“Depression isn’t a straightforward response to a bad situation; depression just is, like the weather...”
-- Stephen Fry, Actor
"A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it's impossible to ever see the end."
-- Elizabeth Wurtzel, Prozac Nation
"It's so difficult to describe depression to someone who's never been there, because it's not sadness. I know sadness. Sadness is to cry and to feel. But it's that cold absence of feeling—that really hollowed-out feeling."
-- J.K. Rowling, Harry Potter series
-- J.K. Rowling, Harry Potter series
Depression, to those who have never experienced it, is a loss of joy, brightness and creativity. It has been described by another sufferer (actor Stephen Fry) as feeling “blackness, lethargy, hopelessness, and loneliness."
You wouldn’t tell someone with a broken leg, cancer, or chicken pox to just get over it. Likewise, depression is a disease. It is treatable, requires medical care and possibly medication. It is not something a user can just “snap out of” as research has consistently proven.
There are multiple types of depression that have been recognized by the DSM (Diagnostic and Statistical Manual of Mental Disorders, considered to be the industry authority). Some of the more common are major depressive disorder (episodic), dysthymia (less severe but chronic), and bipolar disorder.
But in all types, most activities of daily living can feel overwhelming.
Is an MS Symptom
In MS, the incidence of all forms of depression appear oddly high compared to the general population. For example, while "major depressive disorder will affect about 1 in 5 or 20 percent of Americans during their lifetime, [in] people with MS...major depressive disorder may affect over 50%..." (National Multiple Sclerosis Society)
And while being diagnosed with any chronic illness would understandably cause sadness and possibly depression while grieving the life you thought you'd have, the incidence of depression is extraordinarily high in MSers, even over most other chronic conditions.
It also doesn’t correlate with severity of disease or length of time diagnosed. Another study has shown that "some people who are severely disabled are not depressed — while others are very depressed but not physically disabled.” (Multiple Sclerosis Association of America)
Researchers now believe that these higher rates of depression in MS are, in fact, a symptom of the disease as well as the regrettable mood disorder, that in MS the damage to some nerves in the brain lead to "depressive reactions." (ibid.)
And there is even a study showing some evidence that changes in mood lead to changes in certain immune responses.
May Present As Anger
As common as it is in our population, depression still is sometimes difficult to spot in MS. Several symptoms of depression are also frequent symptoms in MS, such as fatigue, sleep disturbance, and cognitive difficulties.
And while disengaging from others to try to preserve energy is understandable when battling fatigue, you must be mindful that this may also result in not taking your medication, eating and sleeping poorly, not having the energy to exercise, and to put into relationships. Obviously these can heighten the depression, which can further lead to a demoralizing downward spiral.
Often, too, depression presents as increased irritability, even anger, where the depressed person is overly harsh with loved ones, caregivers, or even strangers, and seem "consumed by rage." [video]
These similarities can, however, be teased out by a mental-health specialist who has experience with chronic disease, or is certified in MS for example. If left unidentified, depression will likely reduce quality of life and worsen MS symptoms. More on that below.
Share Your Concern
For loved ones understanding the physical symptoms of your MS is often easier than understanding the emotional ones. Because when depressed, a person will often be passive, moody, and exhibit low motivation.
This may irritate others who expect you to find something that will ”snap yourself out of it.” But this requires creativity, which you can’t muster, and energy, which we’ve already agreed you only have in short supply.
So, too, try to remember that no human is a mind reader: to continue to manage your support network, you must somehow keep communicating what you are feeling with others.
Here is something that works for me: sometimes I use educational MS videos offered on YouTube by MSAA, Can-Do MS or NMSS to introduce hard topics like my depression to others. I recommend watching with them on a big screen or full-size TV and letting it lead them to questions which you can then just answer.
Get Treatment Early
Finally, as I have stated before, any symptoms of emotional disturbance that cause suffering and interfere with quality of life deserve to be treated. Don’t hesitate to seek evaluation by a mental-health professional, preferably one with a specialty in chronic disease or MS.
It may be, in this reality of limited time for a doctor’s visit, and with the wide range of physical symptoms MSers could be experiencing, that our physicians may spend most of their time on the physical progression of the disease.
And in dealing with MS ourselves, we too may tend to neglect our emotional health in lieu of our physical concerns, resulting in the case that such problems are not communicated to the doctor.
So it is our responsibility to bring up the issue of mood and emotional disturbances. We need to be aware that these symptoms can be part of MS.
As I’ve said before, no one cares about you as much as you do. Both physical and mental issues are important. And as a reminder, severe, untreated depression can be life-threatening, causing thoughts of suicide and suicidal behavior
If you wonder at all, seek help, and know that depression continues to be vigorously studied by MS researchers
Nothing found here should be considered medical advice. Please consult your doctor before making any changes.