Professional Documents
Culture Documents
1
Understanding and Overcoming Depression in Multiple Sclerosis
2
We feel sad when we experience a loss or more of the following symptoms must be
or tragedy – and this feeling is usually an present for at least a two-week period
appropriate reaction to the situation that (these symptoms are generally reported by
has occurred. Feeling sad is a natural either the patient or a family member who
coping skill that is required for growth observes the patient):
and maturity. Experiencing sadness helps
us to move through painful events. 1. A depressed mood for most of
When sadness manifests itself physically the day, nearly every day
we may feel tension in our chest, or our 2. Loss of interest or pleasure in
hearts may ache. We may also experience all, or almost all, activities for
an overwhelming desire to cry; and some most of the day
are strongly compelled to talk with others 3. Significant change in weight or
about their sorrow. After expressing and appetite
letting out our emotions, we normally 4. Insomnia or excessive sleepiness
begin to feel a sense of relief. Unlike 5. Observable agitation or lethargy
depression, sadness typically passes 6. Fatigue and loss of energy, nearly
within a few days and one begins to every day
embrace life again, enjoying normal 7. Feelings of worthlessness, low
daily activities. self-esteem, or excessive guilt
In contrast to sadness, depression can 8. Difficulty concentrating or
seemingly come from “out of the blue,” indecisiveness
and can last much longer. Someone may 9. Recurrent thoughts of death
not even realize that he or she is depressed, or suicide
and pinpointing any specific trigger for
the depression can be difficult. Additional symptoms may also be
Different types of clinical depression present, but these are not typically
have been identified. The first, which is considered when making a diagnosis.
commonly talked about, is “major depres- Among others, these can include: a
sive disorder” (also known as “major de- reduced interest in personal appearance
pression”). According to the Diagnostic and hygiene; complaints of aches and
and Statistical Manual of Mental Disorders pains, with the worry of these symptoms
(DSM-IV), physicians will look for specific being an indication of a serious health
criteria when diagnosing a major depres- problem or disease; an increased sensitivity
sive episode. These criteria dictate that five to noise; and bouts of crying or sobbing.
3
Understanding and Overcoming Depression in Multiple Sclerosis
4
In general, the symptoms of depression needed to make an accurate diagnosis
can be divided into three categories: phys- of depression for an individual with MS.
ical, emotional, and mental. The physical One of the most commonly used tools
symptoms include fatigue, poor appetite, for diagnosing and evaluating depression
insomnia, and agitation. The emotional is the Beck Depression Inventory (BDI,
symptoms include feelings of hopeless- BDI-II), which is a questionnaire aimed at
ness, depressed mood, low self-esteem, measuring the severity of one’s depression.
guilt, and worthlessness. The mental The 21 multiple-choice questions allow
symptoms include poor concentration, adult patients to report on their depressive
indecisiveness, and for some, thoughts of symptoms. Topics include: physical
death or suicide. The severity of depression symptoms such as fatigue, loss of libido,
can vary from mild to moderate to severe. and loss of weight; emotional symptoms,
Regardless of how severe one’s depression such as hopelessness and irritability; as
may be, it still affects us on all three levels: well as mental (or cognitive) symptoms,
physically, emotionally, and mentally. reflecting any negative thoughts about
In all types of depression, symptoms the world, oneself, or the future.
typically impair daily functioning such The BDI is named after its creator,
as our ability to work or take care of Dr. Aaron T. Beck, and was first developed
household responsibilities. Doing simple in 1961. The questionnaire was revised in
tasks such as bathing or cooking a meal 1971 (BDI-1A), and has since been revised
can seem overwhelming. again in 1996 (BDI-II). All versions of
You may recognize several depressive this inventory for depression translate the
symptoms that are also symptoms of MS. degree of severity into specific numbers
Examples of shared symptoms include from one to three for each symptom.
fatigue, insomnia or excessive sleepiness, The self-reported ratings are added
and cognitive difficulties, as well as rest- together to determine a total score, which
lessness or slowing down. Because many gives physicians an exact number for the
of these symptoms mimic typical MS evaluation of a patient’s depression.
