Symptom Awareness

Dealing With Depression

Winter is fast approaching, and with its long nights, cold temperatures, and gray scenery, some may find themselves suffering from what many call "the blues." This issue's Symptom Awareness column is an overview on depression, taken from the cover story in MSAA's Winter 2003 issue of The Motivator.

If you tend to feel down, you are not alone! Depression can affect anyone, regardless of income, age, gender, nationality, and lifestyle. Nearly 10 percent of the adult American population suffers from a depressive illness during the course of an average year.

Depression is a very treatable illness, and many can enjoy a far greater quality of life just by seeing a professional and getting the help they need. Depression is often best treated through a combination of medication and psychotherapy. In many circumstances, depression may be significantly reduced in a relatively short amount of time.

While anyone is susceptible to depression, individuals with MS experience a much higher incidence. The negative effects of depression on MS are compounded by the fact that depressed individuals may not comply with taking their prescribed medications, and this could cause their condition or other symptoms to worsen. A portion of depressed individuals are at risk of suicide, and this too is greater for individuals with MS.

When diagnosing a major depressive episode, physicians look for five or more of the following nine symptoms to be present during the same two-week period. As noted, a portion of the symptoms listed are also symptoms of MS, which means they may not necessarily indicate depression for someone with MS. These symptoms may be reported by the patient or observed by others, and in general, occur nearly every day.

• Depressed mood for most of the day
• Greatly reduced interest or pleasure in all, or almost all, activities most of the day
• Significant weight loss or gain, or change in appetite
• Feelings of worthlessness or excessive guilt
• Recurrent thoughts of death or thoughts/plans/attempts of suicide

• Difficulty sleeping or excessive sleeping
• Significant restlessness or slowing down as observed by others
• Fatigue or loss of energy
• Diminished ability to think, concentrate, or make decisions

The first line of medications in treating depression is a class of drugs known as "selective serotonin reuptake inhibitors" (SSRIs). These include Fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), and venlafaxine (Effexor®). Additional antidepressants that are considered to be a "first line of treatment" for depression are bupropion HCL (Welbutrin®), nefazodone (Serzone®), and trazadone (Desyrel®). Other drugs, such as anticholinergics or tricyclic antidepressants, as well as monoamine oxidase inhibitors (MAOIs), may be options for people who do not respond to the first line of medications already mentioned.

All of these agents may be given alone, or various combinations may be prescribed. Antidepressants do not have an immediate effect, and typically require between four to eight weeks before reaching their maximum level of benefit.

Sometimes individuals want to stop their antidepressant medication as soon as they feel better, thinking they no longer need it. This type of treatment should be continued for at least four to nine months to prevent depression from returning, and medication for more severe conditions may need to be continued indefinitely. Individuals taking antidepressant medication should never alter their dose, stop taking their medication, or combine it with any other drugs, without first consulting their doctor.

Studies are ongoing to determine if an extract of the herb St. John's wort may have an effect on milder forms of depression. St. John's wort, however, along with other herbal supplements, can have dangerous side effects when taken with other medications. Individuals need to inform their doctor if they are taking any type of herbal supplement.

Psychological counseling is the second and equally important component for treating depression. Individuals suffering from this condition need to work with a psychiatrist, psychologist, or social worker to discuss their thoughts, behaviors, and outlooks. These medical professionals assist people with their coping skills and help individuals to better adjust to their situations and ultimately feel better.

MSAA's Vice President and Chief Medical Officer Jack Burks, MD, specializes in the treatment of MS and stresses the importance of treating depression. Dr. Burks explains, "What causes depression in MS is not an easy question to answer. Having MS certainly adds stress to one's life, and depression can result from dealing with stress. But depression can also result from medications, and damage to myelin could be involved. Other medical conditions, such as thyroid disease and urinary tract infection, can cause depression as well. An individual can even appear euphoric when actually suffering from depression.

"For these reasons, I always look at the patient's entire picture. After making whatever changes are necessary to existing medications and conditions, using a combination of psychotherapy and medication is the most effective means of treatment.

"Psychotherapy is an integral part of treatment. Examples of therapy options include group, peer, family, couple, and individual counseling. Educating family members is important so they understand MS and can provide support to the affected family member. Stress management techniques such as bio-feedback, visualization, and self hypnosis, are other viable options.

"The big hurdle for many people is to get over the stigma associated with counseling. Individuals need to know that they are not 'crazy.' Depression is an illness that needs to be treated. Counseling helps individuals learn how to cope and adjust to one's changing situation. We all experience "dips" from time-to-time and we need to smooth these out.

"Regardless of which medications and forms of therapy best suit an individual diagnosed with depression, the important thing is to get help. Depression greatly affects an individual's quality of life; it can cause additional symptoms, and can even direct a few individuals toward thoughts of suicide. Depression is a serious disorder, and no one should go without treatment."

For more information or to obtain a copy of the original article on depression, readers may call MSAA's Helpline at (800) 532-7667 or log onto MSAA's website at www.msaa.com, click on "publications," select The Motivator, and scroll down to the Winter 2003 issue of The Motivator. Included in the article are various strategies on how to feel happier.

—Susan Wells Courtney

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