Understanding and combating depression.

Depression in patients with multiple sclerosis (MS) can be a warning sign that their MS is getting worse. Depression is serious and disabling, and it can affect every part of your life, including your ability to manage your MS. Depression doesn’t just “get better” with time so getting help for depression is just as important as managing your MS. Depression can also be a side effect of some medications used to treat MS like:

• Steroids to relieve flare-ups
• Certain medications to manage symptoms
• Disease-modifying therapies (DMTs) that slow or modify its course

The first step is learning about depression. This includes knowing your risks, its signs and symptoms, and how to find the right treatment.

Start by reading this article on understanding and combating depression in MS. Share it with family and friends, too. Then talk to your neurologist, CVS Specialty MS CareTeam clinicians and your local MS chapter to learn more. Online and in-person support groups can also provide helpful support and education.

Depression facts.

Depression is a common but often misunderstood health condition. Some people avoid getting help because they feel embarrassed or ashamed. The good news is depression is treatable. First, you and those close to you need to learn about depression and be able to spot its signs. Here are some key points:

• Sadness and depression are not the same. Everyone experiences sadness at some point because of a loss or disappointment, but it lessens with time until you feel like yourself again.
• Unlike sadness, depression seems to come from “out of the blue.” And it’s hard to figure out the exact reason why. It may happen slowly so a person doesn’t even know he or she is depressed. And it lasts much longer than sadness.
• There are different types of depression. Major depressive disorder (MDD) is a common type. You may be diagnosed with MDD if you have five or more of the symptoms below for at least two weeks in a row. You or a loved one may notice:
  • A depressed mood for most of the day, nearly every day
  • Loss of interest or pleasure in all, or almost all, activities for most of the day
  • Significant change in weight or appetite
  • Insomnia or excessive sleepiness
  • Being agitated or lethargic
  • Fatigue and loss of energy, nearly every day
  • Feelings of worthlessness, low self-esteem or excessive guilt
  • Difficulty concentrating or indecisiveness
  • Recurrent thoughts of death or suicide
• Dysthymia (dysthymic disorder or chronic depression) is another type of depression that has similar symptoms to MDD. The symptoms are less severe but last for at least two years, not two weeks. Dysthymia sneaks up on people and it may seem like an ordinary unhappy mood.

Risk factors.

Depression affects one out of two people with MS, which means you’re at higher risk. But if you know you are at risk, you can watch for signs and symptoms and get help right away. Here are some other depression risk factors:

• Being a woman. Women are two times more likely to have MS than men. They are also two times more likely to have depression. This may be due to hormone changes, especially during menopause, pregnancy and after childbirth (postpartum depression). Women may also feel more emotional stress as they try to manage their MS while taking care of their family and sometimes aging parents.
• Having family history. Depression is much more common when a parent has also suffered from depression.
• Dealing with other long-term health conditions
• Lacking support
• Abusing alcohol or drugs

But why are people with MS at even higher risk? Some reasons include:

• Living with MS. Depression is common after someone is diagnosed with a long-term condition like MS.
• Physical and chemical changes in the nervous system. The effects of MS to areas of the brain may cause physical and chemical changes that increase your risk.
• Feeling fatigued. Fatigue is one of the most common MS symptoms. Exhaustion can affect every part of your life and make you more prone to depression.
• Taking certain medications. Steroids, certain DMTs and even some medications used to treat MS symptoms are linked to depression. Ask your MS CareTeam pharmacist if depression is a known side effect of any of your medications. Don’t stop or change your DMT unless your doctor tells you to.

Treatment.

The good news is there are many helpful treatment options, including support groups, counseling and medications called antidepressants.

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are used most often. SSRIs increase levels of a chemical called serotonin in your brain. There are other types of antidepressants, too. Most take weeks to start working and you may need to try more than one before you find what may work best for you.

Talk to your neurologist right away about depression symptoms. Your neurologist, MS CareTeam clinicians, family, friends, or local MS chapter can help you find the right treatment, which may include support groups or counseling.

Combating depression.

Depression can affect every part of your life, including your ability to manage your MS. Understand your risks, be on the lookout for symptoms and seek treatment right away. Take these steps to combat depression and preserve your emotional health, like:

• Exercise. Physical activity releases “feel good” chemicals in your body. Swimming and water exercises are good options for heat-sensitive people. Yoga, walking and biking are also good options. Ask your doctor which type of exercise is right for you.
• Cope with stress. Stress can trigger and worsen MS symptoms, including depression. Massage, meditation, support groups, seeing a counselor and staying connected to friends and family can help you cope with stress.
• Volunteer. Helping people can make you feel great.
• Talk about your feelings. Sharing your feelings with family, friends and other people living with MS can help improve your mood.
• Write in a journal. Writing is a safe way to release negative feelings and emotions.
• Do something special for yourself. Getting a massage, reading a new book or enjoying a dinner out are all small, feel-good rewards.
• Adopt a pet. Taking care of a pet can distract you from life’s stresses and problems.
• Laugh. Like the saying goes, laughter is the best medicine. Spend time with a funny friend, see a comedy show or rent your favorite comedy movie.

Family and friends.

Your family and friends may feel unsure how to help with depression, but they can, and should, be involved. Friends and family can help:

• Encourage you to seek treatment and share the changes they see.
• Attend counseling or support group visits with you.
• Show their love and include you in social activities.
• Help you take your medication exactly as it was prescribed. They can also be on the lookout for side effects or other problems.
• Take care of your emotional health.

CVS Specialty.

CVS Specialty can help you get the best outcomes from your MS treatment, including managing symptoms and side effects like depression. Call us at 1-800-237-2767 to speak to a pharmacist or nurse specially trained in caring for patients with MS.

Find convenient, prescription support online. Register at CVSspecialty.com or download our mobile app to refill, track orders, set reminders and more.