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Depression and MS

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Unread 11-19-2012, 03:39 AM   #1
Natalie8
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Default Depression and MS

Anytime I pick up a book on MS, I always read that depression can be a common symptom. But I don't hear the neuros talking much about it or asking patients about it explicitly. I don't see too much on the topic in forums. It makes sense that MS would cause or exacerbate depression, right? 1. Physically the disease attacks the brain 2. Any chronic disease is bound to cause depression because of the psychological difficulties dealing with never ending health problems.

What seems to make it tricky is the fact that you can't determine what the root cause is--or maybe it's a bit of both. Maybe it doesn't even matter--the depression is just there and overwhelming.

What have been your experiences with depression? Did medication help? Did it ever get worse during MS flares? Did you only suffer from it after your diagnosis?

I've had clinical depression since my early 20s. I got diagnosed with MS at 39. I'm now in my 40s. I've been on antidepressants since the beginning. -- 20+ years ago. I just suddenly realized today that I'm in the midst of a relapse of clinical depression. Sometimes you don't figure it out until you've hit bottom and you look around and think wow: I'm having the old black dog symptoms again.

I've got an appointment with my psychiatrist in a week. Three weeks ago we had talked about trying the newest medicine out there now called Vibrydd. I've tried every other one known to mankind and many of them I just couldn't tolerate because of side effects. What I am on now just isn't cutting it anymore. I just pray the new one is tolerable and helpful.

I try to tell myself the blues are probably the result of severe stressors right now: my hospitalization and bad infection/ recovery for the past 3 months. Then there was all the anxiety of whether or not I could stay on Tysabri. And there has been endless drama and crazy with an out of control teenage stepson. I feel like my house is no longer my peaceful space. And throw in the holidays on top of it.

I'm trying to keep my head above water but feel like I'm sinking deeper. Ughh. I just have to hang on until I see the doctor next week. For those of you with depression, what do you do to survive (in addition to regular therapy and drugs?).

Sometimes I wonder if my depression starting in my early 20s was the first MS symptom until age 39 when optic neuritis arrived.
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Last edited by Natalie8; 11-19-2012 at 04:03 AM.
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Unread 11-19-2012, 07:04 AM   #2
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I'm glad you started this thread. My neuro hasn't really addressed depression as a component of MS, but my PCP is on top of it. I think you're right that it probably doesn't matter whether it's an MS symptom or not--would treatment be any different? As you said, it's tricky.

On some level, even though I KNOW it isn't true, there is the feeling that if it's not a symptom of MS, that I should somehow be able to control it--you know: cheer up, don't wallow in self-pity, look on the bright side, "have more faith", etc.

Was I depressed as a teenager? Or was that typical teenage "they'd be sorry they treated me that way if I died" angst? Did I have clinical depression in my twenties? Or was that situational due to a troubled marriage, physical problems, etc.? Or was that a symptom of the MS I didn't know yet I had? No way to know, ever.

I hope this thread/conversation continues, as I know I'll have plenty more to say during those sporadic times that my brain cooperates!
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Unread 11-19-2012, 07:31 AM   #3
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I think there is both a physical and a psychological component to depression in MS - apart from the fact that the disease process messes around with your brain, the DMD's are known to have depression as a side effect too.

On top of that, it is chronic, unpredictable, can cause a great deal of pain, messes with your moods, frequently causes sleep and appetite disturbance, people who have it often have difficulty exercising (which is known to produce the 'feel-good' chemicals that help combat depression).

Sometimes we laugh or cry when we really shouldn't (emtional lability) - sometimes we feel blue because we can no longer do the things we used to be able to do, and sometimes we are black-and-blue because we fall over when our legs don't work properly.

I was fine (I think) for the first few years - I have a son with Asperger's Syndrome, and coping became just too hard, so I talked to my Neuro who was really good. Then I had open brain surgery to clip an aneurysm - and that kind of interference in my brain certainly caused things to go haywire.

Back to good for a few years - now I am back on anti-depressants - because life, work stress, spinal lesions, falling regularly and nerve pain are getting me down. Small doses - just enough to keep my head above water.

None of us should feel bad about this - our reasons don't come much better, but it is all individual. What one person copes with fine is another person's nightmare.

So, if anyone is feeling lousy, I say, get yourself some help - you have more than enough on your plate, so if this is something that can be helped, please do it.

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Unread 11-19-2012, 10:23 AM   #4
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I'm thinking that depression is just a part of MS as you keep losing something you once could do. I know that depression is part of the grieving process at least as far as CMT. We are constantly in one stage of grief or the other. Something we could do is always being taken away. We know what causes CMT and that doesn't make any difference. There is no cure/treatment for it at the present time. I just try and deal with it and roll with the punches.
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Unread 11-19-2012, 12:55 PM   #5
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((((Natalie)))), so sorry. I did not suffer from depression in my youth. When my MS took hold, I started out with severe anxiety, complete with anxiety attacks...then the clinical depression set in. I was in very bad shape and just wanted to die.

I screamed for help and my Neuro/Psych heard me. He told me that Depression in MS is caused by the demylination of nerves and the anxiety disorder usually goes with. As the others wisely said, if you've got it it doesn't matter what caused it.

