Treatment of Depression
The biggest challenge to successfully treating depression is the reluctance that people have to seek and follow-through with treatment. Some people believe that they need to be strong and resist the emotional difficulties that come with MS. Admitting the need for help is difficult and can seem like surrendering to the disease. However, real strength is reaching out for help when you need it and by so doing, taking charge of your health and welfare.
What are some of the treatment options available for major depression?
There is agreement among mental health experts that the best treatment for major depression is a combination of antidepressant medication and psychotherapy or counseling. While each type of treatment can provide some relief for depression independently, a combination of approaches can be highly effective.
Psychotherapy, or counseling for depression, can be done individually or led in a group setting by a qualified psychiatrist, psychologist, social worker, or counselor. It generally takes several months of treatment to get the best results. So, be prepared to stay with it for a sufficient amount of time. You may also consider taking part in a support group for people with MS. Getting support from a community of people dealing with the same problems as you can be very useful and empowering. While support groups are a useful addition to formal psychotherapy or counseling, they are not a substitute. You can speak to your doctor to get a referral to a qualified mental health professional for psychotherapy or counseling.
Only a qualified physician (typically a psychiatrist) can determine which antidepressant medication will be best for you. However, a variety of types of antidepressants have been used successfully in people with MS who have major depression. These include a class of antidepressants called tricyclics. Tricyclic antidepressants, such as Elavil (amitriptyline), Pamelor (nortriptyline), and Tofranil (imipramine), have been used for many years in patients with MS and were once considered the treatments of choice. However, another class of antidepressants, called serotonergic (related to serotonin) antidepressants, is now more widely used. These include Zoloft (sertraline), Paxil (paroxetine), and Prozac (fluoxetine). Other types of antidepressants can also be useful, such as Wellbutrin (bupropion HCl), Cymbalta (duloxetine), and Effexor (venlafaxine). Because different antidepressants work through different modes of action, possible side effects vary. As no individual person reacts the same to every medication, you will need to work with a psychiatrist to find the right antidepressant for you, based on how well it works and how well you tolerate it. It may take up to 6 weeks to find out how well a particular medication will work for you. So, work closely with your psychiatrist and be prepared to give the process time.
Things to keep in mind about antidepressant therapy
Be patient: Antidepressants can take from 4 to 6 weeks to take effect
Don’t stop taking it on your own:
- If you feel better and stop taking an antidepressant, depression may return
- Stay on your medication as long as your doctor tells you to
It may take time to find the right one: Different antidepressants are more effective in different people and side effects vary from person to person: it may take time to find the right one for you
Try to find the right psychiatrist: Find a psychiatrist who is experienced in treating people with MS or a psychiatrist who is willing to work with your neurologist to learn about MS
Make sure your psychiatrist has the whole picture:
- Since you already take quite a few drugs for MS, make sure your psychiatrist is aware of all these medications
- Some medications can interact with others and cause problems, so make sure that all your doctors are aware of the medications you are taking
Sexual side effects:
- Most antidepressants have sexual side effects
- You can work with your psychiatrist to see how you can get the benefit of antidepressant therapy, while minimize the impact on sexual functioning
Are there MS medications that can increase the risk of depression?
Some medications commonly used to treat MS or symptoms associated with MS can increase the risk of developing depression or worsen depression if you already have it. Corticosteroids are often used to decrease CNS inflammation. People who take high doses of corticosteroids can become energized, anxious, or even giddy. However, when you stop taking the medication, the risk of depression increases. Interferon medications, which are approved for relapsing types of MS can cause depression and have warnings for this side effect. While this warning sometimes discourages doctors from using interferon medications in their patients with MS, the medications are generally recognized to be safe. Experts have recommended that a person with MS who uses an interferon medication should be aware of changes in mood and to alert their doctor if such changes should occur. The disease-modifying treatments, Copaxone (glatiramer acetate) and Tysabri (natalizumab), have not been linked to the development of depression.