Signs Of Mild Depression. Battling The Black Dog ?
Q: The relationship between multiple sclerosis (MS) and depression seems to
be different from other neurological disorders. Instead of fluctuating
levels of neurotransmitters like serotonin, dopamine, and
norepinephrine, MS involves lesions on the brain and spinal cord where
they have been stripped of their insulating myelin. Could demyelination
play a role in depression?
A:The level of depression is the driving force in the
quality of life of people with MS, probably more so than the overall
burden of the disease itself. There is also evidence that depression
impairs the management of MS symptoms, by reducing adherence to
treatment.
As with other neurological conditions, patients with MS-and their
doctors-may find that they focus on the physical symptoms of their
primary disease and pay less attention to the depression. But that's
improving, says Dr. Patten. In 2005, the Multiple Sclerosis Society put
out a consensus statement on screening for depression in MS, and I think
it's had an impact.… I think eventually we're going to learn that if
we deal better with depression in our patients, they'll do better
overall.
But managing this multifactorial susceptibility to depression isn't
easy, as Susan Randall learned. The time-release carbidopa-levodopa
(Sinemet CR) she began taking for her Parkinson's left her with what Dr.
Menza described as a dopamine-derived depression, a crash that occurred
when the drug began to wear off. It would just take