Taking care of your mental health is just as important as taking good care of your physical health (although it receives much less attention), and is especially important during these colder and darker winter months.
We can achieve good mental health broadly by reducing stresses (where possible) and increasing opportunities to feel fulfilled, trying to be effective and productive (at home and at work), reaching goals and ambitions and by giving to others. However, during the winter months our mental wellbeing can take a little bit of a battering and we may begin to suffer ill mental health.
Depression is particularly common in people with MS, with it being thought to affect at least 50% of MSers. It is even more prevalent during the darker and colder winter months, when there is significantly less sunlight. Whilst the mechanisms for this more seasonal depression being unclear, it is thought that the reduced exposure to the sunlight may increase the production of melatonin (which increases fatigue in people with MS), reduces serotonin levels (the hormone that makes you feel happy), and affects your body clock. The lower UV levels are also thought to have a significant impact on vitamin D levels, and the cooler temperatures are linked to an increase in MS symptoms such as spasticity and pain.
Thinking about all of these things, it is clear that it is especially important that we look after ourselves during the winter time!
What are the signs that I might be suffering from ill mental health?
Are you suffering from 5 or more of these symptoms for at least the last two weeks (with them having upset your daily routine/relationships/ability to work?)
- low mood and feelings of hopelessness or despair
- reduced interest in activities
- change in appetite and/or a change in weight
- change in energy levels (although I hear ya…. this one is impossible to judge when you have MS)
- reduced ability to concentrate or think coherently
- feeling worthless
- feeling of guilt
- feeling restless
- inability to sleep
If you think you might have depression or a problem with your mental health that is affecting your quality of life, it is important to be talk to someone as soon as you can so you can get help. Depression is not something to be ashamed of – so don’t be embarrassed reaching out to someone about how you feel.
How does MS contribute to depression and ill mental health?
Well this is quite a complex question because there are several different possible contributing factors:
- Depression can be a medical illness which might be caused by some kind of hormonal or chemical imbalance in your body – this might happen in someone whether or not they have MS
- Mood may be impacted/changed by lesions and other nervous system damage directly caused by MS
- Side effects of drugs
- Mood and mental wellbeing may be effected by the impact of living with a chronic condition and all of the complexities that brings including dealing with daily symptoms, changing/worsening of symptoms, hospital appointments, taking medications, altered relationships with friends and family, and loss of physical function
Depression & MS
Depression has been documented to occur in up to 50 percent of MS patients and is three times more common in people with MS than in the general population. Up to 40 percent of support partners, such as caregivers and spouses, may also experience depression at some point in life. It is thought that the change in roles and responsibilities, money worries and concerns about the person living with MS are all contributing factors to the distress of the care giver.
For people with RRMS, it has been known that early signs of depression are associated with inflammation and the disease. However, later once progressed into SPMS, MSers tend to have depression associated more with helplessness, hopelessness and guilt associated with the loss of function and frustrations with the disease.
Anxiety & MS
Around 50% of people with MS also report suffering from anxiety, and this can occur with or without depression. Anxiety is linked with decreased social interaction, increased experience of pain and lower cognitive abilities.
When it comes to living with MS, it appears that a lot of the anxiety tends to come from the uncertainty of what each day will bring. One day can be so different to the next – in RRMS, flare ups, relapses and exacerbations can come on with little warning. I know that a lot of my personal anxieties come from not knowing what is going to happen – I struggle to plan for the future.
It is difficult living not knowing if the symptoms will worsen over time, or just disappear as quickly as they came on. It can be so difficult not to worry, especially when you have responsibilities such as looking after children or a job to go to.
Avoiding things that make you anxious?
I know as well as anyone that anxiety can make things really difficult, and the way that I tend to deal with it is by avoiding things. This is really not the best way to deal with anxiety (as I was told by my neuropsychologist)… I have anxieties for example about having a bladder accident when I am in public, so I avoid going out to places when I don’t know where the toilets are… or avoid leaving the house completely. By doing this, I have missed out on time with friends and family, for the fear that something might happen.
I am not a mental health expert and can only speak from my own experiences, but I know that this type of behaviour isn’t healthy. If you are avoiding things like going out in public, attending social events or appointments for the fear that something might happen, then you probably need to seek some help from a therapist or doctor. I went to see a neuropsychologist, but they also recommend Cognitive Behavioural Therapy and Acceptance Therapy for this type of thing too.
Talking to your doctor
I have struggled in the past to reach out to my family, friends and wider health care providers. If you have MS (or not?) and you think you might need some support, then don’t be afraid to talk to someone about how you are feeling. You can always go to your doctor or MS nurse to talk about your symptoms and worries, and if they cannot help you directly, they will be able to refer you to someone who can.
Similarly, if you are a friend or family member, or someone who is caring for a person with MS, or any other chronic illness, keep an eye out for signs of decreasing mental health or depression in yourself and the ones you love. Remember – the signs might not always be really obvious (the person might seem and say they are ok).