A discussion on depression for people living with multiple sclerosis (MS).
Mood Changes and Multiple Sclerosis: Understanding Depression
depression
Ask an MS Expert: Managing Depression and Anxiety
Emotional changes – including depression and anxiety – are common, treatable MS symptoms. Join us for a discussion with Dr. Anthony Feinstein, neuropsychiatrist and professor of psychiatry at the University of Toronto, and host Jon Strum as we discuss strategies and treatments to help you manage these symptoms.
How to recover from depression
Leading depression expert and clinical psychologist Dr Michael Yapko draws on research and shares his insights from 40 years of working with those suffering this common mental health issue. Learn the simple skills that research shows can help you or a loved one to recover – and even prevent depression occurring – in this heartwarming and uplifting speech for the Australian Psychological Society.
How Depression and Pain Are Connected
There’s a very close relationship between pain and depression. You can think of it as Bi-directional meaning that each entity influences the other. Pain worsens or can even cause depression and depression worsens your pain tolerance.
This worsening of your pain is not just your perception because you feel down. Depression increases your sensitivity to pain. So it’s as though you feel pain more intensely when you’re depressed then you would if you were not depressed. This is related to what we call the somatization of depression or the tendency to feel depression in your body. Depression can affect you physically.
Even if you don’t have a pain problem, when you get depressed you can be more sensitive to body sensations and experience them in a negative way. So some depressed people can complain of joint pain, headaches or dizziness. You may feel bloated or constipated. It’s not because depression makes you constipated but when you’re depressed you can get neglect your fluid intake, then have slower moving bowels. Then your mental state magnifies the intensity of the experience.
The second relationship between pain and depression is chronic pain that goes unresolved for months can cause depression. Usually chronic pain is pain that lasts more than three months. What can be done about this? When you have a combination of pain and depression, you have to use different approaches to treat both.
As for non-medication options there is cognitive behavioral therapy that is targeted for pain and depression. The focus is usually on helping you reframe your thoughts around your pain and develop better coping skills to manage the pain. Then there is relaxation training using things like progressive muscle relaxation, mindfulness and yoga. Hypnotherapy is a specialized therapy where therapist gets you into a trancelike state and then speaks positive suggestions about your pain that you internalize and act on. Hypnosis is something you can learn to do yourself.
As for medications, there are 3 types of medications that have been studied to treat both depression, anxiety and pain. These are the serotonin-norepinephrine reuptake inhibitors like duloxetine and venalafaxine; the tricyclic antidepressants like amitryptline and some anticonvulsant mood stabilizers like lamotrigine.
Pilot study suggests promise of new approach to treat adults with autism and depression
Medical University of South Carolina researchers report early findings in Autism Research suggesting transcranial magnetic stimulation is safe and could reduce depressive symptoms in adults with autism and depression.
Medical University of South Carolina researcher Dr. Mark George, a pioneer in transcranial magnetic stimulation, demonstrates the technology. Brennan Wesley, Medical University of South Carolina
In a pilot study in adults with autism and depression, transcranial magnetic stimulation, or TMS, was effective in reducing depressive symptoms and had some effects on autistic symptoms, report researchers at the Medical University of South Carolina in Autism Research. This study suggests that TMS warrants further study as a potential treatment for adults with both depression and autism.
TMS has been used as a therapy for treatment-resistant depression and is a candidate treatment for depressed adults with autism. It uses a magnet placed on the scalp to generate electromagnetic pulses that activate neurons in the brain near the magnet.
The study was performed by a team of MUSC researchers led by M. Frampton Gwynette, M.D., director of the General Psychiatry Clinic, Project Rex and the Autism News Network, and Mark George, M.D., a pioneer in TMS, is the Layton McCurdy Endowed Chair in Psychiatry and director of the Brain Stimulation Lab.
People with autism have challenges with social interactions and communication. For example, they might not make eye contact, or they might hold one-way conversations. They can also have restricted interests, fixating on a singular interest, such as trains, for instance, and everything about them, as well as exhibiting repetitive behaviors, such as rocking or hand flapping when excited.
Such communication challenges can make autism very isolating, according to Gwynette, and render people with autism more prone to depression.
“You’ll see very high rates of major depressive disorder in adults with autism, up to 26-50%,” explained Gwynette. “When they have depression, it tends to be more severe than in typically developing individuals. They’re also more likely to have suicidal ideation and more likely to attempt suicide. In addition, their depression is more likely to be refractory to treatment.”
In Gwynette’s experience, depressive symptoms can in turn make autism symptoms more challenging.
“We’re really swimming upstream trying to treat this group,” said Gwynette. “We also know that our standard antidepressant medications are not as effective or as well-tolerated in adults with autism because they’re prone to irritability. Sometimes, the antidepressants can make their autism symptoms worse, so it’s a really difficult thing to treat.”
No treatments for core autism symptoms have been approved by the Food and Drug Administration, so new therapies to treat patients with both autism and depression are urgently needed.
In the study, the researchers recruited 13 adults ages 18-65 with depression and autism to participate in 25 daily TMS treatments. The treatments targeted the left dorsolateral prefrontal cortex, a brain region associated with depression.
After treatment, 70% of participants had a decrease in depressive symptoms, and 40% experienced remission. No changes were seen in self-reported autism symptoms. However, people who knew the participants detected decreases in repetitive behaviors, hyperactivity and irritability.
Overall, the repetitive TMS treatments were well-tolerated, with two participants withdrawing due to anxiety or irritability. Side effects included fatigue, headache and scalp discomfort.
Limitations of the study included its small number of participants and the fact that all participants received the treatment and knew about the treatment. Further conclusions will need to be derived from larger studies that randomize patients to either TMS or a sham intervention and “blind” them as to which treatment group they are assigned.
This study provides early evidence that TMS is safe for treating adults with autism and depression and shows promise in treating depression. These findings will need to be confirmed in future studies. More studies are also needed to elucidate the role of TMS in treating autism symptoms.
George and Gwynette are both optimistic about the future role of TMS in patients with autism and depression and eager to see the results of the next round of studies.
“Daily left prefrontal TMS, as we used in this study, appears to treat not just pure depression but also depression arising in the setting of autism and other disorders like Alzheimer’s,” said George. “These are promising results. I’m particularly intrigued by the improvements not just in depressive symptoms but also in other symptoms in the autism spectrum. That was unexpected. The true answer will come with a double-blind trial.”
“I’m optimistic, as an autism specialist, that TMS will have a role in treating mental and comorbid conditions that come along with autism but also autism itself,” said Gwynette.