symptoms, they may not necessarily The Goldman Consensus Group
indicate depression for someone with MS. (a panel of experts who reviewed the
The similarities in symptoms do in fact issue of depression in MS) recommends
make diagnosing depression challenging that individuals with MS be routinely
in MS patients. A trained professional who screened for depression using a tool
is familiar with both MS and depression is such as the BDI. They also recommend
5
Understanding and Overcoming Depression in Multiple Sclerosis
6
One reason that fewer men are diag- predictors of suicidal intent in those
nosed with depression might be because with MS include:
they are less likely than women to seek
appropriate treatment. As a result, they 1. Severity of depression
are more likely to self-medicate with 2. Abuse of alcohol
drugs and alcohol, or develop a gambling 3. Living alone
addiction, rather than seek the help of a
therapist and take prescribed antidepres- In addition, a family history of mental
sants. Depressive symptoms for men may illness, higher perceived levels of social
present as irritability or anger; for men stress, and anxiety also contribute to suicidal
who do seek therapy, these symptoms may intent. Although fewer men are diagnosed
be mistakenly treated as the primary issues, with depression, they are four times more
rather than the underlying depression. likely to commit suicide than women.
Those who have a predisposition to In a study of individuals with MS
depression prior to their MS diagnosis who had suicidal intent, one-third had not
may be at an even higher risk for depres- received any psychological help and two-
sion. Depressive disorders are one-and-a- thirds (all suicidal and with major depres-
half to three times more common among sion) had not received any anti-depression
those whose parents suffered from de- medication. This research clearly points
pression. Furthermore, other factors such to the importance of seeking treatment for
as a chronic medical condition, lack of so- depression. When treatment is sought,
cial supports, and substance dependence, the risk of suicide drops considerably.
may also contribute to the onset of depres-
sion. Understanding these risk factors, Family Relationships are Often Affected
recognizing depressive symptoms, and Similar to the way in which MS affects
seeking treatment, may play a significant the family, depression also has a strong
role with improving one’s quality of life, impact on relationships. Family members
and possibly prevent potential thoughts will often say that they can handle the pa-
of suicide. tient’s physical MS symptoms, but they
cannot deal with his or her depression.
Depression’s Impact Others may feel helpless as they watch a
Increased Risk of Suicide loved one succumb to the grips of depres-
Suicide is one of the leading causes of sion. Sometimes family members believe
death among MS patients. The primary that they are somehow the cause of their
7
Understanding and Overcoming Depression in Multiple Sclerosis
8
Treatment Compliance and lack of interest in physical relationships.
Health May be Affected When someone is feeling tired, with-
Depression can compromise one’s drawn, or unlovable, he or she is much
willpower to follow his or her MS treatment less likely to be interested in physical inti-
plan. Even simple activities, such as getting macy. Naturally, this has a negative impact
out of bed in the morning, may become dif- on relationships. Loved ones will often feel
ficult. Bigger tasks, such as getting to a rejected and unwanted when their partner
doctor’s appointment, may feel impossible. withdraws from them sexually.
Following a treatment plan for MS Since 25 to 50 percent of men and 50
includes taking medication on a regular percent of women with MS report having
basis. Taking the correct dosage at the some type of sexual dysfunction, depres-
scheduled times, especially with respect to sion only makes matters worse. However,
injections, requires determination, discipline, these sexual issues can often be resolved
and motivation. All of these traits are when the underlying depression is treated.
compromised when a patient is depressed. Some worry that antidepressants may
Other wellness strategies, such as following decrease their sexual desire, however,
an exercise program, eating well, partici- medications have been improved over
pating in support groups, and staying the years and this has become less of an
involved with positive people, may also fall issue. Anyone taking a medication and
by the wayside during depressive episodes. experiencing reduced libido should
Additionally, studies show that discuss the situation with a medical
depression has been linked to many physi- professional. He or she may be able to
cal ailments. These can include (but are not adjust the prescription to minimize or
limited to) such symptoms as: a lowered eliminate this potential side effect.
