Multiple Sclerosis & Depression: What's the Link?

Depression is among the most common multiple sclerosis (MS) symptoms. Up to 50% of people with MS will experience clinical depression or major depressive disorder (MDD) in their lifetime.

The psychological toll of living with MS can cause depression. Additionally, chronic inflammation and demyelination (the breakdown of the myelin sheath that protects nerves) may also perpetuate MS-related depressive symptoms.

This article explores the link between multiple sclerosis and depression.

How Does MS Cause Depression?

There are different ways in which MS can lead to depression and depressive symptoms. The psychological toll of living with a chronic and life-changing condition like MS can lead some patients to develop depression.

There is also accumulating evidence to suggest that high levels of pro-inflammatory cytokines (protein cell messengers) may play a role in causing MS-related depression. This inflammatory response within the brain and spinal cord, called neuroinflammation, is associated with increased depression risk.

In MS, cytokine-mediated inflammatory responses in the immune system are associated with the breakdown of the myelin sheath that protects nerve fibers. Major depressive disorder often goes hand in hand with demyelinating diseases.

The combination of chronic inflammation and demyelination make up the "neuroinflammatory theory" of depression in MS that is supported by research.

Symptoms of Depression in MS Patients

If you feel depressed, it's important to speak with a healthcare provider or mental health professional as soon as possible. The following are some common signs and symptoms of depression:

• Persistent sadness
• Feelings of hopelessness or emptiness
  
• Lack of pleasure from activities you typically enjoy
• Poor concentration or memory
• Free-floating anxiety or catastrophizing
  
• Fatigue and decreased energy levels
  
• Talking or moving more slowly than usual
• Restlessness or trouble sitting still
• Insomnia, early-morning awakening, or oversleeping
• Increased or decreased appetite and/or weight changes
• Suicidal ideation or thoughts of self-harm

When to Get Help

If you experience symptoms of depression, you should consider meeting with your healthcare provider or a mental health professional.

If you are unsure if you're experiencing depression and think you might need help, consider asking yourself the following questions:

1. Over the past two weeks, have I often felt hopeless, down, or depressed?
2. Over the past two weeks, have I had little interest or pleasure in doing things I usually enjoy?

If you answered "yes" to either or both of these questions, it may be time to get help.

How to Get Help

For help finding a mental health professional in your area, the National Multiple Sclerosis Society has a team of trained "MS Navigators" who can give you personalized assistance. Call 800-344-4867 or use their Contact Us form.

Other resources for free, confidential help with depression or emotional challenges include:

• Anxiety and Depression Association of America (ADAA) 
• Mental Health America
• National Alliance on Mental Illness (NAMI)
  

Depression Treatment Options

There are many treatment options for depression. Psychotherapy (talk therapy), such as cognitive behavioral therapy (CBT), is an excellent place to start.

Depending on your diagnosis, other treatment options such as medications may be recommended.

Neurofeedback training, also known as biofeedback therapy, has been shown to reduce depression and fatigue in MS patients.

Exercise training also shows promise for improving depressive symptoms in people with multiple sclerosis.

Suicide and MS

Compared to the general population, levels of suicidal ideation (thoughts or ideas about suicide) are higher in people living with MS. Both thoughts and suicidal attempts are more prevalent in MS patients.

Warning signs of suicide include:

• Talking about death or wanting to die by suicide
• Looking for a way to die by suicide
• Expressing feelings of hopelessness or having no purpose
• Talking about feeling trapped or in unbearable pain
• Feeling like a burden to others

If you or someone you know is exhibiting any of these warning signs, contact a mental health professional or immediately go to an emergency room.

Summary

Depression is one of the most common symptoms of multiple sclerosis. The psychological burden of living with multiple sclerosis can increase depression risk, but this disease's inflammatory nature may also cause depressive symptoms.

Speaking to a mental health professional and getting an official diagnosis is the first step in treating MS-related depression. Many treatment options are available. If there are any warning signs of suicide, seek help immediately. 

A Word From Verywell

If you have MS and are experiencing feelings of depression, know that these symptoms can be common with an MS diagnosis. Reach out for help by talking to a healthcare provider or mental health professional about your symptoms. If you are having thoughts of suicide, seek help immediately by contacting the National Suicide Prevention Lifeline at 988, calling 911, or going to the emergency room.