Depression is more common in people with MS than the general population. There are many things that can cause or trigger depression. This includes MS symptoms such as fatigue, pain, spasticity and bladder problems. But you can become depressed for no obvious reason.

What is depression?

Everyone feels sad, down or unhappy at times. But it’s usually only for a few days at most. Depression is different. It can make you feel low for weeks or months and interfere with work, your family and social life. Depression can be mild, moderate or severe. Some people may feel life is not worth living and have thoughts of suicide. You can experience different levels of depression at different times.

The symptoms are different for everyone. You might lose interest in things you usually enjoy. Or you may find you don’t want to see friends or family. You might feel tearful or hopeless. You may find you lose your appetite or sleep more or less than usual. It’s also common to have symptoms of anxiety.

What causes depression?

It is thought that changes in brain chemistry are at the root of the low mood seen in depression. There isn’t one single cause, and it can have a range of triggers. It is not due to an inability to cope with life, or a weakness or failure of any sort.

Anyone can develop depression at any time in their life without any clear reason. But below are some of the experiences that can make you more at risk of developing depression:

  • a stressful life event such as a relationship breakdown or a bereavement
  • a family history of depression
  • if you have recently given birth
  • if you are socially isolated
  • if you have drug or alcohol problems
  • losing your job or money worries
  • getting older.

All these can happen whether you have MS or not. Sometimes it can be a combination of events which lead to a ‘downward spiral’ and then depression. For example, becoming socially isolated after losing your job or giving birth.

Why is depression more common in MS?

Developing an illness can also increase your risk of depression. There are several reasons why depression may be more common in MS:

  • the challenges of living with a long-term health condition
  • the location of MS lesions
  • the side effects of drugs used to treat MS.

Living with MS

Uncertainty. Feeling helpless. Increased levels of stress. Loss of opportunity. Social isolation. The stigma of disability. These are some of the experiences that living with MS may bring. They can also be triggers for developing depression. 

MS symptoms such as poor sleep, chronic pain and fatigue can also contribute. Pain and depression tend to amplify each other in MS, so it's important to tackle both at the same time.

In MS, the relationship between disability and depression is not straightforward. Depression may occur early in the MS disease course. It can often take hold as you come to terms with your diagnosis. It can also begin later, after living with MS for many years. But many people with MS never develop depression.

Location of MS lesions

Depression can also occur as a direct result of MS itself. If MS lesions occur in areas of the brain involved with mood, they can lead to depression. 

Side effects of drugs used to treat MS

Some drugs prescribed to treat MS can also contribute to depression. These include:

How many people with MS get depression?

Around half of all people with MS experience depression during their lifetime. This is three times higher than for the general population. The extra risk is due both to MS damaging nerves in the brain, and the experience of living with a complex disease. 

People with MS often experience chronic depression. It can last a long time, even several years. In MS, depression is unlikely to go away on its own if it’s caused by underlying lesions. But it is very treatable, so it’s better to seek help early.

The risk of suicide for people with MS is also higher. Young men within the first five years of an MS diagnosis are most at risk of ending their own lives.

What are the symptoms of depression?

The symptoms of depression are wide ranging. The symptoms can be psychological, physical or social. It’s unlikely you’ll have them all.

Psychological symptoms include:

  • continuous low mood/sadness for at least two weeks
  • feeling tearful, guilty, anxious or irritable
  • losing interest in things you usually enjoy
  • negative thoughts about yourself and the future
  • thinking about suicide.

Physical symptoms include:

  • eating more or less than usual
  • sleeping more or less than normal
  • unexplained aches and pains
  • losing interest in sex
  • lack of energy.

Social symptoms include:

  • struggling with home life or work
  • avoiding social activities and spending time with friends.

MS depression may make thinking harder and leave you feeling irritable, frustrated or discouraged.

What can I do if I think I'm depressed?

There is no simple test for depression. If you experience depression symptoms most of the time for more than two weeks, see your GP. Often people try to carry on and cope with their symptoms. The sooner you seek help, the sooner your symptoms will start to improve.