immune response, which could make
someone more susceptible to colds and Less Participation in Social Activities
flu; an increased sensation of pain; mental Depression often causes people to
and physical fatigue; weight gain or loss turn inward, withdrawing from family and
(according to changes in appetite and be- friends, and declining to take part in social
havior); and an increased sensitivity to noise. activities. The thought of picking up
the phone to call a friend or to hold a
Loss of Libido conversation can seem overwhelming for
One of the chief complaints among someone who is depressed. As a result,
individuals experiencing depression is a individuals with depression will often
9
Understanding and Overcoming Depression in Multiple Sclerosis
Losses in Employment
Although many mildly to moderately
depressed patients are able to continue
COMMIT TO TIP working, individuals who are severely
#4 depressed may have great difficulty going
ONE ACTIVITY to the workplace, let alone being productive
EACH WEEK while there. In fact, the Journal of the
Being accountable to a group American Medical Association estimates
can be a motivator to change the annual cost of depression in the
United States is $43 billion. Of that,
one’s environment and get
$23 billion is lost through absenteeism
social support – which can
or loss of productivity in the workplace.
ultimately be uplifting. For the depressed individual with MS, the
loss of employment and insurance benefits
discontinue social activities and commit can have a devastating long-term impact.
ments. Friends may eventually become
discouraged and stop calling to urge the Depression is Under-Reported
depressed patient to join them. and Under-Treated
Severely depressed people may feel Despite all of the devastating implications
that they have very little to give others, as of depression, this disease is still too often
they are often using all of their energy just under-reported, and as a consequence,
to make it through the next few minutes. under-treated. Several factors contribute
The net result is that support systems tend to this urgent situation.
10
One obstacle is the fact that depres- disease, educating patients, evaluating
sion, along with other psychological is- treatment approaches, managing
sues, is less tangible, especially given the medications, and making referrals to
relatively short times that a patient spends other specialists. With all of the things
with his or her physician. Typically, both a doctor must do, one can easily under-
healthcare providers and patients may stand how a problem like depression
feel more comfortable discussing physical may be overlooked.
MS symptoms (which are easier to In addition, individuals – including
observe and evaluate), while ignoring MS patients – may not recognize the
the less obvious (and more sensitive) symptoms of depression, particularly if
psychological issues. they are experiencing irritation and anger,
This issue is further complicated rather than the more common emotion
by the demands placed on practitioners of a depressed mood. Some patients may
during a typical office visit. Most practi- automatically assume that their feelings
tioners have good intentions, but they are of depression are MS symptoms, and that
challenged during office visits to complete they must simply live with the sadness
a multitude of tasks. These include and other negative emotions. Finally,
answering patients’ questions, listening to some patients may not realize that
their concerns, managing MS symptoms, treatments are available for depression,
tracking changes in the course of the so they do not pursue the issue.
JOURNAL
TIP
#5 YOUR
FEELINGS
Take time to write
down your feelings.
This is a very safe
outlet to release
negative thoughts
that may be building
up inside.
11
Understanding and Overcoming Depression in Multiple Sclerosis
12
Additionally, recent research shows Physiological Causes
that depression may be experienced during Damage to the central nervous
disease activity. Three predictors strongly system caused by physiological changes
correlate to the level of depression the may impact mood. In some cases,
patient experiences. These include: depression is thought to be caused by
lesions in the right frontal and temporal
1. Present state of illness (if lobes of the brain.
the individual is currently The authors of Comprehensive Nursing
experiencing an exacerbation) Care in Multiple Sclerosis (second edition,
2. Level of uncertainty about new edited by J. Halper and N.J. Holland,
symptoms and the future Demos Medical Publishing, 2002) note,
3. Poor coping skills such as “Both clinical depression and less severe
“emotion-centered” and “escape- emotional distress are common in MS…
avoidance” reactions, rather than [occurring at] a rate much higher than
constructive problem solving in the general population or in other
conditions with similar disabilities, e.g.,
The uncertainty a patient experiences spinal cord injury. In fact, the very high
during an exacerbation strongly influences frequency of depression in MS has led
the level of depression that may result. many to theorize that it may be due in
During the course of MS, people can feel part to damage to parts of the brain con-
as if they have lost control not only of their cerned with the regulation of emotions.”
bodies, but their thoughts and feelings as
well. Healthcare providers may be able to Chemical Changes
reduce the level of depression that patients Chemical changes that occur within
experience by offering reassurance, the body and the brain can affect mood.
