OVERVIEW
Self care is of vital importance for patients suffering from a chronic illness such as MS. Regular exercise and a healthy diet can help reduce the onset and severity of symptoms, and decrease the likelihood of developing mental illness (Bahmani, D.S, et al. 2019). However, the challenges of living with MS make self care more difficult due to low mood, or painful relapses. This can often precipitate the onset of depressive symptoms, and can easily go undiagnosed when confused with symptoms of MS. Sadly, depression forms part of living with MS for over 50% of patients.
In this video Cheryl Hile describes her story of living with MS. The diagnosis was a shock and at first, and she explains how it caused her to become depressed. She was a marathon runner who decided not to let her diagnosis prevent her from continuing with exercise.
Despite experiencing some falls during training she battled on and found ways to overcome this. She discovered a Functional electrical stimulation (FES) device to wear in her trainers. This stimulates the muscle to make its usual movement (DISabled to ENabled, 2020).
Depression has been characterised as among the symptoms of MS since its earliest clinical diagnosis in the 19th century. It is currently 2-3 times more prevalent among MS patients than in the general population (Jones, K.H, et al. 2012). Neurologist Jean Martin Charcot (1825-1893) diagnosed the first known case of MS in a patient presenting with severe depression. He identified brain lesions (sclerosis) that appeared to cause nerve damage resulting in behavioural changes. As we know by looking at the theoretical models, these early findings can be supported by recent neuroimaging studies analysing CT scans of patients with MS, showing that brain lesioned patients were more depressed than others with only spinal lesions (Lassman, H. 2019).
HOW CAN RESEARCH HELP IN PRACTICE?
Examining disease pathology in this way can help your clinician to identify a pattern of behavioural changes, with the potential to predict depressive episodes that occur as a response to MS inflammation. This can be useful for implementing a suitable treatment plan.
However, the stressful reality of living with MS, and the disability caused by the disease, can influence the psychological and social factors in our lives. The onset of depression can profoundly effects an individual's emotional and social functioning. The negative impact on of this on interpersonal relationships has been widely documented by patients and their significant others. Depression and MS leads to job losses, housing, and social isolation, which can produce implications for a patients social support system. For example, strained relationships or avoidance of social settings may further exacerbate depression and worsen MS disability (Kiropoulos, L. et al, 2020).
DIAGNOSING DEPRESSION
It is commonly accepted that a clear link exists between psycho-social conditions, the activation of MS symptoms, and impairment of immune functioning (Jones, K. H, 2012). Therefore, diagnosing and treating depression is an essential component when living with MS. A review of the suicide risk among this population by the Multiple Sclerosis trust in 2012, found severe depression to be among the significant factors, alongside early disease course, progressive MS and higher levels of disability (Definition of MS, 2015). Additionally, those who were socially isolated, or on a lower income were at greater risk of suicide. Suicide is currently the third leading cause of death among this population, and severe depression is 7.5 times more likely among MS patients.
Considering the evidence for how social support plays a significant role in moderating the negative psychological effects for MS patients, it highlights the importance of discussing your concerns with a GP, so they can recognise and investigate levels of depression, and discuss individual support systems available.
For example, it must not be assumed that all patients have spousal support, or friends who are close enough to offer emotional guidance and prevent isolation. Reduced independence and poor psychological functioning can have behavioural consequences for patients living with MS. Patients whose circumstances involve financial concerns, familial worries, or a complex life history may be particularly vulnerable to mental illness (Kasikci, E, 2020).
INDIVIDUAL
Your awareness and attitude towards any mental conditions may influence your experience of the disease. Self belief will play a role in how you perceive your disability. For example, if you suffer with low self efficacy, you may assume that you are unable to cope with the employment challenges, or not be able to visualise how symptoms will ever get better. These beliefs alone can make you more likely to develop depression as a result of living with the disease (Probst, Y. et al, 2022).
ENVIRONMENTAL
Access to adequate healthcare resources, or social support can heavily influence your state of mental wellness. For instance, if you do not have the resources to use the internet or contact local help groups may be more vulnerable to becoming psychologically unwell (Mayo, C.D, et al. 2023).
SIGNS & SYMPTOMS OF DEPRESSION
Irritability,
Loss of interest in hobbies, or sexual relations
Feelings of hopelessness, and suicidal thoughts
Sleep disturbances/insomnia
Loss of appetite
If you experience any of the symptoms described above, and feelings of hopelessness persist then it is important to speak to your GP and seek help. There are many treatments for depression, such as SSRI's including Fluoxetine, Prozac, or Citalopram. These are a safe way to improve your mood and generally only cause mild side effects (Farre, A, 2017).
OTHER WAYS YOUR GP CAN HELP
Being aware of any signs of mental illness is the first step to addressing any behaviours that may impede upon your quality of life. Seeking available guidance to help with techniques in problem solving can be empowering. However, all patients have varying levels of self esteem, and may struggle with assertiveness, or self management (Mikula, P. et al, 2021). If this sounds like you, then it is important to talk to a trusted friend or health care practitioner who can put you in touch with agencies who can help and support you, or recommend cognitive behavioural interventions (Delgadillo, J, et al, 2020). These can be found in additional resources.
ACCESS TO RESOURCES
Despite additional social support systems available, your individual circumstances surrounding mental health such as a complex life history or substance abuse disorders, may mean you continue to struggle with low mood and motivation and are less likely to make follow up visits (Papa, A. et al, 2021). For example, utilising activities due to social anxiety associated with post traumatic stress disorder (P.T.S.D) , or other illnesses that develop as a result of addiction problems may render you unable to attend clinical visits. Full disclosure of your problems to a GP may seem frightening, but it can make a profound difference to your overall wellbeing. This can be done via the telephone if necessary, to increase your access to available treatments.
Click and join the link above to find useful resources and others who may share the same experiences as you, and learn new strategies for coping.
This short video describes how common depression can be among MS patients, and that levels of severity may vary. Patients share their experiences and recognise the importance of talking about depression, and getting the help they need (NationalMSsociety, 2011).