Depression and its Impact in Multiple Sclerosis

Most of us know that depression is a very common symptom of multiple sclerosis (MS). What people may not know, perhaps because the topic is rarely discussed at dinner parties, is that suicide is one of the leading causes of early death in people with MS.

For this reason, I was interested in the presentation at ECTRIMS 2015 of the Swedish study entitled, “Multiple sclerosis and risk of completed and attempted suicide – a national cohort study. ”  To be clear in our definitions, “completed suicide” is that which results in death and “attempted suicide” is that which does not.

The researchers identified over 29,000 people with MS listed in the patient registry of Sweden. They matched each of these to people without MS who were the same age, gender, education level, and from the same region of Sweden. They then looked at comparisons of cause of death and suicide attempts.

This is what they found:

  • Over twice as many people (2.18 times) with MS attempted (unsuccessfully) to commit suicide as people without MS.
  • A smaller proportion (1.87 times as many) people with MS committed suicide.
  • Men were 60% more likely to commit suicide than women.
  • Women were 30% more likely to attempt suicide than men.
  • Risk for suicide was highest among 18-40 years olds and lowest among those 66 years and older.

It was no surprise that in this study, depression was the most important risk factor for both attempted and completed suicide.

The research group postulated that the lower risk for suicide among elderly people could be explained by higher physical or cognitive impairment, which may prevent their ability to commit suicide, although this was not examined in the study.

Interestingly, among people without MS, people with a higher education were 30% less likely to commit suicide than those with a lower level of education. Among people with MS, however, people with a higher education were actually slightly more likely (10% more) to commit suicide.

Compared with the general population, people with MS were more likely to use pills than other forms of suicide, perhaps because they had easier access to pills than to guns or other methods.

A comprehensive paper looking at 13 studies of suicide in people with MS was published in 2012 and found that the Swedes are not unusual, as most studies have documented a higher suicide rate in patients with MS compared to the general population. Across the studies, suicide in people with MS was associated with several risk factors, including severity of depression, social isolation, younger age, having a progressive form of MS, lower income, earlier disease course, higher levels of physical disability, and not driving.

I asked if assisted suicide or euthanasia was included in the study, and was told that this was not specifically looked at. I assume that it is excluded from the data, as I found the following information on a website about assisted suicide laws: “While it is correct that Sweden has no law specifically proscribing assisted suicide, the prosecutors might charge an assister with manslaughter - and do. In 1979 the Swedish right-to-die leader Berit Hedeby went to prison for a year for helping a man with MS to die.” (The assisted dying organization, Dignitas, is located in Switzerland, not Sweden.)

Bottom Line: Depression is a very common symptom of MS. As the research shows, it is the key risk factor for suicide. It therefore is extremely important to be alert to the the warning signs of depression, as depression is one of the MS symptoms that can actually be successfully treated.

I learned that it’s important to keep tabs on how you are feeling by asking yourself the following questions:

  1. During the past two weeks, have you often felt down, depressed or hopeless?
  2. During the past two weeks, have you had little interest or pleasure in doing things?

If you answer “yes” to either of these questions, you may be depressed and need to seek help. I also learned that depression is not a sign of weakness and it is not your fault. It CAN be treated successfully. Talk to your doctor openly and honestly about how you are feeling – you owe it to yourself and those who love and care about you.

To connect with a National MS Society Navigator for help, information, or assistance finding a mental health professional in your area, call 1-800-344-4867 or fill out this form.

If you are having thoughts about harming yourself or feel you are at risk of hurting yourself or someone else, call the National Crisis Hotline at 1-800-273-TALK (8255) or text "ANSWER" to 839863.

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Julie Stachowiak, PhD

Julie is the author of the Multiple Sclerosis Manifesto, the winner of the 2009 ForeWord Book of the Year Award in the Health Category. She is an epidemiologist who is also a person living with MS, Julie has an in-depth understanding about current research and scientific developments around MS. She also has first-hand knowledge of the frustrations and anxiety surrounding the disease, as she had MS for at least 15 years before receiving a diagnosis in 2003 and has had several relapses since her diagnosis.

