Being diagnosed with MS is a stressful, life changing event that carries with it the inevitable emotions of shock and disbelief. These feelings can then give way to anger and possibly denial. However, after a person has come to terms with being diagnosed and worked through these initial feelings, a certain hopelessness can kick in. It is hard to say goodbye to your 'normal' life and accept that this is the way it is going to be from now on. It's demoralising to live with debilitating symptoms every day without seeing any signs of improvement. Being stuck in this negative emotional cycle can lead to depression.
Depression is a common symptom of MS. In fact, more than half of people with MS will be diagnosed with depression at some point in their illness. Another study found that one in four people with MS have unrecognised and undiagnosed symptoms of depression. This is dangerous because depression can make MS progress more quickly if left unchecked.
Dr. Jelinek states in his book 'Overcoming MS' that the single most important factor in determining the quality of life of people with MS is the presence or absence of depression, not disability or fatigue. Therefore, recognising and dealing with depression is of paramount importance for those with MS. The great thing is that just a few lifestyle changes can make all the difference but the first step is recognising this monster.
How Do I Know if I'm Depressed?
It's important to make the distinction between true depression and feeling upset because perhaps something has gone wrong for you. Maybe you would really like travel more but can't afford it right now. You may state that you are 'depressed' about this. You could have lost your job or you may just be having one of those days where everything goes wrong. This may make you feel frustrated or down in the dumps. But, within a few days you are back to your cheery self, enjoying life again. These emotional ups and downs are normal and do not mean that you are clinically depressed.
Symptoms of Depression
It becomes apparent that someone has true depression when they experience feelings of hopelessness, sadness or loss of interest in normal activities that persist for at least two weeks.
The Mild - Severe Continuum
Depression exists on a continuum and can range from mild to severe. Mild depression may involve some of the following symptoms but to a much lesser extent than clinical depression. It is usually treatable without medication and is responsive to lifestyle measures such as exercise, healthy food and good sleep. This is probably the most common form of depression in people with MS.
Major depression, however, is more intense and often involves a neurotransmitter imbalance in the brain which requires medication. To be diagnosed with major depression, the person must be experiencing at least five out of the following eight symptoms:
- Depressed mood (feeling blue, down-in-the-dumps, hopeless)
- A significantly reduced level of interest or pleasure in most or all activities
- Considerable weight loss or gain (5% or more change of weight in a month when not dieting) or change in appetite
- Frequent thoughts of death or suicide (with or without a specific plan) or attempt of suicide
- Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia)
- Behavior that’s agitated or slowed down, which is readily observable by others
- Feeling fatigued or very low energy
- Having thoughts of worthlessness or extreme guilt
- A diminished ability to think, concentrate, or make decisions
Studies have suggested that clinical depression, the severest form of depression, is more frequent among people with MS than it is in the general population or in persons with other chronic, disabling conditions.
Avoiding and treating depression is vital in the management of MS. It's all about finding ways to stop the negative cycle you are caught in and discovering healthier ways to deal with the emotions. If you feel that you may have clinical depression, it is best to book an appointment with your doctor immediately. Medication may be needed to get you out of the deep, dark hole you are in. However, all of the suggestions below will help and work in conjunction with the medication. They will also make it easier for you to come off the meds. Here are six lifestyle strategies for overcoming MS related depression.
1. Find Quiet Time for YOU
It is vital that you find some space and time to clear your mind and just rest. This should not involve watching TV or movies and should preferably not be in a busy public place. Being outdoors, in a beautiful garden or park, is a good place to clear your head and sort through your thoughts and feelings.
When you are depressed, your mind is clouded and bogged down by the myriad of things that are going on around and inside you. You just need a little serenity, once a day, to put all of that into perspective and to mull over some strategies to climb out of the hole you find yourself in. If you're a Mom, it can be difficult to find time away from your children and family responsibilities. You need to be deliberate about asking for help so that you can get some quiet time.
2. Exercise - The Positive Cycle Starter
Getting your blood pumping regularly does wonders for your mood and general outlook on life. Your body loves it and this has a remarkable effect on your mind. I always say that exercise starts a positive, healthy cycle of behaviour. Against all odds, you finally get to the gym or the park. Once you get going you realise that it's not as bad as you thought it was going be -it's actually really quite wonderful. You feel alive and focused and you're able to sort through issues that have been plaguing your mind as you cycle, power walk or run. Those 'feel good' endorphins start to flow which lets a little bit of light into your dark hole. Endorphins improve natural immunity and reduce the perception of pain. They may also serve to improve mood.
You get home feeling a little less down and a little more in control. This leads to other healthy behaviours such as eating well and making good decisions about time commitments, bed times and other behaviours. You start to feel more positive about yourself and your self image and confidence begin to improve. This, in turn increases the possibility that you will exercise again quite soon! Hence, the start of a healthy cycle. With each successive cycle you should start feeling more like your normal self again.