answering questions, and working to For instance, studies find that the expres-
reduce uncertainty whenever possible. sion of interferon-gamma (IFN-gamma)
Focusing on what the patient still has and other Th 1-type cytokines (pro-inflam-
control over can also help to reduce the matory protein molecules involved in cell-
feelings of depression. Studies show that to-cell communications, shown to worsen
when individuals have the perception that MS) correlate with depression scores dur-
they can influence their environment, ing an acute exacerbation. Another study
they feel a greater sense of engagement, showed that the level of depression, as
energy, and happiness. well as IFN-gamma production, declined
13
Understanding and Overcoming Depression in Multiple Sclerosis
Fatigue
Patients report that fatigue is the most
disabling of all their MS symptoms. Between
75 and 90 percent of the MS population
14
Downs of Multiple Sclerosis (Hunter House connection between these drugs and
Inc., 2006), can help give you a structured depression.
way to begin monitoring causes of your While this news is encouraging, the
fatigue. interferons have been shown to decrease
the amount of serotonin formed in the
Medication Side Effects brain. Decreased levels of this chemical
Some of the medications prescribed in the brain may be linked to depression.
to MS patients may be linked to depres- Therefore, individuals who are taking an
sion. Steroids top the list. These are interferon and experience a change in
often prescribed during exacerbations their emotional state, are advised to talk
when patients are already vulnerable to with their doctor immediately.
depressive symptoms. Steroids tend to Other medications given for MS
induce a short-term euphoric “steroid high” symptom management may also cause
when first given, followed by a plunge depression. These include: baclofen,
into depression once the medication prescribed for spasticity; benzodiazepines,
is stopped. taken for dizziness, vertigo, or spasticity;
Some neurologists recognize the and other sedating drugs. When taking
emotional roller-coaster which steroids any of these medications, patients, family
can cause and they are prescribing members, and the treating physician
medications to lessen the emotional should closely monitor any changes
effects often associated with the treatment. in mood, watching for the signs of
These might include anti-anxiety and depression listed earlier.
antidepressant drugs given prior to
starting a steroid treatment. Other Factors Increasing
Many relapsing-remitting MS Susceptibility to Depression
patients are now taking interferons In addition to the potential causes
(Avonex®, Betaseron®, and Rebif®) to of depression already mentioned, other
help slow the progression of MS and factors can make a person more vulnerable
reduce the number of attacks. Anecdotal to depressive episodes. By being aware of
reports suggest a possible association these situations, you can be extra sensitive
between this type of immunotherapy and to your mood changes during these high
increased depression. Recent follow-up risk times and seek treatment if you
studies, including data from SPECTRIMS notice yourself slipping into a depressive
and PRISMS trials, failed to show a episode before it becomes too severe.
15
Understanding and Overcoming Depression in Multiple Sclerosis
16
1. Vacation in a sunny location Low Self-Esteem
2. Spend at least a half-hour Many people with chronic illness face
outdoors challenges to their self-esteem. We may
3. Use some type of bright contend with issues such as poor body
visible-spectrum light image, fewer social activities and friends,
4. Talk with your doctor about and the loss of a job or other responsibilities
your concerns and learn about that made us feel worthy in the past.
additional strategies As our abilities change, we may begin
to see ourselves as less valuable to both
Changing Medications ourselves and others.
Frequently when changing medications, Feelings of low self-esteem can lead to
one’s mood is initially feelings of worthless-
impacted. A few ness and guilt – which
weeks may be needed The responsibility is on each can in turn lead to
to adjust to the new of us to find ways that we can depression. One of
chemicals in your still contribute our talents the tasks that all
body. Informing your and skills, regardless of the people with MS must
doctor of any mood changes that have taken achieve in order to
changes when on a maintain mental health
place within our bodies.
new medication is im- is the reinvention of
portant to the success a worthy self; despite
of a treatment as well as one’s wellbeing. physical disability.
