Depression is common in MS. It can be the result of difficult life situations or stresses, but may also occur from the MS disease process, because of damage to areas of the brain that are involved in emotional expression and control. Additionally, depression can also be a side effect of various medications used in the management of other MS symptoms. MSAA’s booklet, Understanding and Treating Depression in Multiple Sclerosis, may be very helpful and can be downloaded or ordered at no charge.
Because of the wide-ranging issues that affect people with MS and can also contribute to depression, the effective results are usually obtained with a combination of "talk therapy," (through some type of counseling or therapy), pharmacologic agents, and exercise.
A wide variety of antidepressant medications are useful in managing depression associated with MS. Most of them appear to work by slowing the removal of specific neurotransmitters, thus increasing their activity because they stay in the system longer. This means that the chemicals that make us feel good remain in the body longer, and this positively affects mood. The two main neurotransmitters affected by antidepressant medications are serotonin and norepinephrine. These medications belong to a variety of subcategories, depending on the neurotransmitter they affect.
SSRI antidepressants (Selective Serotonin Reuptake Inhibitors)
including Prozac® (fluoxetine), Zoloft® (sertraline), Paxil® (paroxetine), Celexa® (citalopram), and Lexapro®(escitalopram)
This group of antidepressants was developed to treat general mental depression and panic disorders, and has proved effective in treating depression and anxiety, as well as several other symptoms of MS. SSRIs inhibit the reuptake of serotonin (a chemical produced within the body, which is known to elevate mood), allowing it to remain in the body 's system longer.
Side effects of this class of drugs include decreased sexual drive or ability, drowsiness, dry mouth, headache, and weakness, as well as psychological symptoms that may include agitation and nervousness.
SNRI antidepressants (Serotonin and Norepinephrine Reuptake Inhibitors)
including Cymbalta® (duloxetine hydrochloride), Serzone® (nefazodone), Wellbutrin® (bupropion), and Remeron®(mirtazapine)
These are oral medications in tablet form. With Side effects similar to the SSRIs, SSRNIs are a newer type of antidepressant and provide additional treatment options.
Side effects vary with the specific drug, but may include gastrointestinal problems, fatigue, sleepiness, drowsiness, and dizziness. Contact your healthcare provider if you experience any sudden emotional or behavioral changes while taking this medication.
including Elavil® (amitriptyline), Tofranil®(imipramine), Pamelor (nortriptyline)
These are oral medications in tablet form. The dose normally ranges from 10 to 150 mg per day (amitriptyline), 75 to 150 mg per day (imipramine), and 10 to 175 mg per day (nortriptyline).
Side effects include dry mouth, constipation, sexual problems, dizziness, and drowsiness.