The incidence of depression amongst people with Multiple Sclerosis has been a matter of controversy for many years. In the early years of research it was thought that relatively few people with the condition had ‘clinical’ depression, but more recent research indicates that the level of depression is far higher than was previously thought.
Recent research suggests that up to 50% of people with MS (compared to only 5–15% of people without) will experience serious depression at some point in their lives, and at any one time perhaps one in seven may be experiencing this kind of depression. It is a very broad subject and could fill a book in its own right. An inspirational personal account on coping in MS is given in Multiple Sclerosis – a personal exploration by Dr Sandy Burnfield.
Sometimes people ask about the incidence of suicide amongst people with Multiple Sclerosis. Although it is difficult to give precise figures, it does appear that the rate of suicide is higher for people with MS compared with the general population. There may be many reasons for this:

• Depression is associated with a higher rate of suicide – and as we have indicated people with MS have a higher rate of depression.
• There are also many other life crisis-based circumstances that may be linked with suicide whether or not people have MS.
• The consequences of having MS may, however, be linked more with things like general stress, employment problems, and problems with money, family or relationships, than for some other people.
• Also, when people feel a lack of hope for the future, sometimes suicide may seem an option.

In all these circumstances, it is very important that all avenues are explored for help, for through the management of depression and feelings of hopelessness, often situations that seem hopeless at the time are then viewed differently. Psychotherapy and or medication can assist greatly here.
Of course there is a related major debate under way, which is about the extent to which people can, or should be able to end their life if they
wish – if necessary with assistance – if they are acting rationally knowing what they are doing and in full command of all their faculties. Such assistance is currently illegal in Great Britain and a number of recent high profile court cases have confirmed this position. This debate raises considerable emotions on all sides and no doubt will continue to be a matter of great controversy.

Management

As far as depression is concerned, it is important that you seek medical help partly because there are various forms of depression that may require dif ferent kinds of management. It is good that you have recognized that you may need help, because much can be done for you. Initially you may feel that seeking such help is a ‘waste of time’, or indeed carries with it some kind of stigma, similar to what people some- times feel is associated with mental illness or ‘weakness’, but a sensible approach can substantially prevent you feeling miserable and improve your relationships.

Counselling and cognitive behaviour therapy
Depending on the nature of the depression, you may be of fered counselling – and this is increasingly available both in general and hospital practice – or, rather more rarely, psychotherapy in larger and more specialist centres. In certain situations, where it may be helpful to discuss the depression in a family context, family therapy might be offered, although this again is very likely to be at the largest and most specialist centres. It is possible that these more specialist forms of therapy will involve onward referral, for assessment through a psychiatrist, for example. Cognitive behaviour therapy has been found very effective in some people with Multiple Sclerosis.

Drugs
More usually, you may be prescribed one of the antidepressant medications. Until recently, ‘tricyclic antidepressants’ were the most commonly used drugs, such as imipramine (Tofranil), amitryptiline (Elavil) and nortriptyline (Pamelor). However, another family of antidepressants, called ‘serotinergic antidepressants’, is now being prescribed much more regularly, drugs such as fluoxetine (Prozac), for example. These drugs have to be carefully administered and monitored, so it is important to follow medical advice. A combination of counselling and drug therapy may be needed.