Are you depressed or anxious? Don’t suffer in silence ask for help. #ClinicSpeak #MSResearch #MSBlog
When you last saw your neurologist, or nurse specialist, did they ask you about depression and/or anxiety? Have you ever brought up the issue of depression and/or anxiety with your HCPs? Are you someone who knows that you have mental health issues, but suffers in silence?
The study below using administrative data confirms what we know already that MSers are much more likely to be depressed and have anxiety than matched control subjects. In addition, bipolar disorder was almost 3x more common in MSers. We know that hidden mental health issues affect quality of life. In addition, depressed and anxious people are much more likely to have sleep disorders, misuse substances and alcohol, and suffer from fatigue. Fatigue is one of the core symptoms of depression. Another issue is social isolation. Depressed people don’t like going out and socialising; they withdraw and their social capital contracts. Reduced social capital is associated with poorer outcomes. Put simply when you are depressed or anxious it creates a downward spiral.
It is important to realise that there is a lot that can be done to help you. Under the NHS we have CBT (cognitive behavioural therapy), mindfulness therapy, group therapy, exercise programmes and if all else fails pharmacological interventions that can help. It is also clear that depression and anxiety may be linked to ongoing inflammatory activity as part of ‘sickness behaviour’. Sickness behaviour occurs in response to inflammation and is evolutionary conserved behavioural response to inflammation. I have seen many patients with depression and/or anxiety improve from simply having the MS disease activity brought under control.
Another is financial issues. MS is associated with mass unemployment. If you have financial issues there are things that can be done to help. We have a socialist healthcare system and there safety nets in place for people with chronic disease. If you don’t ask you won’t know what is available.
For HCPs it is important to manage MS holistically and to ask about hidden symptoms. Treating patients with MS holistically can make all the difference, it also shows you care. Knowing that someone cares about you, particularly your HCPs, can make the difference between having hope and hopelessness. It also important to remember that having MS is a risk factor for suicide; MSers are between 2-7x more likely to commit suicide. It is our jobs to screen for depression and treat it with the aim of reducing this risk.
Marrie et al. Physical comorbidities increase the risk of psychiatric comorbidity in multiple sclerosis.Brain Behav. 2016 Jun 29;6(9):e00493
BACKGROUND: Risk factors for psychiatric comorbidity in multiple sclerosis (MS) are poorly understood.
OBJECTIVE: We evaluated the association between physical comorbidity and incident depression, anxiety disorder, and bipolar disorder in a MS population relative to a matched general population cohort.
METHODS: Using population-based administrative data from Alberta, Canada we identified 9624 persons with MS, and 41,194 matches. Using validated case definitions, we estimated the incidence of depression, anxiety disorder, and bipolar disorder, and their association with physical comorbidities using Cox regression, adjusting for age, sex, socioeconomic status, and index year.
RESULTS: In both populations, men had a lower risk of depression and anxiety disorders than women, as did individuals who were ≥45 years versus <45 years at the index date. The risk of bipolar disorder declined with increasing age. The risks of incident depression (HR 1.92; 1.82-2.04), anxiety disorders (HR 1.52; 1.42-1.63), and bipolar disorder (HR 2.67; 2.29-3.11) were higher in the MS population than the matched population. These associations persisted essentially unchanged after adjustment for covariates including physical comorbidities. Multiple physical comorbidities were associated with psychiatric disorders in both populations.
CONCLUSION: Persons with MS are at increased risk of psychiatric comorbidity generally, and some physical comorbidities are associated with additional risk.