When people talk about the common symptoms of multiple sclerosis (MS), they usually mention problems like vision problems, tingling, numbness, and fatigue. Depression rarely makes it into that list, but it should. Researchers now know that depression is one of the most common symptoms of MS. “It’s not just a reaction to the challenges and losses and fears that come with chronic disease,” says Rosalind Caleb, PhD, vice president of the Occupational Resource Center at the National MS Society. It is also due to inflammatory changes in the immune system. We have evidence of a relationship between inflammation and depression.” At least 50 percent of people with MS will experience major depression at some point in their lives, says Dr. Kalb, and while people with other chronic disorders also have high rates of depression, the The rate is higher among people with chronic disorders — such as MS — that are inflammatory in nature. “We also know that the risk of suicide in people with MS is twice that of the general population, so it’s critical to recognize the changes,” she says. moods and coping with it.” Anxiety, which often accompanies depression but can occur on its own, is also common among people with MS and may be caused in part by the inflammation associated with MS. Even when inflammation causes or worsens depression and anxiety, Both can be effectively treated with a combination of psychotherapy (talk therapy), antidepressants or anti-anxiety medications, social support, and healthy living strategies such as regular exercise and diet. My diet. Related: How to Find Emotional Support When You Have MS. Normal Anxiety and Grief for a Chronic Illness Being diagnosed with any serious chronic illness is considered a life crisis, Caleb says, and having feelings of anxiety and worry is a normal human reaction to such a misfortune. It’s also normal to feel sad when you first learn you have MS — or another chronic disease — or when you experience an MS-related loss. Grief is generally characterized by a variety of emotions that may include shock, anger, guilt, and grief. Some of these feelings may occur in depression, but grief and depression differ in that the feelings that accompany sadness eventually become less intense, although they may resurface in times of health relapses. Says Caleb, “Normal healthy grief happens and does happen frequently.” When to seek help for depression or anxiety such as grief. Depression may go away on its own, but often it does not, and instead becomes chronic, weighing you down emotionally; causing physical symptoms such as physical aches and pains, decreased energy, and digestive problems; And cause negative effects on social and professional relations. When symptoms of depression don’t go away on their own, it’s time to seek professional help. Likewise, when anxiety becomes chronic or exaggerated and reduces a person’s quality of life, it should be addressed with the help of a mental health professional. Kathy Chester, a 58-year-old New Jersey-based freelance writer who was diagnosed with MS at age 28, suffered a bout of depression after a health crisis, and luckily, she got help for her symptoms. A few summers ago, she had kidney stones and gallstones at the same time. “After that was taken care of, my hormones went down,” says Chester. “I understood that dark cloud feeling, which is the most horrible feeling. I knew then what depression was.” She sought help from a psychotherapist and a psychiatrist in treating her depression. “With the help of medication and CBT, he took care of it,” she says. Cognitive behavioral therapy, or cognitive behavioral therapy, is a form of psychotherapy based on the premise that a person’s thoughts — not external events — largely determine how they feel. In therapy, a therapist helps the individual learn to challenge negative thoughts and replace them with more realistic thoughts. According to Caleb, cognitive behavioral therapy has been shown to be very effective in people with MS who also suffer from depression. Related: How to help when a loved one with MS is depressed Do you suffer from depression or an anxiety disorder? The following two questions have been shown to serve as effective depression screening tools: During the past month, have you often been bothered by feeling down, depressed, or hopeless? During the past month, have you often been bothered by a lack of interest in — or a lack of pleasure in — doing things? If your answer to either of these questions is “yes,” then you should seek an evaluation for depression. “Depression is not feeling a little sad, bad, or blue in the day. It’s a diagnosable condition that deserves careful attention and treatment. It’s another symptom of MS that needs treatment,” Caleb says. To screen for anxiety, a test that is done can help. A self-administered test called a GAD-7 (GAD stands for “Generalized Anxiety Disorder”) helps assess whether you have mild, moderate, or severe anxiety. According to Caleb, “Generalized anxiety controls everything. You can’t stop thinking about your fears.” You can’t focus on other things and enjoy them.” If this sounds like your state of mind, talk to your primary care physician about getting help for anxiety. Finding Help for Depression and Anxiety “Depression and anxiety are very treatable if people seek help,” Caleb says, so if you notice significant mood changes in yourself, talk to someone on your care team. Many primary care providers treat mental health problems themselves, or they can refer you to a behavioral health specialist. Both talk therapy and medication have proven helpful, and the general feeling among experts is that a combination of the two is optimal. Know that if you receive mental health care from your primary care physician, he or she will likely only prescribe a medication or two. If these disagree with you or are ineffective, it may be best for you to seek help from a psychiatrist who is knowledgeable and can prescribe several pharmaceutical options. How to Practice Good Emotional Self-Care In addition to medication and talk therapy, exercise is very helpful in managing mood, Caleb says. “It works well in combination with other treatments, not in place of them,” she says. It can also help distract you from your worries with relaxing and enjoyable activities, such as hobbies or meditation, says Kalb. She advocates working with a health coach to find other simple and effective stress management techniques. International Web-Based Depression Treatment Study Scientists are still working to better understand the link between MS and depression, as well as how best to treat depression in people with MS. The National MS Society is currently sponsoring a study to test the effectiveness of a computer training program in treating depression in people with MS. The study, which is still recruiting participants, is taking place at three sites in the US – Los Angeles; Kansas City, Missouri; and State College, Pennsylvania—and two in Germany. Participation in the study requires two visits to a study site and Internet access at home, among other requirements. Interested individuals over the age of 18 who have been diagnosed with MS and present with symptoms of depression are encouraged to contact the nearest study site to learn more about eligibility for this study. Resources for Depression and Anxiety Not sure if you’re depressed or anxious? Need a friendly ear to listen? These resources can connect you to the help and information you need. You can take free, confidential online testing for depression, anxiety, and other mental health disorders at the website of Mental Health America, a community-based nonprofit organization that provides services to people with mental illness. The National Multiple Sclerosis Society’s MS Navigators can help you find support groups and other resources to help deal with emotional issues. Call 800-344-4867 or go online to email or live chat using MS Navigator. For immediate help with suicidal thoughts or emotional despair at any time, call the National Suicide Prevention Lifeline – 800-273-TALK (8255) – or access the Lifeline Crisis Chat. Trained crisis workers are available to speak 24 hours a day, 7 days a week. Your free confidential call goes to the nearest Lifeline National Network crisis center. These centers offer crisis counseling and mental health referrals. Find the 24-hour mental health hotline for your area and save it to your phone. You may want to share it with family and close friends as well. Serious setbacks often happen at odd hours, so be prepared with a number to call when you need it. To find mental health services in your area, call SAMHSA’s Treatment Guidance Service – 800-662-HELP (4357). The referral service is free and operates 24 hours a day, 365 days a year.
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