Multiple sclerosis (MS) is a potentially debilitating disease in which the immune system attacks the insulating layer surrounding the nerve fibers, causing communication breakdowns between the brain and body. Over time, this may result in permanent nerve damage.1

The symptoms of MS are far-ranging — patients may experience numbness and weakness in the limbs, tremors, problems with coordination, fatigue, slurred speech, impaired vision, and dizziness, to name some. One symptom that’s not always talked about, however, is depression, despite its prevalence among patients with the chronic autoimmune disease.

Experts agree depression is much more common in patients with MS than it is in the general population. The National Multiple Sclerosis Society says major depressive disorder (MDD) will affect more than 50% of patients with MS at some point.2 Johns Hopkins University likewise estimates approximately half of patients with MS will experience depression that interferes with their daily functioning.3 A systematic review and meta-analysis of 58 articles sampling 87,756 MS patients identified depression 30.5% of the time.4

Investigators have sought to identify why this association exists and suggest that depression in MS is biologically mediated by processes relating to the immunopathogenesis of the condition. Specifically, it may be a result of increased proinflammatory cytokines, the activation of the hypothalamic-pituitary-adrenal axis, and a decline in neurotrophic factors that occur in MS. If these processes do play a role in the onset of MDD, treatment may have a positive effect not only on depression but also in slowing down the progression of MS. This makes treating depression a “neuropsychiatric imperative,” the investigators concluded.5 

Strategies for Treating Depression in MS

MS is unique in each individual and depression is not a universal experience. Regardless, screening for MDD is imperative. In fact, the US Preventive Services Task Force (USPSTF) recommends depression screening for all adults.6 

If a patient with MS does have depression, there are strategies you can share with them that might help alleviate their symptoms. Therapy—cognitive behavioral, analytical, and other forms—has shown to be effective at treating depression.7 In addition, the National Multiple Sclerosis Society offers a series of recommendations, including2:

  • Exercising daily
  • Maintaining social networks and joining support groups
  • Eliminating stressors when possible
  • Incorporating breathing exercises and meditating
  • Writing in a notebook
  • Steering clear of alcohol and other addictive substances
  • Staying in touch with their doctor

References:

1. Multiple sclerosis. Mayo Clinic. Updated January 7, 2022. Accessed October 26, 2022.

2. Minden SH. Depression & multiple sclerosis. National Multiple Sclerosis Society. 2019. Accessed October 26, 2022.

3. Hughes A. 5 myths about multiple sclerosis & depression. Johns Hopkins University. Accessed October 26, 2022.

4. Boeschoten RE, Braamse AM, Beekman ATF, et al. Prevalence of depression and anxiety in Multiple Sclerosis: A systematic review and meta-analysis. J Neurol Sci. 2017 Jan 15;372:331-341. doi: 10.1016/j.jns.2016.11.067. https://pubmed.ncbi.nlm.nih.gov/28017241/

5. Pucak ML, Carroll KAL, Kerr DA, Kaplin AL. Neuropsychiatric manifestations of depression in multiple sclerosis: neuroinflammatory, neuroendocrine, and neurotrophic mechanisms in the pathogenesis of immune-mediated depression. Dialogues Clin Neurosci. 2007 Jun; 9(2): 125–139. doi: 10.31887/DCNS.2007.9.2/mpucak https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181849/

6. Screening for Depression in Adults. US Preventive Services Task Force. January 26, 2016. Accessed October 26, 2022.

7. Depression: How effective is psychological treatment? InformedHealth.org. Updated June 18, 2020. Accessed October 26, 2022.



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