A couple weeks ago, I asked my friends on Instagram what they would like to see on StumblePup about mental health and chronic illness. Their suggestions did not disappoint; everything from cost and accessibility, to medical PTSD and lack of information about the mental health connection in general from providers came up.

Rest assured, I heard all. of. you. And I will get to every topic suggested to me, because they’re all important. Today though, I’m focusing on the subject brought up most often in my poll – depression.

de·pres·sion ; feelings of severe despondency and dejection.

This is one mental health topic I’ve covered a little – but not in the depth it deserves. I’ve dealt with depression even longer than I’ve dealt with MS, so this post is long overdue.

I dealt with a lot of BS growing up. What’s important to note here is that the traumatic events I suffered through earlier in life left their mark. More specifically, they left lesions.

The sole reason I bring this up is because according to the study linked above, and many more just like it, these early life stressors are much more prevalent in people with MS than the general population. Depression is also much more likely to be experienced by people with MS. The majority of studies says around 50% of us.

In some people with MS, they could scour their memories for hours, and come up with little one would consider traumatic. Unfortunately, there is a real link in alot of us. In order to treat it correctly, we have to be aware of the different factors playing into our personal situation.

Because of this, the primary cause of depression can be very blurred when it comes to someone with MS. Where a chemical imbalance or traumatic experience would usually be blamed, we also have to consider disease modifying therapy side effects and nerve disruption from lesions. Trickiest of all, more than one, or all four, could be contributing factors.

I’ve covered both anxiety and trauma in previous posts. I think they have some really great coping mechanisms in them. In this post I’m going to go over depression in MS in more depth, what research tells us works for it, and quickly cover what I do to try to manage my own depression.

Depression doesn’t always start with a diagnosis of MS. I’ve talked about Clincally Isolated Syndrome before, and its name is pretty self-explanatory. What’s not widely known is that by the time we suffer our first exacerbation, science shows most of us are already suffering from depression and anxiety.

This is true even for those who never suffered from depression prior to MS symptoms. In fact, there’s clear evidence that the majority of people who are eventually diagnosed with MS see all types of specialists, including psychiatrists and psychologists, in the five years prior to dx. I mention this because it sheds a little light on the potential biological affect of MS on our propensity to have depression.

Moving beyond the biological impact of MS – disease modifying therapies can play a role, too. In recent years, research has begun in earnest on the effects of DMD’s on the mental health wellness of patients. It’s been proven that Rebif, or interferon beta 1a’s, can cause depression in certain individuals. Some neurologists will place newly diagnosed MS patients on Copaxone because of this if they have a history of depression.

With of all the new therapies available, this research is more important than ever before. With MS, patients already typically report a lower HRQOL (health related quality of life) and if you add in mental health disorders, these scores drop even more dramatically. The problem with ALL of these studies? The inability to properly assess and categorize mood changes and abnormalities.

There are a ton of difficulties in dealing with depression in MS. Regardless of the cause, if we want to feel well, we have to figure out how to deal, right?

There have been some studies done on this subject, which I found really refreshing. I’ve talked about being on an anti-depressant before; what I haven’t talked about is why. It actually does very little to relieve my depression. I take it for the nerve pain relief it provides.

I’m always excited and encouraged when I read or hear about other MS warriors finding relief with anti-depressants. Interferon related depression is one of those most difficult to treat with medication, so I’ve had to turn to other modalities for relief.

Stress has always been my achilles heel. It’s been shown that researchers can predict new and/or enlarging lesions in the brain in people with MS, based on the events they endure and how they cope during the study. This study had very similar results.

The good news is studies have shown that stress management can actually prevent new lesions in the brain and spinal cord.

Science tells us that mindfulness based stress prevention and management has been the most effective in treating depression in people with MS. It not only helps with depression, but fatigue scores went down while HRQOL scores drastically improved after just 8 weeks of therapy.

That’s just what science tells us. How am I translating this information into daily habits?

If you’re a regular reader on Stumble Pup, you know my three key tenants to my own wellness – nutrition, exercise, and stress prevention/management. You’d also know I’m no where near perfect, and I’m learning as I go along.

Lack of proper nutrition is almost always a factor in developing a physical ailment. Why then do we usually ignore nutrition as a tool to prevent depression? This study, which is rather long and tedious, shows that most patients with depression also lack proper nutrients. Because of this, I try my hardest to stick to a whole food plant based diet.

Everyone around me has to be getting tired of hearing me talk about how good exercise is for my MS. In this study, when people with major depressive disorder introduced exercise into their routine, they experienced sharp declines in their depressive symptoms.

I talked about the obvious benefits of less stress above – hello, less lesions? Count me in. I’ve talked about meditation quite a few times before, too. It’s really important to my daily routine, and I feel off without it. I don’t do anything too long, around 10 minutes a day is sufficient for me for now.

I’m also really trying to incorporate “me time” and personal deveopment into my daily routine. Again, nothing too much. Little things, like;

• Instead of listening to the radio on my way to school this week, I turned on Mindset by Carol Dweck.
• While doing yoga in the morning, I’ll turn the TV off and focus on how my body feels and being in the moment.
• Because of that awareness in the morning, I’ve begun to notice and tailor my day to my body’s needs.
• For an hour nefore bed, I’ve started disconnecting a little so to speak. I don’t check email, or listen to another lecture and write some last minute notes. I’ve started reading a book that’s for personal development or enjoyment.
• Before school started, I decided that one day a week would be completely school and work free. This semester, Saturday’s are looking like a good fit.
• The past few weeks, in anticipation of school, I’ve upped my counseling sessions to once weekly; it can be a time crunch, but it’s been worth it.

All of these little things are adding up, and really contributing to keeping my stress level down, which leads to my mood being dramatically higher. If I neglect one aspect of my health, all of them suffer.

I’ve talked about this before, but it bears reminding. I’m also using this manual to overcome some of my past traumas. It isn’t easy work, but it’s necessary if I want to live my best life. If you’ve dealt with hard stuff, it’s an excellent resource to begin healing with.

You know what they say – you can’t pour from an empty cup. Making yourself a priority can lead to less depressive symptoms.

Right now, it’s time for me to get back to some studying. I hope you’re all heading for a happy weekend! I’ll be posting this poll on my Instagram later, but I want to know – have you experienced depression with MS? If so, did your neurologist talk with you about potential depression or anxiety? I’m super curious!

On Monday, I’ll have my update on how I’m doing with Rebif – the good, the bad, and the itchy 😉 TGIF!