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  • Lauralynn Bourn   Oct 12, 2015 10:53 AM
    I was disappointed that they looked into education as a factor in their percentages but nothing was said about people with MS & their faith being a factor.
  • Jamie Byers   Oct 12, 2015 11:34 AM
    I was diagnosed in2010 with rrms sure I was upset but now live life in a different. way It is what it is
  • Ree  Oct 12, 2015 8:18 PM
    I am living with MS since 1994 and never had any thoughts about suicide, however other people think just because I have MS that suicide is a factor. I would like to change people minds about MS. It is so important to educate people, than maybe we can have a world without MS.
  • Damaris Vazquez   Oct 13, 2015 12:07 AM
    I have MS since 2013 some days i feel fine and some days i feel sad and i cry that the only conform me then i think about my boys and my Granddaughter and that made me continue to be strong
  • Wolfie Hogan   Oct 13, 2015 12:50 AM
    Depression is only a small part of what I'm going through I'm going to be homeless in two weeks and John have many prospects
  • annamarie0526  Oct 14, 2015 12:43 PM
    I have been diagnosed since.October of last year, and lately it seems like the depression, hopelessness, and waking up every morning wondering what I have to do to just go back to feeling like myself. The person who use to be happy. I have been on several different antidepressants, and nerve medicine but it seems like nothing is helping anymore. Anyone else have the same.feelings and found a way to deal with them and start living again??
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    maria1  Oct 14, 2015 1:33 PM
    In the Discussion section under Treating MS are some of the tools used in the Take Charge of My MS study at the University of Washington. These tool work for depression, pain and fatigue. They are worth a look.
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    oldhippie  Oct 14, 2015 3:46 PM
    I wish I the end all answer for this question, but I found that (well at least mine) seems to come at me very day some more then others but everyday. What have found that that works best for me, is everyday that I wakeup and can look around the room is a good day and I will hold on to that for as long as I can!
    Having been dealing with depression for over 45 years and more then once thought and even tried to comment suicide (but thank GOD I failed) I have found that even on my worst day's I can and will find something I can be happy about no matter how small it seems if I can find something, anything to get me past it I will take it and never let it go. And hold fast to the thinking that GOD is not done with me or even ready for me (not yet anyway). Can I tell you of a little story about me and my past? I am combat Veteran (one and a half year recon in Vietnam) lost my entire team all at one time (I am the only one of eight) that made it out and some 45 years later I am still asking why, why me. And then one night while sitting in the cab of my Kenworth semi facing a 500 foot drop into canyon thinking that could just drive over the edge and be bone with all of it, I had what have told me (a Devin encounter) I sat there for what seemed be a lifetime when heard a voice in the darkness(mind you was alone) this of a vary young girl (saying not now it's not your time, you have to save me) with this it made me look back into the darkness and saw a brightness, this was a vary young girl smiling at me and then had this filling that she touched me on my forehead and she was gone. I to this day can not explain this, but it has changed everything about my life, it has not stopped the depression but it dose help managing it.
    I hope that will give a better perspective about depression and maybe all whom read's this a glimmer of hope!!
    Frank (old hippie)
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    oldhippie  Oct 15, 2015 8:34 AM
    Can someone answer a question for me? Why is it that when you go to a blog on here and put a comment on it that it shows up on the main page but no one ever seems to respond to any of your comments or ever has anything to say in response?
  • weeb   Oct 16, 2015 6:19 PM
    Pills are not the cure for chronic depression. Please give tai chi and/or yoga a chance along with daily walking. The keys to health are exercise, mindfulness, and moderation. Find quiet time and just be for a few minutes ever day. Finally, make the effort to socialize and do new things!
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    cadailey514  Oct 27, 2015 1:48 PM
    I was having a really bad day this past Saturday and I spent hours thinking exactly HOW I could get rid of myself. It's funny, but it's not. I was trying to think of something painless. I don't take anti-depressants, only over the counter vitamins and my ms drug so I didn't really think that pills would be an option at all. Was afraid that just taking a bottle of aspirin wasn't going to do the job at all. Thinking, thinking and then thought I am only hurting myself by considering this at all and I need to DEAL with it. I feel bad for my husband, he never knows from one minute to the next what kind of mood I will be in and he LOVES to travel and I'm not sure that I can? This was supposed to be our retirement years and lots of fun but... Each day (it's only been 3) but I try to start out with a better attitude and let things that bother me go right over my head. I am tired of wasting time and energy over my evil mother-in-law! I feel better just letting this out. Thank you.
  • Vivian Callender   Oct 27, 2015 2:42 PM