I am on Prozac now for the last 9+ years, but my saving meds were Buspar and then Paxil for the 8 years before that.. Prozac didn't help me early on but is great now (After Paxil stopped working), for keeping me steady.

The only difference that what causes your depression matters, is your meds. If MS has caused a chemical imbalance, then one of the Anxiety/depression meds(SSRIs), such as I mentioned (and many more), will usually work. If your depression is caused by your situation, then Psychotherapy, along with a milder dose AD may help you more?
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Unread 11-20-2012, 02:44 PM   #6
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Imo, a psychiatrist is key for someone like you who has had difficulty finding a SSRI that is effective sans side effects. Neurologists and PCPs rarely have the experience to do much more than the bare minimum when it comes to psych meds in most cases again, imo.

That said I have found many medications are changed prior to reaching the maximum dose and if there is even a partial response I would prefer to finish with one before moving to another. You could also consider augmenting with a second medication if one just isn't enough.

Good luck.
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Unread 11-20-2012, 04:02 PM   #7
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I firmly believe it's caused by both MS and the situational dealings with our daily stressors and sometimes our inability to handle those stressors due to nerve damage.
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Unread 11-25-2012, 04:13 PM   #8
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Quote:
Originally Posted by Debbie D View Post
I firmly believe it's caused by both MS and the situational dealings with our daily stressors and sometimes our inability to handle those stressors due to nerve damage.
I think Debbie is right on this one. Although I have not yet been diagnosed, I can say that this latest episode of symptoms were accompanied by sudden and radical change in my mood, that my typical low dose SSRI wasn't able to stabilize. I had to have an increase in dose to stabilize my mood. I was still feeling low, but certainly not to the level of despondency I was feeling before.

Pain, stiffness, loss of function, sleep changes and appetite changes can radically effect mood, as well as nerves that are not able to appropriately transmit signals, and/or interpret them properly in the brain.

I do think that people with neuro disorders should see a neuro/psych, and or psychiatrist, whether they think they need one or not as part of their treatment plan. Many people with progressive illness minimize their symptoms of depression, thinking: "Of course I'm depressed! I have this horrible debilitating disease. How am I supposed to feel?" Just because you have a reason to be depressed doesn't mean you don't need treatment, especially when the cause of your depression is not going to go away, and is probably going to become worse over time.

Medication can be helpful in stabilizing mood, restoring a feeling of emotional well-being, AND decrease pain. A therapist is also helpful in addressing the real life stressors we deal with on a daily basis, and help us to gain some perspective on how well we are coping with our illness.

There are so many things we can do to help ourselves outside of meds and therapy. Laughter and music help to release endorphins that regulate and stabilize our mood. Broadening your support network to include more people you trust helps you to see worsening symptoms of depression, and provide an outlet to vent when we are not feeling well. Participating in activities with our social circle helps us to feel less isolated, and also helps to improve mood. Eating a balanced diet helps our bodies work properly, and if nothing else, promotes a sense of general health. Sleep....so important. The body heals when it sleeps. Even with debilitating disease, sleep allows our brain to release stress through dreams, and allows our neurons to recharge for the next round.

So....try watching a funny movie, go do something with your friends, sing, keep in touch with people you trust, eat some vegetables, and get some sleep! It may not help, but I don't think it will hurt either!

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Unread 11-25-2012, 05:50 PM   #9
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The chronic, unrelenting, and miserable pain is enough to cause depression, isn't it?
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Unread 11-25-2012, 07:26 PM   #10
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Quote:
Originally Posted by lefthanded View Post
The chronic, unrelenting, and miserable pain is enough to cause depression, isn't it?
It sure is! Not every one with neuro symptoms also has depression that is caused by their disease. Sometimes the depression is situational, but it is none the less, depression.

In cases where depression is caused by the disease process, medication is used to balance the neurotransmitters that are affected by the disease. In cases where depression is situational (caused by symptoms and disability) medication is used to uplift mood, to give the person the opportunity to address symptom management and apply new coping mechanisms.

Regardless of the cause of depression in people with chronic disease, medication and therapy help. Finding a medication that works well for you may be a challenge, but good communication with your doc will help them to prescribe the correct meds. Keep an eye on your symptoms, and tell your doc if the medication is only helping some symptoms and not others. In psychiatry, medication is prescribed based on the symptoms that are reported by the patient and what the doc observes. So in other words, if you go to your doc and say "I feel just great!" But you haven't bathed in a week, chances are the doc is going to have a more in depth conversation with you about how you feel. That said, if you go there and say "I feel terrible! My life is awful, and I can't take it anymore!" then report that you need to make the appointment short because you are going to get your nails done, and then out to dinner with the girls, the doc will probably determine that you are not depressed to the point where you need medication.

A lot of people feel uncomfortable about seeking help for mental health issues when they are already exhausted by their illness, or feel that they are a burden, or feel they just need to ignore it. Depression is a real, physical illness, and should be treated.

Most of the people in this forum are here to find ways to improve their quality of life, or help someone improve theirs. Dealing with depression as a real illness that requires treatment is a fantastic way to improve your quality of life.

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