A study published in 2005 found that walking fast for about 35 minutes a day, five times a week or 60 minutes a day, three times a week, had a significant influence on mild to moderate symptoms of depression. Interestingly, walking fast for only 15 minutes a day five times a week or doing stretching exercises three times a week did not help as much.
3. Cleanse the Body & Eat Healthily
When you're depressed and feeling down, this can have a big impact on your appetite and food choices. Whilst some depressed people eat very little, many eat too much of the wrong kinds of food. Comfort food helps 'in the moment' but can actually worsen depression in the long run. This kind of food is usually high in saturated fat, sugar, salt and preservatives which means that your body is probably stockpiling toxins. It is also pro-inflammatory and will definitely increase your MS symptoms and your chances of having future relapses. An unhealthy body will make you feel sluggish, decrease your mental clarity and increase your feelings of depression.
Eating raw food gives your body a chance to get rid of some of those toxins. It is highly cleansing and will help to clean out any junk that is clogging your gut. It's amazing what a clean gut can do for the mind! I definitely feel down when I feel that my gut is unhealthy. Whereas, I feel so much more in control and emotionally stable when I feel clean on the inside! Raw food is also exceptionally healing with all its antioxidants and anti-inflammatory compounds. Fabulous MS nutrition.
Gluten, by itself, could actually be the cause of your down feelings. If you have a sensitivity to it, it could be the cause of your symptoms of depression. Gluten can bring on lethargy, mental fogginess, frustration and irritability. Many people feel like a blanket has been lifted off their heads once they stop eating gluten. When I look back on my gluten eating years, there were times when I really felt down, without any obvious reason. I'm pretty sure these were, what I call, gluten-related depressive episodes. There are so many wonderful gluten-free options so, you needn't miss out on your favourite dishes. Have a look at my post on going gluten-free for more info.
Sugar is one of those trigger foods that can start a negative cycle and send you spiralling down into a hole very quickly indeed. Following on from my last post on sugar, this refined substance not only has a negative impact on the body but can seriously affect your mind and emotions. I mentioned that refined sugar definitely causes a mood change in me. I'm suddenly short tempered with the children, irritable with my husband and I don't feel good about myself. This starts a downward spiral which inevitably leads to eating more sugar and more 'down' emotions. It seriously needs to be avoided if you're going to get out of depression or prevent yourself from going in that direction.
4. Increase Omega 3's
Omega 3 fatty acids have a key part to play in preventing and treating depression. These amazing healthy fats help to keep the immune system functioning and cell membranes strong and flexible. They also help keep the myelin sheath of nerves healthy. All in all, omega 3s have a protective effect against stress and keep the brain functioning optimally. Studies comparing different populations have found that countries, where fish forms a major part of the diet, have lower rates of depression than countries where fish is not as highly consumed. I recommend eating fish a few times a week and taking flaxseed oil as a supplement every day. These are all essential elements of the ms diet.
5. Vitamin D
We already know that Vitamin D is a requirement for the successful management of MS symptoms. However, it is also vital for preventing or treating depression. To get enough vitamin D and keep your levels high there are two things you can do. Firstly, spend 20-30 minutes in the sun each day with most of your body uncovered (no sun screen so choose a time of the day when the sun is less harsh). Secondly, find good vitamin D supplement and take 5000-10000iu each day.
6. Do Something You Love Every Week
Some of you may have forgotten what makes you come alive! What is it that awakens your senses and makes you feel great? Is there something that creates exquisite joy in your heart and mind? For me, there are a few things. I love singing and playing the piano. This is a unique way that I can express myself and my creativity. Listening to and creating music feeds my soul and the world doesn't seem so overwhelming after I have spent time doing this. The other thing that that makes me come alive is this blog. I thoroughly enjoy researching and writing posts but it is even more rewarding to be able to communicate with women all over the world in the same boat as me.
It is exceptionally important to nurture these creative expressions of ourselves. As women, we often put these pursuits on the back burner so that we can take care of our families and run households. Having a family is wonderful and fulfilling but it can also be draining and very self sacrificial. We need something else that reminds us of who we are, apart from our families. Think about what this is for you, discuss it with your loved ones and then make time for it every week. It may be an art class or some time to yourself, baking in the kitchen - just for the fun of it!
Summing It Up
Depression is not something you just have to live with. It can be managed and overcome in a variety of ways that are proving effective. Start with one of the above suggestions this week - perhaps a trip to the health shop to pick up some flaxseed oil or a walk in the park, by yourself. If you feel that your depression is more on the serious side, have a chat to your doctor. In this case medication or counselling might be the best starting point. Getting rid of depression is a conscious and deliberate choice that requires a bit of hard work. It will not just go away on its own. You need to take quick and decisive action to deal with it. Another key to fighting depression, that hasn't been overtly mentioned, is being part of a supportive community and I am so happy to be part of this one with you.
Please drop me a line if you need to chat! You are also welcome share some things that make you come alive and have helped you deal with any depressive symptoms.
Chat to you soon!
Overcoming Multiple Sclerosis (An evidence based guide to recovery). Professor George Jelinek. 2010