Multiple Sclerosis and Depression

This blog post was published in October 2021 for #WorldMentalHealthDay to raise awareness of mental health as an integral part of overall health. This article aims to highlight research on mental health in people living with MS.

Crisis Services Canada – If you’re thinking about suicide, or are worried about a friend or loved one, the Canada Suicide Prevention Service is available 24/7 for voice and 4pm to 12am ET for text. 

Research has shown that major depressive disorder and depressive symptoms are more common in people living with MS. Depression is characterized by a persistent low mood and loss of interest/pleasure in daily activities. Depressive symptoms are associated with reduced quality of life and can include apathy, fatigue, feelings of guilt, feelings of worthlessness, as well as loss of appetite or insomnia.¹

Incidence of depression is reported to be between 2-3 times greater in people living with MS than in the general population.² The reason for these elevated rates of depression is not well understood, and may be due to a number of possibilities such as the unpredictable nature of MS, pressure to maintain occupational/social performance standards at the same level as pre-diagnosis, changes in physical functioning and symptoms, inadequate social support systems or coping skills, changes in brain structure, lesions in the central nervous system, and altered immune function.³ A recent population-based study examined mental health in people with immune-mediated inflammatory conditions in Manitoba, including those with MS, inflammatory bowel disease (IBD), and rheumatoid arthritis (RA), and found that all three conditions had an increased the risk of mental health conditions (i.e. depression, anxiety, bipolar disorder, and schizophrenia), implying there may be a common underlying biology for these mental illnesses in people with immune-mediated inflammatory conditions. Notably, this study showed that depression and anxiety affected the MS population more often than in the IBD or RA populations.⁴

Despite the high prevalence of depression among people living with MS with rates of depression reported up to 50% over a lifetime, it remains challenging to diagnose.^5,6 For instance, MS and depression have many confounding symptoms, making it difficult for clinicians to determine if it is a symptom of one condition or the other (e.g., shared symptoms include fatigue, insomnia, altered appetite, difficulties with information processing, and impaired memory and concentration).³ Given the overlap of some symptoms and high risk of depression, it is important for people with MS to be effectively screened for depression by qualified health care providers.⁷

For those diagnosed with depression, there are several effective evidence-based treatments available, including medications and other therapies such as cognitive behaviour therapy (CBT). Researchers are investigating other interventions such as, mindfulness based intervention (MBI), an intervention related to CBT, that aims to provide non-judgemental awareness of everyday moments to positively adjust a person’s perceptions, sense of control and acceptance. MBI has shown some success in people living with MS by improving depression and quality of life.^8-9 Additionally, there is some evidence showing that physical activity in people living with MS is associated with improved levels of energy and social function, and improved mental health.¹⁰

More research in this area will help to develop, evaluate and implement new mental health tools and interventions, including evidence-based digital tools for screening and treatment that are effective for people living with MS. There is also a need for innovative models of care that integrate mental health expertise in collaborative MS health clinical care teams to enhance access to needed treatment options for people living with MS.

If you have questions about mental health and MS, please contact your health care team to discuss your symptoms. If you live with MS and are facing challenges with your mental health, the MS Navigators can also help direct you to resources for support. Contact them today at 1-844-859-6789 or by email via msnavigators@mssociety.ca. Additional wellness resources can be found – here.

Support and mental health resources:

• Crisis Services Canada – If you’re thinking about suicide, or are worried about a friend or loved one, the Canada Suicide Prevention Service is available 24/7 for voice and 4pm to 12am ET for text.
• Wellness Together Canada offers online tools and resources to help Canadians with a variety of mental health challenges.
• Government of Canada connects Canadians with mental wellness supports during COVID-19
• Centre for Addiction and Mental Health 
• Webinar: Mental Health and MS (Rocky Mountain MS Center)
• Resiliency: Addressing the challenges of MS and watch the video on YouTube
• Canadian Psychological Association

References

1. Feinstein, A. (2011). Multiple sclerosis and depression. Multiple Sclerosis Journal, 17(11), 1276-1281.
2. Persson, R., et al. (2020). Incident depression in patients diagnosed with multiple sclerosis: a multi‐database study. European journal of neurology, 27(8), 1556-1560.
3. Feinstein, A., et al. (2014). The link between multiple sclerosis and depression. Nature Reviews Neurology, 10(9), 507-517.
4. Marrie, R. A., et al. (2017). Increased incidence of psychiatric disorders in immune-mediated inflammatory disease. Journal of psychosomatic research, 101, 17-23.
5. Sadovnick, A. D., et al. (1996). Depression and multiple sclerosis. Neurology, 46(3), 628-632.
6. Marrie, R. A., et al. (2015). The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review. Multiple Sclerosis Journal, 21(3), 305-317.
7. Beal, C. C., Stuifbergen, A. K., & Brown, A. (2007). Depression in multiple sclerosis: a longitudinal analysis. Archives of psychiatric nursing, 21(4), 181-191.
8. Grossman, P., et al (2010). MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial. Neurology, 75(13), 1141-1149.
9. Morrow, S. A., et al. (2021). A mindfulness group intervention in newly diagnosed persons with multiple sclerosis: A pilot study. Multiple Sclerosis and Related Disorders, 52, 103016.
10. Marck CH, et al. Physical activity and associated levels of disability and quality of life in people with multiple sclerosis: a large international survey. BMC Neurol. 2014 Jul 12;14:143.