The responsibility is on each of us
Other Physical Conditions to find ways that we can still contribute
One should not automatically assume our talents and skills, regardless of the
that depression is caused by his or her changes that have taken place within our
MS. Individuals need to work with their bodies. Fortunately, we get to choose our
doctor to rule out any other medical or self-image. This means that regardless of
physical issues that may be contributing what our abilities are or how they change,
to depression. Hormone or thyroid prob- we can consciously decide to adjust our
lems, changes in blood-sugar levels, and expectations of ourselves and, in turn,
urinary tract or other infections, are adjust what we value about ourselves.
among the types of medical conditions One positive way to combat low
aside from MS that can cause depression. self-esteem as well as depression is to
17
Understanding and Overcoming Depression in Multiple Sclerosis
18
patients report experiencing side effects symptoms, again consult with your doctor
when taking these medications. Common about adjusting your dose or switching to
side effects may include headache, another medication.
nausea, sleeplessness, anxiety, drowsiness, Some patients find that monitoring
and sexual dysfunction. These side effects their treatment progress by keeping a
may subside with time, or one’s doctor log of their symptoms is helpful. Since
may adjust the prescription or dosage. improvements may be gradual, this can
Newer antidepressants include “serotonin be an effective way of documenting any
and norepinephrine reuptake inhibitors” changes you see in your mood. Sugges-
(SNRIs), such as Cymbalta® and tions include noting changes in appetite,
Effexor®, with side effects that are energy, interest in activities, increases in
similar to the SSRIs.
Other drugs which are not SSRIs
(belonging to other drug classes), such
as Desyrel®, Remeron®, Serzone®, and
Wellbutrin®, are options which may result
in fewer side effects. Numerous other
drugs are also FDA-approved for the
treatment of depression, many of which
either augment another antidepressant,
or are used to treat specific behaviors
found in various types of depression –
including anxiety, mood swings, manic TIP REWARD
episodes, insomnia, and excessive eating #9
(among others). The key is to work YOURSELF
closely with your treating physician and Do something that makes
therapist to determine the correct drug
you feel good. Ideas include
and dosage that will work best for you.
getting a massage, renting your
When starting a prescribed treatment
for depression, understanding that many
favorite DVD, spending time
of these drugs can take up to six weeks at the park, enjoying a delicious
before reaching maximum effectiveness meal, and reading a great book,
is important. If after six weeks you are just to name a few.
not seeing any improvement in your
19
Understanding and Overcoming Depression in Multiple Sclerosis
20
health providers. MS organizations, The Interview Process
support group participants, and/or friends Ideally, patients should have the
and family may also be able to offer recom- opportunity to interview potential therapists,
mendations. Understanding the differences just as they would when selecting other
between the types of professionals that members of their medical team. As an
offer counseling services is helpful as you empowered patient, you have the right to
begin the selection process. choose who treats you and to understand
21
Understanding and Overcoming Depression in Multiple Sclerosis
his or her treatment philosophy. If you These questions will help give you
don’t click with the first person you speak the facts, but how you feel about the
with, meeting with more than one provider therapist at a “gut level” is the most
is reasonable when making this important important consideration. Does he or
decision. Some of the questions you might she listen to you? Do you feel that he or
consider asking include: she cares about your concerns? Do you
feel comfortable with the therapist?
1. Do you have experience working Does the therapist understand issues
with MS patients? relating to chronic illness? The questions
2. What is your success rate in you ask, along with a certain amount of
treating depression? intuition, will help guide you toward the
3. What is your psychological right match.
treatment approach? Once connected with the right thera-
4. What are your office hours? pist, a relationship can be established.
5. Do you work closely with physicians? This may ultimately help you to feel
6. How do you feel about using less alone as you gain a greater
medications to treat depression? understanding of your emotions and
7. Are your services covered by my how to feel better again.
insurance?
ADOPT A PET
TIP Although a pet
# 10 can be hard work
initially, owning a pet
can help to take one’s
attention away from
his or her despair.
Pets provide the
unconditional love
that is so desperately
needed during
depressive episodes.