    Am a baby boomer(born between 1946-1964) and have exhibited MS symptoms such as clumsiness, repeated falls, blurry vision, depression, kidney infections all of which were experienced and observed from the age of three. Dots never connected even though medical attention was sought and each symptom was treated. Condition worsened in my 20's through later 30's leading to a diagnosis of severe mental illness, major depressive disorder, spinal stenosis, constant pain. Mid 40's mobility worsened as did depression leading to several attempts at suicide and being hospitalized. Fell in 2010, received first CT scan of my life to make sure did not have a brain bleed but received initial diagnosis of MS, followed by MRI's, lumbar puncture, total review of my life history, neurological exam, leading to confirmed, without a doubt diagnosis of MS. Based upon reviews of my numerous MRI's, it was concluded that given several lesions were now black holes, had probably had MS my entire life..ALL of this is to say, that I am of the group who suffers a lifetime, undiagnosed, untreated to finally catch up to technology for diagnosis and treatment as my diagnosis was not finalized till I was 50 years old. Living now with "known" MS for seven years now and remain grateful for finally learning I was not an ALIEN..
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    ViviM1  Oct 27, 2015 2:58 PM
    Have been on every type of anti-depressant for decades including Prozac, Xanax, Trazadone, Paxil, and on and on..what has FINALLY managed my lifetime MDD as a result of a Lifetime of MS is CBT, Cognitive Behavioral therapy and the practice of MINDFULNESS along with a SSDI's of Wellbutrin and Eflexor..I also self inject Rebif 44mg three times per week and am determined to be here as best I can to continue to raise my young sons aged 13 & 14 as a single Mom. I AM GOOD, especially when I remain in the NOW as it is also where I find the most joy.
  • Janet Flaherty   Oct 27, 2015 3:16 PM
    I was diagnosed with bipolar at 15 and MS at 41. Two brain diseases. Anyone else?
  • Delecia   Oct 27, 2015 5:05 PM
    I was diagnosed with MS in 2009 after years of odd, painful and unexplained symptoms. I too suffer with the burning feet and feeling like electrical wires have short circuited in my arms, hands and the lower parts of my legs and feet, and it doesn't matter if I'm up on my feet 10 or 15 mins. during the day, that pain and burning makes it very difficult to fall asleep at night. And this happens even though I take my meds daily. And oh yes there are other symptoms I'm still experiencing, but through it all I don't have any thoughts of suicide. My family and circle of friends some of who suffer with MS encourages me not to give up, and especially my hope, the spiritual hope I receive from the Bible gives me further incentive to stay positive.
  • Judith   Oct 27, 2015 6:36 PM
    There is a hidden danger in this issue. MS patients are not necessarily depressed because of psychological reasons but because of physiological reasons. I was prescribed an anti-depressant by a physician who really was not well-informed about MS (not a neurologist) for reasons I will not go into. After a few days (less than 8 days) I became psychotic - screaming, crying, and just totally "nuts." Thankfully, my family recognized my personality change and knew it was the medication. I stopped taking it immediately and have not taken anti-depressants since. I am not depressed as I love life and look forward to each day. I do have the usual sadness and anger due to extreme fatigue, which we MSers know can really drag us down. I have been dealing with my "condition" since 1978, have held my own, and have been down many roads with many ill-informed people. There is a total lack of understanding of MS and many of us withdraw and lead a lonely life because of non-acceptance of our illness by loved ones and friends - not because of depression. We need to educate the world about MS being a disease of the brain, not of legs that no longer work.
  • Jody Erickson   Oct 30, 2015 9:29 AM
    Had first symptom in 1997. Graduated High School in 1990. Got diagnosed almost 10 years later. Please do not put me on your mailing list, have enough to go thru and delete. Want to know...Is your book published? I will go 2 the library and check it out! A professional by trade. Business Computer Programming. Those days are over.
  • wiselady39  Nov 23, 2015 7:02 PM
    The suicide stats are sobering and not surprising. I've been there. PTSD and MS symptoms don't mix, and I have paradoxical reactions or the worst possible reactions to most of the psych drugs I have tried, probably because of the MS. I am a newbie, and have a bazillion questions about what is what!! Meanwhile, I am having to white knuckle it through all of the anxiety.
  • Susan   Nov 27, 2015 2:44 PM
    I have a friend who suffers from MS. He has the type that there are no medications however has realized that eating healthy helps him stay as healthy as he can. He also discovered taking niacin helped, but due to recent extreme stress he lost a little ground. I can't believe in this day and age that there is no medication that can help him. I'm interested in any clinical trials out there for him. He has a lot of hope in the future with stem cells. I already received an email from the MS Society warnings about making our choices.

    I'm very interested in learning more about how nutrition can help my about being/feeling helpless.
  • Carmenza Ryan   Oct 12, 2016 12:30 PM
    Depth depresión sometimes but not have the feeling for wanted comit suicide.