According to Johns Hopkins Psychiatric department.
60% of those with MS have depression. Of all diseases, MS has the
highest rate of depression and suicide.
The above information was obtained from watching the Montel
Williams show on Jan., 13th 2004 Don't suffer in silence. Please
contact a health care professional or join us in chat.
Thank you, Veronica Davidson
Depression Care Modifies Interferon-Gamma
Production in Multiple Sclerosis
Archives of Neurology
07/16/2001
By Elda Hauschildt
Depression is linked with interferon gamma (IFN-gamma) production in patients
with multiple sclerosis (MS). Treatment of depression is associated with a
reduction in non-specific and antigen-specific IFN-gamma production.
"These novel findings suggest that treating depression may be an important
disease-modifying component in the treatment and management of relapse-remitting
MS," explain researchers from the University of California, San Francisco.
"Depression is associated with increased IFN-gamma production, and IFN-gamma
production can be down-regulated by treating depression."
Investigators add that the observed relationship between IFN-production,
depression and treatment of depression may have "particular salience for MS
patients as IFN-gamma has been implicated as a major factor in the
pathophysiology of this disease."
Researchers conducted a randomised, comparative outcome trial that included
three 16-week treatments for depression.
Three treatment programs included both behavioural and pharmacological
treatments: individual cognitive behavioural therapy designed to improve coping
skills, group psychotherapy designed to provide social support and
psycho-pharmacological therapy based on the antidepressant, sertraline.
Of 14 MS patients with major depressive disorder who participated, 10 (71
percent) were women. Average age was 47.4 years. Mean time since MS diagnosis
was 11.3 years. Mean Expanded Disability Status Range was 3.6.
Participants were assessed at baseline, week eight and at the end of treatment.
Variability in immune assays was controlled for using eight non-depressed,
healthy subjects enrolled at the same time as MS patients were enrolled.
Investigators used the Beck Depression Inventory to assess depression. They also
measured IFN-gamma production by peripheral blood mononuclear cells.
"Over the course of treatment for depression, decreases in levels of
depression were associated with decreases in levels of IFN-gamma
production" among the MS patients, the researchers report.
There were no changes in IFN-gamma production or in depression among the healthy
controls.
"Although the manipulation of depression through treatment supports the
argument that depression can cause changes in IFN-gamma production, these
findings do not rule out the possibility that IFN-gamma production can cause
depression," investigators note.
"It has been suggested that immune dysregulation in MS may cause
depression, and the increased incidence of depression during disease
exacerbation is consistent with this argument.
"Thus the present findings might better be interpreted as supporting the
notion that the relationship between immune dysregulation and depression in MS
is dynamic and reciprocal."
Treatments and Studies for Depression:
Combination therapy more effective than
monotherapy in depression treatment with Zyprexa, Prozac
A combination of antidepressant Prozac (fluoxetine, Eli Lilly and Co.) and
schizophrenia drug Zyprexa (olanzapine, Eli Lilly and Co.) proved to be a more
effective therapy than either drug alone in reducing the symptoms of
treatment-resistant depression and depression with psychotic features, according
to new data.
Treatment-resistant depression is defined as a disorder that fails to
respond to treatment in two or more trials involving two or more different
classes of antidepressants. Approximately 30 percent of patients with a major
depressive disorder fail to respond to conventional treatment, Lilly said.
In the analysis, researchers evaluated data from two studies and used
several rating scales to measure patients’ symptoms.
They found that a combination of Zyprexa and Prozac was
“significantly” superior to monotherapy with either drug.
The study was presented at the 154th annual meeting of the American
Psychiatric Association.
On:
Depression and MS
by Martha M. Jablow
Revised
in 1998 from InsideMS, Vol. 11, No. 3
The
words depressed and depression are used so casually in everyday conversation
that their meaning has become murky. True depression is a disorder that will
affect from 5 to 20 percent of Americans during their lifetime. Depression is
not a fleeting emotion. It is a persistent disturbance of mood with complex
roots in an individual’s physiology and psychology, and it has marked
symptoms.
People
with MS and other chronic illnesses experience depression more than the general
population. When "depression" and "MS" are mentioned in the
same breath, some people say, "Of course you’d be depressed if you’d
been diagnosed with MS," or "How would you feel if your ability to
walk just suffered a major setback?" Such reactions assume that depression
is a direct psychological response to a diagnosis or symptoms of MS. That is one
explanation, but researchers are also looking at possible physiological causes
of depression in people with MS.
The
pull-up-your-socks syndrome
While researchers
look at brain chemicals and chart the positive effects of medications, many
people still believe severe depression can be overcome by will power.
"There’s a strange feeling in this country that depression is a character
flaw. It is not. There is treatment for depression, and it is curable,"
said Dr. Randolph B. Schiffer, at the Texas Tech University, School of Medicine,
a neurologist and psychiatrist who has done research on the psychological
aspects of MS.
Cause
or effect?
Dr. David Michaelson, a staff psychiatrist in the neuroendocrinology branch of
the National Institute of Mental Health, has studied the interaction between the
body’s hormone system, immune system, and central nervous system in people who
have both depression and MS.
"There
is some evidence to suggest that the physiology of MS may predispose people to
depression," said Dr. Michaelson. "At the same time, these people
carry the burden of MS—the changes in daily life, the loss of function. We
don’t know the answer definitely yet. But whether one becomes depressed in
reaction to the illness, or depression is a part of the biology of MS, the fact
to remember is there are effective interventions."
The
interferons—an added factor
Beta-interferon drugs are effective treatments for relapsing-remitting MS. The
side-effects of Avonex and Betaseron may include depression. If you are using
either of these medications, be aware of any symptoms of depression, and discuss
them with your physician.
