Mood and MS

Those of us who have been involved in both the research and care of people with MS walk a tightrope sometimes between pointing out the severity of a problem and solving it. We want to alert our patients without overwhelming them. On Thursday, I attended a session on depression and other mood disorders at the Consortium of MS Centers meeting in Seattle that really brought home how prevalent these symptoms are in people with MS. While the numbers are sobering, the message is clear: bringing this information to light can only bring us closer to finding solutions.

Depression is two or more times more prevalent in people with MS than in the general population, says Dr. Scott Patten (from the University of Calgary) in his review of the studies (find his presentation here). When researchers try to find out what factors predict lower quality of life, depression gets high marks. Not surprising, since depression affects how you function at work, in school, in your social life and during recreational activities.

It’s crucial to distinguish depression from other MS symptoms, though, and Dr. Patten made some great points. People may feel “low” from MS fatigue, but that is the kind of feeling that gets worse as the day goes on. Depression is worse earlier in the morning. So, the “scales” we use to measure such symptoms are important, but more importantly, providers need to keep their eyes and ears open. Truthfully, just two questions can help: During the past two weeks, have you often felt down, depressed or hopeless? During the past two weeks, have you had little interest or pleasure in doing things?

Dr. Anthony Feinstein (University of Toronto) discussed treatment options. There are several antidepressants that have shown promise for treating MS-related depression, and which you might be prescribed can depend on your other symptoms. If you have fatigue, you want to take something that will not make you more tired. If you have cognitive impairment, you may want to take something that will keep working even if you miss a dose. Read more in his presentation.

Cognitive behavioral therapy works, he said, whether it’s given individually, in groups, or even via telephone. It doesn’t have to be a long, involved process. Cognitive behavior therapy is a short-term treatment that helps people to take a practical approach to problem solving. Changing how you think can help you to resolve difficulties, and that can change how you feel. I was encouraged by his discussion of options like computerized cognitive behavioral therapy—now under study. People in rural areas or people with mobility challenges need viable options for addressing mental health challenges.

Does personality matter? It might, according to novel research presented by Dr. Ralph Benedict (University at Buffalo). He showed how a test that evaluates five personality traits—neuroticism, extraversion, openness, agreeableness and conscientiousness—can be used in people with MS. What’s the point? Some traits—like really high levels of neuroticism—are associated with mood disorders. His team is working on strategies that might help people to compensate for these traits. If you try to help people overcome mood disorders, you need to know what stands in the way.

We have to combat the stigma around discussing depression and other mood disorders. There’s nothing shameful about having depression. Depression is treatable, and we don’t want to miss this opportunity to make life better for people with MS.
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Nicholas

Nicholas LaRocca, PhD

Dr. Nicholas LaRocca is a consultant to the National MS Society. He is a clinical psychologist who has worked in the field of MS for over 30 years. He was an associate professor at Albert Einstein College of Medicine and New York Medical College before joining the Society in 1997. Dr. LaRocca served as vice president of health care delivery and policy research in the research programs department of the Society. In this role, he was responsible for Society funding of research to address the symptoms of MS, and the rehabilitation, epidemiology and psychosocial aspects of MS, as well as health policy studies.

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    1 Comments

  • Rachel   Jun 16, 2019 1:53 PM
    Depression and MS aren't just difficult to live with, it can also mean living in fear. Fear that your medication will be stopped in reaction if you say "yes I am experiencing it," fear that your symptoms will exacerbate because they took you off the medicine and an exacerbation of your depression because of the increased stress. It is an absolutely viscious cycle and you just feel helpless.