Living with MS: Increased Risk of Depression, Anxiety, and Suicidal Thoughts
People living with multiple sclerosis are at risk for several comorbidities, including depression and anxiety, both of which can be associated with suicidal thoughts and behavior. There have been several studies conducted over the years investigating suicide in MS patients. Here are the results of a few.
Depression and anxiety, overlooked and untreated
Clinically significant depression affects up to 50% of people with multiple sclerosis over the course of their lifetime. Associated with increased morbidity and mortality, depression greatly affects quality of life. Although depression is treatable, it is often an overlooked and under-treated condition in MS patients.1,2
Anxiety disorders can affect up to 35.7% of MS patients, according to one study which identified panic disorder (10%), obsessive compulsive disorder (8.6%), and generalized anxiety disorder (18.6%) as common diagnoses. Diagnosis had been missed in the majority of participants, so they had gone untreated. Subjects with an anxiety disorder were more likely to be female, have a history of depression, drink to excess, report higher social stress, and have contemplated suicide.3
In another study, clinically significant anxiety was reported by 25% of MS patients (n=152). Researchers found that anxiety co-morbid with depression, rather than anxiety or depression alone, was associated with increased thoughts of self-harm, more complaints with no known medical cause, and greater social dysfunction.4 Lack of treatment seems to become a common theme throughout many studies.
Suicidal thoughts and neurological disease
It is believed that suicidal thoughts and behavior occur more frequently in MS patients compared to the general population. This increases the risk of self-harm. Suicide in MS patients is associated with several risk factors: depression, social isolation, younger age, progressive disease subtype, lower income, earlier disease course, higher levels of physical disability, and not driving.5 MS is one of three neurological diseases, including epilepsy and Parkinson’s disease, that are most associated with suicidal ideation.6 It became widely known after his suicide that actor Robin Williams struggled with depression for years and had been diagnosed with Parkinson’s disease.
In another small study in which MS patients were interviewed (n=16), all participants said that perceived loss of control elicited thoughts of suicide. Other triggers were increased family tension, loneliness, hopelessness and frustration, physical and psychological impact of MS, loss of perceived masculinity or femininity, regaining control, and failure to achieve desired or expected role functioning.7 Loss of control was a powerful central theme throughout the interviews.
In a survey of veterans with MS (n=445), 29.4% of respondents reported ever having had suicidal thoughts, and 7.9% reported persistent suicidal thoughts in the 2 weeks prior to the survey. Several factors were found to be associated with suicidal ideation, including younger age, earlier disease course, progressive disease subtype, lower income, not being married, lower social support, not driving, higher levels of physical disability (mobility, bowel, bladder), and depression. However, only severity of depression was found to be independently associated with persistent suicidal ideation.8
Rate of suicide in people with MS, variable
In a recent survey of mortality in commercially insured MS patients in the U.S. (this excludes those covered by Medicare), principal causes of death were categorized as MS, cancer, cardiovascular, infectious, suicide, accidental, pulmonary, other, or unknown. While the rate of death due to suicide was slightly higher in MS patients than matched controls (17/100K vs 13/100K patient years), it was not significantly different.9
However, these results contrast with a study published over 10 years ago that discovered suicide was the underlying cause of death in 1.8% of Swedish MS patients during 1969-1996. The mean period of time between MS diagnosis and suicide in 90 cases was 5.8 years, a shorter period of the time than death due to other causes. Suicide risk was significantly elevated (SMR = 2.3; standardized mortality ratio) among MS cases compared with the general population. Researchers found that suicide risk was particularly high in the first year after initial diagnosis, and among younger male MS cases.10
What can I do if I feel I might harm myself?
Suicide is a serious choice. If you are feeling suicidal, you may not feel like you have a choice, but you do. In honor of National Suicide Prevention Week, September 8-14, 2014, I ask that you to take a moment to read the following suggestions of how to deal with suicidal thoughts, excerpted from HelpGuide.org.11 If you have MS, experience depression or anxiety, have other risk factors, and/or ever feel hopeless, powerless, and alone, I hope that the following words may come back to you and keep you safe until you can get help.
Step 1. Promise not to do anything right now.
Even though you’re in a lot of pain, give yourself some distance between thoughts and action. Make a promise to yourself: "I will wait 24 hours and won't do anything drastic during that time." Or, wait a week. Thoughts and actions are two different things and your suicidal thoughts do not have to become a reality.
Step 2. Avoid drugs and alcohol.
Suicidal thoughts can become even stronger if you have taken drugs or alcohol. It is important to not use nonprescription drugs or alcohol when you feel hopeless or are thinking about suicide.
Step 3. Make your home safe.
Remove things you could use to hurt yourself, such as pills, knives, razors, or firearms. If you are unable to do so, go to a place where you can feel safe. If you are thinking of taking an overdose, give your medicines to someone who can return them to you one day at a time as you need them.
Step 4. Take hope – people DO get through this.
Even people who feel as badly as you do right now manage to survive these feelings. Take hope in this. There is a very good chance that you are going to live through these feelings, no matter how much self-loathing, hopelessness, or isolation you are currently experiencing. Just give yourself the time needed and don’t try to go it alone.
Step 5. Don’t keep suicidal feelings to yourself.
The first step to coping with suicidal thoughts and feelings is to share them with someone you trust. It may be a friend, a therapist, a member of the clergy, a teacher, a family doctor, a coach, or an experienced counselor at the end of a helpline. Don’t let fear, shame, or embarrassment prevent you from seeking help. Just talking to someone can release a lot of the pressure that’s building up and help you find a way to cope.
Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the National Hopeline Network at 1-800-SUICIDE (1-800-784-2433). These toll-free crisis hotlines offer 24-hour suicide prevention and support. Your call is free and confidential. To find a suicide helpline outside of the US, visit IASP or Suicide.org.
Do you have a fear of needles and take medication that requires injection?