Depression

Multiple Sclerosis is a tough disease. It has many common symptoms, vision problems, balance issues, cognitive difficulties. But one that isn’t mentioned, but should be, is depression. Depression is one of the most common symptoms of MS, but one of the least talked about.

Prevalence

The numbers can vary from study to study, but around 40-50% of individuals who have MS will also experience an episode of depression at some point during the disease course. Some studies list it as higher, some lower, but the evidence is clear that depression and MS are linked.

The first reaction for many would be “this makes sense”. MS is a life altering condition that brings high anxiety about the future. But grief and depression are different. Grief is expected and usually improves over time. Or can increase if a new symptom is present, or a relapse occurs. Depression on the other hand, doesn’t improve as time goes on. Yes, if treatment is involved it can, but if left alone, usually it won’t reverse course on its own.

Brain Lesions

Several studies have looked at lesion burden, location and if these impact rates of depression. Studies found that brain lesions do seem correlated to depression rates, as those individuals with higher rates of brain lesions had higher rates of depression. Going a bit further, in these studies researchers were able to target specific areas of the brain and correlate depression with lesion location. Specifically the left anterior temporal and parietal regions. Now, I’m not saying that if you have lesions in your brain, or in these specific areas, you’re going to be depressed. Not at all. There are many other factors that are at play as well.

Cognitive Difficulties and Depression

Cognitive difficulties are another common symptom of MS. Around 40% of individuals state they have some aspect of cognitive issues. Although once thought to not be connected, cognitive issues are also connected to depression as well, especially moderate to severe depression. Studies are showing that tasks that require effort, like information processing, working memory and executive functioning are the things that are affected by depression. Routine tasks that are more like reflexes are not as affected. This might be one of the reasons why it might have been thought that depression and cognition were not correlated. At first on the surface, it seems like they aren’t. But once you dig a bit deeper and look at the full array of processing, it turns out they are.

Inflammation and Depression

One of the causes of depression that has been showing up in research in the past few years is inflammation. Even in individuals without MS, it has been shown that higher inflammation levels are correlated with depression rates. A study published in the Journal of the American Medical Association reported that brain inflammation was 30% higher in individuals who experienced depression. There is also evidence of increased proinflammatory cytokines in cerebrospinal fluid.

Treatment

With all the information regarding where depression may stem from for individuals with MS, you’d think treatment regimens would be clear. However, it’s not that simple. Considering many of the symptoms of depression and MS look similar, fatigue, cognitive issues and somatic pain (among others), diagnosing depression apart from MS can be rather tricky. However, this shouldn’t deter anyone from seeking treatment. Cognitive Behavioral Therapy is a form of talk therapy that is very effective with depression. Learning coping skills to help manage depression can be instrumental to living a functional life. Having a solid support system around you as well is important. And, trying measures to reduce both systemic and brain inflammation can be key as well. This could include daily stress management techniques, exercise, eating well and taking supplements. Finding what works for you in your self care plan is crucial.

It is clear that MS and depression are highly correlated. But that doesn’t mean it is an absolute, or a forever if you’re in it now. There are key steps you can take to reverse depression and feel in control again.

If you’re ever feeling suicidal, or in extreme emotional distress, call the National Suicide Prevention Lifeline — 800-273-TALK (8255) — or access the online Lifeline Crisis Chat. Crisis workers are available 7 days a week, 24 hours a day. Your toll free, confidential call will be routed to the nearest crisis center in the national network. These calls will provide crisis counseling and mental health referrals.