Reviewed by: HU Medical Review Board | Last reviewed: April 2023

Multiple sclerosis (MS) can cause physical, mental, and emotional symptoms. While physical symptoms like pain or numbness are hard to deal with, so are the invisible symptoms. These include things like depression, anxiety, or emotional changes. Depression is common in people with MS. It can be serious if not diagnosed and addressed.1

What is depression?

Depression is a type of mental health condition. People with depression have feelings of overwhelming sadness or hopelessness. This is different from general sadness or grief. Feelings of depression can be severe. They typically last for weeks or months at a time. Depression can be caused by a medical condition, life stressor, or no obvious reason at all.2

As many as 1 in 6 people will experience depression in their lifetime. It can take a toll on the ability to enjoy regular activities or complete daily tasks. Feelings of depression can become severe or life-threatening. Common signs of depression include:1,2

  • Depressed or sad mood
  • Losing interest in things you once enjoyed
  • Low energy or fatigue
  • Feelings of guilt or worthlessness
  • Weight or appetite changes
  • Slowed speech or movements
  • Problems with concentration or thinking
  • Sleeping too little or too much
  • Inability to sit still, pacing, or other fidgety behaviors
  • Thinking of death or self-harm

To meet the criteria for depression, several of these symptoms must be present for at least 2 weeks.2

People cannot control whether they have depression. Thankfully, more people are talking about mental health and encouraging each other to seek support when needed. Depression and other mental health issues are not things to be ashamed about. They are medical conditions that can be treated.1,2

Why does depression occur in MS?

As many as 2 out of every 3 people with MS experience emotion-related symptoms, including depression. There are many reasons why this might occur.3

Chronic pain, fatigue, and anxiety are common in MS. These issues can all increase rates of depression. Problems with thinking (cognitive dysfunction) and inflammation related to MS may also be at play.1,3

Some drugs also cause depression as a side effect. Steroids used to treat MS are an example of this. Plus, navigating a new diagnosis, life with a chronic condition, or managing frustrating symptoms can all lead to mental health distress.1,3

Depression can develop at any point along a person’s MS journey. It can also develop unrelated to MS. Regardless of when or why, depression is something to take seriously. It sometimes makes other symptoms worse, such as anxiety, cognitive issues, pain, and fatigue. This can create a cycle of symptoms that severely reduce quality of life.1

How is depression diagnosed and treated?

There are several steps in diagnosing depression. Your doctor will ask you a few questions about your mood, daily activities, and other depression-related symptoms. Answering these questions honestly is important for an accurate diagnosis. Being diagnosed with depression is not shameful. It does not mean a person has to go to a hospital or complete intense therapy.2

Your doctor will also review your medical history and the drugs you take. Because depression can be caused by other health conditions, like thyroid problems, they may run some blood tests, too.1,2

Once a diagnosis of depression is made, you and your doctor will determine the next best steps. Many depression treatment plans involve depression-treating drugs (antidepressants) and some form of talk therapy.1,2,4

There are many antidepressants that treat other issues, such as chronic pain, fatigue, and anxiety. However, some drugs have side effects that might make MS-related symptoms worse. Finding the right option for you may take time, but more than 80 to 90 percent of people respond well to treatment.1,2,4

Along with antidepressants, there are other therapy and behavioral options that can help treat depression. Some of these include:1,2,4

  • Talk therapy with a mental health counselor or psychologist
  • Physical activity
  • Stress-lowering techniques like meditation or mindfulness
  • Addressing feelings through writing or creative outlets
  • Reducing or avoiding addictive substances like alcohol or drugs
  • Finding a support group
  • Connecting with family and friends

While many of these options help, depression can still cause overwhelming emotions. If you feel like you might harm yourself or someone else, the National Suicide Prevention Lifeline can help. It can be reached at 1-800-273-TALK (1-800-273-8255) at any time.1

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