A Light at the End of the Tunnel
Help and Healing for People with MS Suffering from Depression
By Laurie Long
In 1999, Montel Williams, popular talk show host and celebrity, stepped out in front of a moving car in an attempt to end his own life. He had been diagnosed with MS just months earlier. In January of 2004 he went live in front of millions of viewers on his own talk show and discussed the attempt. Why did he finally talk about it? "Because we [MS sufferers] need to stop lying about ourselves", Montel explained. "We need to stop lying about the pain we're in."
According to various studies, up to 50% of patients with MS will suffer a major depression during the course of their illness. This is three times the prevalence reported for the general population and higher than other neurologicaldisorders.1In addition, suicide was found to be 7.5 times higher among patients with MS compared to the general population.2 Yet despite these high prevalence rates, depression remains under-recognized and under-treated in MS. This is distressing, not only because depression can often be successfully treated with antidepressant drugs and psychotherapy, but also because depression may worsen MS symptoms. Dr. David C. Mohr, Director of Medical Psychology at the Mt. Zion MS Center of US San Francisco, explains, "There's some early evidence that depression can increase the immune disregulation associated with MS. So getting treatment for depression may be even more important for people with MS than it is for the general population.3"
So why hasn't more been done to recognize and treat this issue? In some cases the signs of depression may not be recognized as separate from the general symptoms of MS. The symptoms of MS fatigue, especially, can mirror those of depression: extreme tiredness, loss of appetite, loss of interest or pleasure in everyday activities, sleep disturbances, problems with thinking or concentration and a slowing of reactions. But in addition to these symptoms, depression may also cause a deep sadness that continues more than two weeks, feelings of worthlessness or guilt, and persistent thoughts of death or suicide. Often the depressed or suicidal person will not come out and tell you how they are feeling. Depression, often viewed as a "mental health disease" rather than a physically-based disease, may not be reported by the sufferer or by close friends or family because of the perceived stigma attached.
How to Recognize Depression
There are a number of symptoms that someone suffering from clinical depression will exhibit. According to Dr. Jon Richard, psychologist, in a recent interview, "Typically, serious depression is not just a single symptom or feeling, like a bad mood, but is a syndrome, a group of symptoms or feelings that may include loss of appetite, sleep disturbance, most typically bad insomnia, intense anxiety…and also may include intense feelings of worthlessness or guilt or shame. An especially important feature of clinical depression is a pervasive feeling of hopelessness that occurs for many people; the sense that not only do things feel terrible and not only does the outlook seem to be terrible from within the depression, but there is a distinct feeling that this will never change.4" Dr. Richard also emphasized that any time these feelings continued for two weeks or more, it is an indication that professional help is needed. Wishes for death or thoughts of suicide, even if other symptoms are absent, are red flags for immediate professional support.
If these periods of depression are mixed with periods of overexcitement, impulsiveness, irritability and agitation, then the person may be suffering from bipolar disorder. Bipolar disorder is 13 times more common in people with MS than in the general public5.It is important to recognize the difference, because the drugs used to treat bipolar disorder are not the same as those used to treat depression.
How to Help
If you think you have been experiencing some of the symptoms listed above for two or more weeks, especially those that are specific to depression alone, then you should consult with your doctor as soon as possible. There are a wide variety of antidepressants available to treat depression and, in conjunction with psychotherapy, the depression can be greatly reduced and even eliminated. If you have a friend or loved one who you think may be suffering from depression, talk to them about it openly. Dr. Sarah Minden of Harvard Medical School and Brigham and Women's Hospital in Boston states, "People are ashamed of being diagnosed with depression. By and large, it's treatable, and since it can be debilitating and disabling, it is a shame when someone doesn't get treatment for depression - either because they won't ask for help or because they've gone to the wrong type of provider.6 "Dr. Minden believes people with MS and their families should be educated and encouraged to recognize depression and seek referral.
If you are feeling suicidal, tell someone and follow this up by contacting a therapist or the Crisis Clinic (866-427-4747).It is important to talk to someone as soon as possible. The Crisis Clinic is open 24 hours a day. They are experts at assisting individuals who are having a rough time emotionally, or who are feeling suicidal. They provide counseling, support and referrals. If the caller is unable to agree that they can keep themselves safe, they will provide immediate intervention. Remember that there are always options, and relief can be obtained even though depressive thoughts may try to convince you otherwise.
For the person who has been told by a friend or loved one that they are feeling suicidal, let them talk about it. Try not to edit their words. Accept that it will make you uncomfortable. Listen and encourage or assist them with calling the Crisis Clinic, or calling a therapist that day.
Things You Can Do
In addition to antidepressants and therapy, you can help yourself in overcoming depression by increasing positive, pleasant things and decreasing negative things in all areas of your life. For instance:
· Do as many little pleasant things as you can each day. Read a fun book, hold hands, look at the clouds, relax. Avoid frustrations and hassles whenever possible.
· Stop or limit negative thoughts whenever possible .Think about good things; count your blessings instead of dwelling on your problems.
· Be comfortable, learn to relax, try meditation or yoga. Don't stay tense all the time.
· Have good times with your friends and family; don't close yourself off. Make social dates, talk to people.
