When people talk about common symptoms of multiple sclerosis (MS) they usually mention such issues as vision problems, tingling and numbness, and fatigue. Seldom does depression make it onto 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 worries that come with a chronic illness,” says Rosalind Kalb, PhD, the vice president of the professional resource center at the National Multiple Sclerosis Society. “It’s also due to inflammatory changes in the immune system. We have evidence of an association between inflammation and depression.”

At least 50 percent of people with multiple sclerosis will experience a major depression at some point in their lives, Dr. Kalb says, and while people with other chronic disorders also have high rates of depression, 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 people in the general population,” she says, “so it’s critical to recognize mood changes and deal with them.”

Anxiety, which often accompanies depression but can occur by itself, is also common among people with MS and may be caused in part by the inflammation associated with MS.

Even when depression and anxiety are caused or worsened by inflammation, however, they can be effectively treated with some combination of psychotherapy (talk therapy), antidepressant or antianxiety medication, social support, and healthy living strategies such as getting regular exercise and following a nutritious diet.

The Normal Anxiety and Grief of a Chronic Illness

Being diagnosed with any serious chronic illness qualifies as a life crisis, says Kalb, and having anxious, worried feelings is a natural human reaction to such a crisis.

It’s also entirely natural to grieve when you first learn that you have MS — or any other chronic illness — or when you experience a loss related to MS.

Grief is generally characterized by a variety of emotions that may include shock, anger, guilt, and sadness. Some of those same emotions may occur in depression, but grief and depression are different in that the feelings that accompany grief eventually become less intense, although they may resurge at times when health setbacks occur. Kalb says, “Normal healthy grieving happens and happens repeatedly.”

When to Seek Help for Depression or Anxiety

Like grief, depression may lift on its own, but it often doesn’t, and instead becomes chronic, weighing you down emotionally; causing physical symptoms such as bodily aches and pain, low energy, and digestive problems; and bringing negative effects on social and professional relationships.

When symptoms of depression don’t lift on their own, it’s time to seek professional help.

Similarly, when anxiety becomes chronic or exaggerated and lowers a person’s quality of life, it should be addressed with the help of a mental health professional.

Cathy Chester, a 58-year-old New Jersey–based freelance writer who was diagnosed with MS at age 28, experienced a bout of depression following a health crisis and, luckily, 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,” Chester says, “my hormones plummeted. I understood what that dark cloud felt like, the most awful feeling. I knew then what depression was.”

She sought help for her depression from both a therapist and a psychiatrist.

“With the help of medication and CBT, that took care of it,” she says. CBT, or cognitive-behavioral therapy, is a form of psychotherapy based on the premise that a person’s thoughts — not external events — largely determine how he feels. In therapy, the therapist helps the individual learn to challenge negative thoughts and replace them with more realistic ones.

According to Kalb, cognitive-behavioral therapy has proven very effective in people who have MS who also have depression.

Do You Have Depression or an Anxiety Disorder?

The following two questions have been shown to serve as effective screening tools for depression:

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 having little interest in — or deriving little pleasure from — doing things?

If your answer to either of these questions is “yes,” you should seek an evaluation for depression.

“Depression is not feeling a little sad or bad or blue for day. It’s a diagnosable condition that deserves careful attention and treatment. It’s another symptom of MS that needs to be treated,” Kalb says.

To screen for anxiety, a self-administered test called the GAD-7 (GAD stands for “generalized anxiety disorder”) can help you assess whether you’re experiencing mild, moderate, or severe anxiety.

According to Kalb, “Generalized anxiety takes over everything. You can’t stop thinking about your worries. You can’t focus on other things and enjoy them.”

If that sounds like your state of mind, speak to your primary care doctor about getting help for anxiety.

Finding Help for Depression and Anxiety

“Both depression and anxiety are very treatable if people seek help,” says Kalb, so if you observe significant mood changes in yourself, speak to someone on your care team. Many primary care providers address mental health problems themselves, or they can refer you to a behavioral health specialist.

Both talk therapy and medications have proven helpful, and the general sense among experts is that a combination of the two is optimal.

Be aware that if you’re receiving mental health care from your primary care doctor, they are likely to prescribe only one or two medications. If those disagree with you or are ineffective, you may do better seeking help from a psychiatrist who is familiar with and can prescribe many more pharmaceutical options.

How to Practice Good Emotional Self-Care

In addition to medication and talk therapy, exercise is extremely helpful for managing mood, says Kalb. “It works well along with and not instead of those other treatments,” she says.

It can also help to divert yourself from your worries with relaxing, enjoyable activities, such as hobbies or meditation, says Kalb. She endorses working with a health coach to find other simple yet effective stress-management approaches.

International Study of Web-Based Depression Treatment

Scientists are still working to better understand what links MS and depression, as well as how best to treat depression in people with MS.

The National Multiple Sclerosis 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 locations in the United States — Los Angeles; Kansas City, Missouri; and State College, Pennsylvania — and two in Germany.

Taking part in the study requires making two visits to a study site and having home internet access, among other requirements. Interested individuals who are older than 18, are diagnosed with MS, and have symptoms of depression are encouraged to contact the nearest study site to find out 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 with the help and information you need.

You can take a free, confidential online test for depression, anxiety, and other mental health disorders on the website of Mental Health America, a community-based nonprofit that provides services for 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 with an 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 online Lifeline Crisis Chat. Trained crisis workers are available to talk 24 hours a day, 7 days a week. Your confidential, toll-free call goes to the nearest crisis center in the Lifeline national network. These centers provide crisis counseling and mental health referrals.
Find the 24-hour mental health hotline for your area and save it in your phone. You may wish to share it with close family and friends, too. Serious setbacks often strike at odd hours, so be ready with a number to call when you need it.
To find mental health services in your area, call the SAMHSA Treatment Referral Routing Service — 800-662-HELP (4357). The referral service is free and is staffed 24 hours a day, 365 days a year.

Depression, Anxiety, and MS: What’s the Connection?

7 Ways To Fight MS Fatigue With Your Fork