22
Financial Considerations
Therapy can be expensive. Fees can
range from $60 to more than $200 per
hour, depending on where the patient
lives and the professional credentials of
the practitioner. If the patient has medical
insurance, the insurer should be con-
tacted directly to determine if any of the
costs are covered for the specific therapist
selected. Questions to ask the insurer in-
clude: what is the yearly deductible, how
TIP
much will the company pay per visit, and CREATE A # 11
how many visits are allowed each year. GRATITUDE LIST
If finances are an obstacle to treatment,
By consciously taking the time to
other options may be available. Individuals
shift the focus from all that is
may talk with their church, the city or
county public health department, social
going wrong, to all that is going
service agencies, or an MS organization, right in your life, you can create
to see if any of these agencies have pro- moments of pleasure.
grams which provide financial assistance
and/or low-cost counseling. Some thera- resolve problems through verbal ex-
pists offer a sliding-scale fee based on change with a therapist; (2) “behavioral
income. If the patient has Medicare or therapy,” which helps an individual find
Medicaid, a mental health benefit may reinforcement through rewards based on
be available to pay for therapy. Exploring his or her own actions; (3) “interpersonal
these avenues can sometimes uncover therapy,” which concentrates on issues
more affordable options. arising in relationships with others; (4)
“cognitive/behavioral therapy,” which
Types of Therapeutic works to change negative ways of think-
Approaches ing and acting into more positive ap-
A variety of therapeutic approaches proaches; and (5) “psychodynamic
may be used during the counseling therapy,” which helps to resolve internal
process. These include: (1) “talk therapy,” conflicting feelings, often stemming from
which helps the patient gain insight and past experiences.
23
Understanding and Overcoming Depression in Multiple Sclerosis
24
TIP
MAINTAIN A
# 12 SENSE OF HUMOR
Laughing provides therapeutic
value – even consciously smiling
can help one feel better. You may
cheer up by going to a comedy club,
renting funny movies, and spending
time with someone who makes you
laugh. People shouldn’t always take
themselves too seriously.
If the patient agrees to the idea, you she continues to take the drug(s). If you
may want to accompany your loved one to notice a change in personality after starting
the doctor’s office to discuss the changes the medication, either positive or nega-
you have seen and to obtain a referral for tive, talk with the patient and physician
a therapist. This can help get the ball about those changes.
rolling. You may also offer to attend the Finally, living with a depressed person
first therapy appointment with the patient. can be extremely challenging, and quite
Let him or her know that you will provide frankly, depressing at times. Care partners
support in any way you can as he or she (family or friends helping with the care
seeks treatment. of a patient) need to be sure to take care
Patients may be encouraged to participate of themselves. As a care partner, you
in activities, helping to draw them out of should try to keep balance in your life
their depressed state. Family and friends and to do the things that bring you
may make plans for social activities, inviting pleasure. If experiencing depressive
their loved one to come along. Provide symptoms, a care partner should also
these individuals with opportunities to do seek professional help.
the things that they previously enjoyed.
Let them know that you love them, no Immediate Positive Steps
matter how depressed they may feel. While these tips have been highlighted
If your family member is prescribed throughout this booklet, to follow is a
medication, help to make sure that he or summary of these important positive
25
Understanding and Overcoming Depression in Multiple Sclerosis
26
Resources for More Information Mental Health America
The resources to follow offer support, Formerly known as National Mental
advocacy, and information about depression Health Association (NMHA)
(the first three can provide specifics on Phone: (800) 969-6642 or (703) 684-7722
depression and MS). Many of these resources TTY: (800) 433-5959
can assist with locating a mental health Website: www.nmha.org
professional and treatment center in your area.
National Alliance on Mental Illness
Multiple Sclerosis Association of America Phone: (800) 950-6264 or (703) 524-7600
Helpline: (800) 532-7667 Website: www.nami.org
Website: www.msassociation.org
National Institute of Mental Health
Multiple Sclerosis Foundation Information Resources and Inquiries Branch
Phone: (888) 673-6287 Phone: (866) 615-6464 or (301) 443-4513
Website: www.msfacts.org TTY: (301) 443-8431 or (866) 415-8051
Website: www.nimh.nih.gov
National Multiple Sclerosis Society
Phone: (800) 344-4867
Website: www.nmss.org Suicide Hotline and Website
National Suicide Prevention Lifeline
Phone: (800) 273-8255
Association for Applied Psychophysiology
and Biofeedback SuicideHotlines.com
Phone: (800) 477-8892 or (303) 422-8436 www.suicidehotlines.com
Website: www.aapb.org Website visitors may scroll down to select the
state where they live to find local CONTACT
Depression and Bipolar Support Alliance and crisis hotlines.