· During pleasant activities or good times, don't allow negative thoughts, physical tension or minor hassles reduce your enjoyment.
· Don't set difficult goals or assume large responsibilities. Set priorities, make a schedule and pace yourself. Break things down into manageable pieces.
· Avoid alcohol and recreational drugs.
· Don't blame yourself. Emotional changes and depression are common, treatable, and often part of the disease process. Treat it like any other symptom by understanding it and getting help for it.
Montel Williams views his MS and the depression that it engendered as a chance to speak up. "It gave me the opportunity to get the message out there - it's not a shame to be ill. It's not a disgrace." He continues, "I used to want people only to see me at my best - now I don't."
"Had I not come out," Williams explains, "I probably wouldn't have realized how blessed I am."
(Note: Quotes from Montel taken from the Montel Williams Show, January 13, 2004.)
Resources for Depression:
Local (Seattle) -
Crisis Clinic Line: 206-461-3222 or 1-866-427-4747
King. Co. Crisis and Commitment Services: 206-296-5296
Helpline: 206-767-7124
Washington Advocates for the Mentally Ill Crisis Line: 206-783-9264
National -
International Foundation for Research and Education on Depression:
http://www.ifred.org/
Depressive & Bipolar Support Association: 1-800-826-3632 http://www.dbsalliance.org/
National Mental Health Association: 1-800-969-6642 http://www.nmha.org/
National Hopeline Network: 1-800-784-2433
http://www.hopeline.com/
Was this information helpful? Then please consider making a donation. We are a small, independent nonprofit agency and are dependent on donations from our supporters. Thank you from all the staff at the MSA.
Endnotes
1.Sadovnik AD, Remick, RA, Allen J, Swartz E, Yee IML, Eisen K, et al. Depression and multiple sclerosis. Neurology 1996;46:628-32.
2.Rose, John W., MD, Houtchens, Maria, MSIII, Lynch, Sharon G., MD. Multiple Sclerosis Lectures: Prognosis. Medlib.med.utah.edu
3.Mohr, David C., PhD., Minden, Sarah, MD, Hample, Henry. Depression: The Doctors are In. InsideMS. 2001.
4.Richard, Jon, PsyD, Ask The Doctor, www.healthtalk.com 12/29/03.
5.Joffe, Russell T., Lippert, Gerard P., Gray, Trevor A., Sawa, Gordon and Horvath, Ziporah. Multiple Sclerosis and Mood Disorders. Archives of Neurology, April 1987, Vol 44, pp.376-8.1987 AMA.
6.Hinson-Smith, Vicki. Are You at Risk for Depression? Real Living with MS March 1997.
Additional Bibliography
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Tilson, Mark, PhD. Can't Beat the Blues? Enlightening News, Oregon Stroke Assoc.
Minden, Sarah, MD. Talking about Depression and Other Emotional Changes. Professional Resource Center, NMSS 2003.
Crickmer, Ann, MSW. Depression Treatments for MSers. MS Assoc. of King Co. 2000.
Yirmiya, Raz. Depression in Medical Illness: The Role of the Immune System. Western Journal of Medicine, 173(5):333-336, 2000.
Kanner, A.M., Barry, J.J. The impact of mood disorders in neurological diseases: should neurologists be concerned? Department of Neurological Sciences, Rush Medical College, Chicago, IL.
Crickmer, Ann, MSW. Maintaining a Sense of Well Being. MS Assoc. of King Co. 2000.
Koutsouraki, E., Tsavdaridou, Th., et. al. Depression and cytokines in multiple sclerosis. Presentation in ENS Congress, Milan, 1999.Journal of Neurology, Vol. 246, Suppl. 1, 156 June 1999.
PVA Staff. Depression Following Spinal Cord Injury: A Clinical Practice Guideline for Primary Care Physicians. Paralyzed Veterans of America, August 1998.
Feinstein, Anthony. Multiple sclerosis, depression and suicide: Clinicians should pay more attention to psychopathology. BMJ Journal, No.7110, Vol 315
MOW Staff. Suicidal Thoughts Common in People with Multiple Sclerosis. Medical Observer Weekly, September 2002.
Stenager, E.N. and Stenager, E. Suicide and patients with neurologic diseases. Methodologic problems. Archives of Neurology, Vol 49 No. 12, December 1992.
Fredrikson, S., Cheng, Q., Jiang, G.X., Wasserman, D. Elevated suicide risk among patients with multiple sclerosis in Sweden. Neuroepidemiology, 2003 March - April;22(2):146-52.
Miller, Mary, PhD. Training Workshop Manual for Suicide Interventionists. The Information Center. San Diego, CA, 1986.
DBSA Staff. Suicide Prevention. Depression and Bipolar Support Alliance, 2004.
Feinstein, A., MD, PhD. An examination of suicidal intent in patients with multiple sclerosis. Neurology 2002;59:674-678.
Mayo Clinic Staff. Suicide and coping with suicide. Mayo Foundation for Medical Education and Research, Nov. 2001.
NMHA Staff. Suicide facts. National Mental Health Association, 2004.
CDC-NCHS Staff. Self-inflicted Injury/Suicide. US Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center of Health Statistics, March 2004.