Within this series of posts exploring topics related to Mental Health and Emotions, we have discussed mood swings, medication side-effects, stress, depression symptoms and depression causes. Now let’s talk about treatments for depression in multiple sclerosis.
Symptoms of depression are not similar to symptoms of an MS relapse, unfortunately, where if you wait long enough the relapse will subside given you have a relapsing form of the disease. Depression will often get worse over time if not addressed.
Fortunately, depression is very treatable. Taking a prescribed medication AND participating in psychological counseling appear to be the most effective duel approach in addressing depression. Taking advantage of both approaches together is more effective than either treatment alone - medication or therapy.
Medication for Depression
The most frequently recommended medications for depression come from a class of drugs known as "selective serotonin reuptake inhibitors" (SSRIs). These antidepressant medications inhibit the reuptake of serotonin (a chemical produced within the body which is known to elevate mood), allowing it to remain in the body’s system longer. Some of the more commonly prescribed SSRIs include Celexa ®, Lexapro ®, Paxil ®, Prozac ®, and Zoloft ®. Common side effects may include headache, nausea, sleeplessness, anxiety, drowsiness, and sexual dysfunction. These side effects may subside with time, or one’s doctor may adjust the prescription or dosage. Newer antidepressants include "serotonin and norepinephrine reuptake inhibitors" (SNRIs), such as Cymbalta ® and Effexor ®, with side effects that are similar to the SSRIs.
Other drugs which are not SSRIs (belonging to other drug classes), such as Desyrel ®, Remeron ®, Serzone ®, and Wellbutrin ®, are options which may result in fewer side effects. Numerous other drugs are also FDA-approved for the treatment of depression, many of which either augment another antidepressant, or are used to treat specific behaviors found in various types of depression - including anxiety, mood swings, manic episodes, insomnia, and excessive eating (among others). The key is to work closely with your doctor and therapist to determine the correct drug and dosage that will work best for you.
To treat my depression, I have used a SSRI for many years and still do. Last year, my neurologist added Wellbutrin to my arsenal of medications, a change which has been much welcome. It seems to help my fatigue level in addition to depressive symptoms. Some of the anti-depressant medications are also used to help treat pain associated with MS. So don’t think that you need to be depressed before finding benefit from an anti-depressant.
When starting a prescribed treatment for depression, keep in mind that many of these drugs can take up to six weeks before reaching maximum effectiveness. If after six weeks you are not seeing any improvement in your symptoms, please talk to your doctor who may want to adjust the dose or switch to a different medication.
Medications for depression usually need to be continued for at least four-to-nine months to prevent depression from quickly returning. For those with severe depression, medication may need to be continued indefinitely (as the blogger raises her hand). Never alter the dose, stop taking medications, or combine a prescription with other medications, without first consulting your doctor or pharmacist. Of course, if you are experiencing an adverse reaction to the drug, please contact a medical professional immediately.
As an alternate to prescribed medication, some individuals may decide to try dietary supplements as a way to help improve their symptoms of depression. Examples of popular supplements which are promoted for depression include St. John’s Wort and Ginkgo Biloba. If you are considering any type of supplement, first consult your physician, as these can cause serious side effects and/or interactions with other medications.
Therapy for Depression
Psychiatrist, psychologist, social worker, psychiatric nurse, family therapist, or counselor - each of these types of professionals are specifically trained to help those suffering from depression or other mental health issue. Your neurologist, family physician, or local MS Society chapter may be able to give referrals to mental health professionals in your area who are experienced in working with MS patients.
A variety of therapeutic approaches may be used during the counseling process, including:
- Talk therapy - which helps the patient gain insight and resolve problems through verbal exchange with a therapist
- Behavioral therapy - which helps an individual find reinforcement through rewards based on his or her own actions
- Interpersonal therapy - which concentrates on issues arising in relationships with others
- Cognitive/behavioral therapy - which works to change negative ways of thinking and acting into more positive approaches
- Psychodynamic therapy - which helps to resolve internal conflicting feelings, often stemming from past experiences
Support groups and peer counseling are often particularly helpful for MS patients and a number of these programs are made available through MS organizations. These programs are not a substitute for professional therapy, but may be a nice addition. Talking to others who can relate first-hand to what it is like to live with MS and/or depression, helps to validate what you are experiencing…just look at our wonderful community of MS patients right here at HealthCentral. It’s almost like therapy online.
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