Is
it sadness, grief, or true depression?
Grief and sadness lift a little when something pleasant happens. Depression is
heavy; it stays in place. Symptoms of clinical depression are listed following
this section. They are quite specific. But recognizing depression is not always
easy because some of the symptoms are common to both MS and depression.
"It
can be hard to sort out signs and symptoms such as fatigue or loss of energy,
which are signs of depression and also signs of MS," Dr. Schiffer said.
"Sometimes patients, families, and doctors are slow to recognize depression
because it may appear so gradually. One thing I’m sure of is that depressive
symptoms tend to be at their worst when MS symptoms are exacerbated."
Once
depression is acknowledged, specialists agree, don’t wait; reach out for
professional help.
Symptoms
of Depression
The hallmark of these symptoms is their persistence. They linger. They are not
the normal, transient "blues" that everyone experiences in response to
a sad or distressing event. According to the American Psychiatric Association in
its Diagnostic and Statistical Manual of Mental Disorders IV-R, the symptoms of
major depression last at least 2 weeks. During that time, the person has 5 or
more of the following 9 symptoms on a daily, almost round-the-clock basis.
·
Feelings
of hopelessness, sadness, despair
·
Loss
of pleasure or interest in most activities
·
Significant
weight loss or gain; or increase or decrease in appetite
·
Persistent
sleep problems, either insomnia or excessive sleep
·
Ongoing
fatigue and loss of energy
·
Feelings
of personal worthlessness or inappropriate guilt
·
Inability
to concentrate or make decisions
·
Observable
restlessness or slowed movement
·
Recurrent
thoughts of death, violence, or suicide
The
symptoms not only persist over time but also impair daily functioning. Depending
on their number and severity, depression is categorized medically as mild,
moderate, or severe.
OK,
I need help
To find help, Dr. Schiffer advises asking your neurologist or general medical
doctor first. "Ask the one with whom you’re best connected," he
said.
Dr.
Andrew H. Miller, a psychiatrist at Emory University School of Medicine in
Atlanta, Georgia, agreed that people with depression shouldn’t wait for it to
go away. "The quality-of-life issues are serious. Treatment can optimize
your daily functioning."
The
Society office nearest you can give you referrals to mental health professionals
who understand MS. Call 1-800-FIGHT MS [1-800-344-4867] and select option #1.
Drug
therapy
"If you’re severely depressed, with major impairment in function at home
or work, it is best to try antidepressant medication," Dr. Miller said.
For
those with mild to moderate symptoms, there is "a choice among
psychotherapies and the possibility of medication."
Many
types of antidepressants are available, but none are magic bullets. Most work
gradually. They may bring some improvement after several days, but the drug’s
full effect may not appear for several weeks. If there are no improvements after
6 weeks, the doctor will prescribe a different drug.
"It’s
very important to target selected symptoms and to follow them to see if the
medication is helping," Dr. Miller said. He pointed out that a person is
likely to respond to the same antidepressant drug that has worked well for a
family member. Biochemistry runs in families.
Side
effects are no longer a major obstacle. The older antidepressants were notorious
for causing dry mouth, urinary hesitancy, constipation, blurred vision, fatigue,
drowsiness, weight gain, sexual dysfunction, and other unpleasant symptoms. They
are now rarely used. The newer agents are generally well tolerated and have far
fewer unwanted effects. All side effects should be discussed with your doctor.
Often, the drug or the dosage can be altered to provide the best effect with the
fewest problems.
Talk
therapy
Very few physicians believe that medication alone cures depression. "Most
combine drug therapy with some form of counseling," said Dr. Sarah L.
Minden, a psychiatrist who treats patients with MS at Brigham and Women’s
Hospital and Harvard Medical School.
Psychiatrists,
who are MDs, can prescribe medication as well as provide counseling. Talk
therapy can be obtained from certified social workers, psychologists,
psychiatric nurses, licensed professional counselors, or other qualified
non-physicians, who will seek evaluations by a psychiatrist regarding the
selection and monitoring of medication if it is indicated.
Talk
therapy takes several forms. It may be time-limited and address a current
crisis. It may be supportive and focus on finding ways to cope. Or, it may
involve in-depth exploration with the goal of helping a person develop greater
self-awareness. The form depends on the individual’s needs, and these may
change over time or with the stage of illness.
Therapy
can be supplemented by participating in a support group. Ask your Society
chapter about support-group programs near you specifically for people with MS.
A
good relationship
"No matter what form talk therapy takes, a good ‘fit’ between you and
your therapist is essential. You should feel that you can bring up any
topic," advised Dr. Michaelson.
"Treatment
is very relationship-sensitive," Dr. Schiffer explained. "What’s
important is that you see somebody who believes in what he or she is doing,
someone with whom you can have a good relationship." This may mean a period
of shopping around. Obviously, not every qualified therapist is the right one
for you. "Don’t give up on the concept of treatment," Dr. Schiffer
said. "When that relationship is developed, it can help you understand your
emotions and gain more control over your life."
Disability
and depression
"Some people who are profoundly disabled are not depressed—while others
are very depressed but not physically disabled at all," Dr. Minden said.
Research has shown no correlation between depression and an individual’s
degree of disability.
"What
makes a person depressed seems to relate to a host of factors," she
explained. "Disability may contribute but it’s not an either/or issue.
The other factors include genetics, individual coping styles, past and present
experiences, and what sorts of social supports a person has. But while we
don’t yet know how depression originates, we do know how to treat it."
©
1999 National Multiple Sclerosis Society
Current as of January 2001
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