Phone: (800) 826-3632 or (312) 642-0049
Website: www.DBSAlliance.org
Recommended Reading
Families for Depression Awareness Allen J.G., Coping with Depression: From
Phone: (781) 890-0220 Catch-22 to Hope, American Psychiatric
Website: www.familyaware.org Publishing, 2005.
International Foundation for Research Burns D.D., Feeling Good: The New Mood
and Education on Depression (iFred) Therapy, Avon Books, 1999.
Phone: (410) 268-0044
Website: www.depression.org or DePaulo J.R., How to Cope with Depression,
www.ifred.org Ballantine Books, 1996.
27
Understanding and Overcoming Depression in Multiple Sclerosis
Henry A.D., et al, Parenting Well When You’re Halper J. and Holland, N.J., Comprehensive
Depressed: A Complete Resource for Maintain- Nursing Care in Multiple Sclerosis (second
ing a Healthy Family, New Harbinger Publica- edition), Demos Medical Publishing, 2002.
tions, 2001.
Harvard Mental Health Letter, Sept. 2004.
Kbat-Zinn J., Full Catastrophe Living, Bantam
Dell Publishing, 1990. Jablow M.M., “On: depression and MS,”
revised from InsideMS, Vol. 11, No. 3,
Naparstek B., Staying Well with Guided National Multiple Sclerosis Society magazine.
Imagery, Warner Books, 1994.
Kohn A., “Beyond selfishness,” Psychology
Shadday A., MS and Your Feelings: Handling Today, October 1988.
the Ups and Downs of Multiple Sclerosis,
Hunter House Publishers, 2006. Mann J., “The neurobiology of suicide,”
Lifesavers, 10, no. 4 (1998).
Solomon A., The Noonday Demon: An Atlas of
Depression, Simon & Schuster, 2001. Ratliff C., “Mental health in children of
parents with MS,” Multiple Sclerosis
Foundation’s MSFocus magazine, Vol. 9,
References Used for This Booklet Issue 1, Winter 2007.
American Psychiatric Association, Diagnostic
and Statistical Manual of Mental Disorders, Scelfo J., “Men & depression: facing
Fourth Edition, DSM-IV, 1994. darkness,” Newsweek, February 26, 2007.
Courtney S.W., “Recognizing, understanding, Schapiro R.T., et al, “Sexuality and MS,”
and treating depression,” Multiple Sclerosis web article previously found at:
Association of America’s magazine, www.bluelf.com/ms/msi_sex 1.html, 2005.
The Motivator, Winter 2003, pp. 9-21.
“The changing rate of major depression,”
Depression and Multiple Sclerosis, National Journal of the American Medical Association
Multiple Sclerosis Society brochure, 2003. 268, no. 21, 1992.
Haidt J., The Happiness Hypothesis: Finding Various statistics and definitions confirmed
the Modern Truth in Ancient Wisdom, pg. 93, through: Depression and Bipolar Support
Basic Books, 2006. Alliance; National Institute of Mental Health;
United States Department of Health & Human
Services; and WebMD.
28
This booklet was made possible
through a generous grant from
The Horizon Foundation for
New Jersey. The staff and Board
members of MSAA would like
to express much appreciation
for this kind and purposeful gift.
The mission of the Multiple Sclerosis Association of America (MSAA) is to enrich the
quality of life for everyone affected by multiple sclerosis. MSAA accomplishes its mission
by offering many vital programs and services to members of the MS community.
MSAA’s free programs and services include: toll-free telephone Helpline with trained
consultants (English and Spanish); MSAA publications; Equipment Distribution Program;
Cooling Equipment Distribution Program; MRI Institute and MRI Diagnostic Fund; Barrier-
Free Housing Program; regional events and activities; Networking Program; Lending
Library; and other programs. Please call the Helpline at (800) 532-7667 or visit
MSAA’s website at www.msassociation.org for information and assistance.
Help or support to MSAA in any way is truly appreciated. To inquire about volunteering,
fundraising, or making donations, please contact MSAA at (800) 532-7667 or visit
MSAA’s website at www.msassociation.org for information and assistance.
National Headquarters
706 Haddonfield Road, Cherry Hill, New Jersey 08002
Phone: (800) 532-7667 • Fax: (856) 661-9797
Website: www.msassociation.org • Email: msaa@msassociation.org