a chronic condition, MS symptoms are often serious and unpredictable. There is no way an MSer can predict when to expect a symptom, which symptom it might be, how serious it might be, how long it might last and whether it might come back. All of this sounds like a recipe for depression to me.
MS-Related Reasons for Depression1. Physiological
One link between multiple sclerosis and depression may be physiological. First, insulating myelin may be destroyed by the disease. This prevents nerves from transmitting signals affecting mood. In addition, a plaque may develop in the Limbic Cortex, the area of the brain that controls emotions. Then the disease may create chronic depression as a symptom which may come and go as unpredictably as any other MS symptom. This organic cause may strike at any time regardless of stress or any other symptom.
2. Isolation and Loneliness
A typical cause of depression is dealing with the uncertainty and stress of any MS symptom as it comes and goes at any time. Recurring symptoms such as fatigue, weakness, and pain may interfere with the ability to complete daily tasks and therefore to keep a job. Suddenly the environment changes, often not by choice. In addition, loss of a job interferes with personal lives because the coworkers are no longer available daily, and other friends are busy during working hours, too. This may cause isolation and even loneliness. To organize or attend social activities is difficult. Energy and effort are needed to socialize, especially when fatigue sets in. It is often difficult to make a commitment knowing a symptom may suddenly appear and interfere with a schedule.
3. Drug Contraindication
Here is another twist. Many disease-modifying drugs, while reducing or eliminating the effects of many MS symptoms are actually creating depression. Interferons have a side effect of depression. The problem is when a person with MS is depressed, it is difficult to decide if the depression is caused by the disease or by the disease-modifying drugs. Many, but not all, MS drugs are based on interferons.
One cause of depression is simply living with the disease. That includes losing the lifestyle before MS and facing the lifestyle of dependence in a wheelchair or even living from a bed. The possibility of a bleak future is with every MSer, always, and that may develop into depression. Often, however, a positive attitude, gratitude, and flexibility lead to contentment and even happiness. There is always hope.
There is a controversy among professionals about severity, duration and the course of depression based on specific symptoms.
Here is one study that based results on 739 respondents in a Washington survey. It used both MS and psychiatric measuring tools. Severity of MS was determined using the Expanded Disability Status Scale (EDSS). The severity of depression was determined using the Epidemiological Studies Scale (CES-D). This study found that the severity of the multiple sclerosis was found to relate more with the level of depressive symptoms. More severe MS means more severe depression. Of the respondents, 28.1% had moderate depression while 41.8% were severely depressed.
This study concluded clinicians should evaluate the depression in patients with a recent diagnosis of multiple sclerosis. Major changes in functioning, or limited social support are included as factors behind depression. These patients are the ones who have high stress, causing severe depression that may end in suicide.
In 1978-1988, a small Canadian study found “The proportion of suicides among MS deaths was 7.5 times that for the age-matched general population.” That was 28.6% of the respondents. We have to realize there were no MS drugs at this time, and the drugs have made a difference in quality of life. Current studies say there is a life expectancy of 35 yrs after an MS diagnosis.
Depression, regardless of the cause, can be treated effectively. Treatment is critical because untreated severe depression can end in suicide. It is important to check severely depressed MSers for warning signs.
The first step in treatment is recognizing the problem and asking for help. A qualified health care provider can offer several options of antidepressants. In MS, antidepressant drugs are most effective when used in conjunction with therapy where the therapist can help identify particular triggers for the depression. Help would be received to handle and work through the stress, reducing the bad effects and perhaps ending the depression earlier than it would end normally.
A relatively healthy person with healthy and positive support teams may prevent or treat depression. Some exercise routines must be adapted, but it is important they are continued. A vigorous five-mile walk will do more good for an unhappy but otherwise healthy adult than all the medicine and psychology in the world. ~ Paul Dudley White
Along the same line, there are activities that help everyone involved. Noble deeds and hot baths are the best cures for depression. ~ Dodie Smith
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