Many people may loosely say 'depression' to describe short periods of feeling down or low. Clinical depression is something much more severe, which prevents you from functioning normally and continues for more than a couple of weeks.
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Perhaps 50 per cent of people with MS experience this more serious depression at some point.
You are considered clinically depressed if at least five of the following symptoms are present for at least two weeks:
- depressed mood, feelings of hopelessness and despair
- significantly reduced interest or pleasure in most activities
- changes in appetite and noticeable weight loss or gain
- insomnia (inability to sleep) or hypersomnia (excessive sleeping)
- feelings of excessive restlessness or sluggishness
- fatigue or loss of energy
- feelings of worthlessness, excessive or inappropriate guilt
- reduced ability to think or concentrate, or indecisiveness
- recurrent thoughts of death or suicide
These symptoms would need to be severe enough to upset a daily routine, interfere with relationships, or severely impair work. Healthcare professionals will also need to establish that the depression is not linked to another cause such as medication or bereavement.
Depression is often misunderstood, so people affected might not get a diagnosis or treatment.
If you think you may be depressed, it is important to consult a health care professional as soon as possible. Depression is something you cannot prevent, and it should not be considered embarrassing or shameful.
There are three main points of view about the causes of depression:
- Depression is a medical disease, caused by a neuro-chemical or hormonal imbalance
- Depression is caused by certain styles of thinking
- Depression is a result of negative experiences
The most commonly held is the view that it is generally caused by some combination of these three.
Depression and other MS symptoms
Some symptoms of depression are also symptoms of MS, and it can be difficult to identify what is causing them. For example, fatigue can be related to depression, or may be a direct result of MS, or a combination of the two.
In some conditions there can be a link between being disabled and having depression, but in MS, depression does not seem to be related to how disabled a person is. For example, someone with little physical disability may experience severe depression and vice versa.
There is also no clear link between how long someone has had MS and the risk of being depressed. For example, someone who is recently diagnosed can be as depressed as someone who has had MS for many years.
Nerve damage and depression in MS
Research has been done to see if depression can be directly linked to MS-related damage in particular areas of the brain.
Some studies have suggested that there is a link, though they also suggest that MS-related nerve damage is only part of the equation.
Other factors, including psychological reactions to living with MS, side effects of medication, individual situations and social circumstances are also thought to play a part.
If your doctor thinks you might be depressed, they should complete an assessment and draw up a list of factors that may be contributing to it. They should develop a proper depression management strategy, and further assessment, treatment and support should be given.
This might include:
- antidepressants - Most common are selective serotonin reuptake inhibitors (SSRIs)
- talking therapies - including psychotherapy and cognitive behaviour therapy (CBT) - can help you develop the 'coping skills' needed to deal with depression-related difficulties. See the emotional support section of the site for more information.
- St John’s Wort - might work as well as some antidepressants in mild depression, but not severe. Speak to your GP before taking any complementary medicine.