Your GP will ask you questions about your physical and mental health. They may carry out blood and urine tests. This will rule out other causes of depression such as an underactive thyroid. Be honest about how you’re feeling. Health professionals rely on your answers to decide if you have depression and how severe it is.

Recognising depression

It’s not always easy to recognise depression in yourself. Symptoms often come on slowly and build up over time. It may be a family member or friend who notices changes in you. Your GP, MS nurse or neurologist may also recognise the signs of depression. 

Recognising depression when you have MS can be especially difficult. Many symptoms associated with depression are also common in MS. Fatigue, poor concentration and difficulty sleeping are prime examples. These symptoms can worsen during a relapse or due to an infection. But if you experience a worsening of these symptoms with no obvious cause it may be a sign for concern.

Talking about depression

It’s important to let people around you know how you feel.  This can be difficult. The stigma sometimes perceived around mental health problems can also act as a barrier.

Simply describing the symptoms of depression cannot capture the enormous impact it can have on your life. It can lead you to withdraw from intimate or social relationships. Family and friends may not recognise that this is due to the condition. They may interpret this as rejection or disinterest which could lead to a lack of empathy or sensitivity towards you. This can feed into the depression, resulting in you withdrawing even further.

Depression can interfere with your ability to concentrate. This can affect your work performance. If your work colleagues are unaware of the situation, they may label you as lazy or incompetent. Can you tell a colleague, HR person or manager about your depression, so you can get support at work?

Without the right help, depression can spiral out of control. This is why it’s important to speak to a GP or another person you trust as early as possible.

Getting help

Depression is often accompanied by feelings of despair, uselessness or loss of self-worth. This can lead to self-neglect. You may stop caring for yourself in the way that you usually would. You may stop following a healthy lifestyle. Or neglect to take your usual prescribed medication. This may be your MS medication and/or medication prescribed to treat your depression. 

Because of the impact depression can have on you and the management of your MS, it is important to seek help. 

Your MS team, GP or neurologist can work with you to find the best approach to treating your depression.

If life seems unbearable

Studies have found that over a quarter of people with MS think about suicide. This can happen when the future looks bleak. You may think friends and family would be better off if you weren’t around. 

There is help available if you are having thoughts of suicide or feel especially low at any time. The Samaritans provide a free 24-hour telephone service in the UK and Republic of Ireland. Call them on 116 123. They can support you until you can contact your regular team of health professionals.

Friends and family can also help – the vital thing is to involve other people even though this may not be easy.

How is depression treated?

There are several approaches to treating depression. These include self-management strategies, talking therapies and/or medication. Treatments are often used in combination for the best result. The best solution for you will depend on several factors, including:

  • the severity of your depression
  • your personal preferences
  • the extent of your support network
  • if you’ve experienced depression before.

Your GP, MS specialist nurse or neurologist will work with you to decide the best course of action. A neuropsychologist or other mental health specialist may be involved in your care. Services vary around the UK.

NICE has useful guidance on what should happen when you first talk to a health professional about depression.

Hayley, from Great Ormond Street Hospital shares her top tips for coping with the emotional side of an MS diagnosis.

Self-management – what can I do to help myself?

The NICE guideline recommends self-management techniques for mild to moderate depression. This may include strategies to adopt healthier habits, such as:

You could also consider accessing support through:

  • a self-help group
  • a telephone counselling service
  • an online discussion forum
  • one of the many mental health charities.

Your progress should be reviewed on a regular basis to ensure your mood is improving.

It’s important to recognise your own risk factors. Keeping a diary of how you feel can be valuable.

Some people use the unlicensed herbal remedy St John's wort to treat their depression but it is not currently recommended by NICE. This is for several reasons. Concerns around the correct dose. Variations between preparations from different manufacturers. It can affect the efficacy of other drugs including warfarin and oral contraceptives. It also interacts with some drugs used in MS including amitriptyline and carbamazepine.

Talking therapies

Talking therapies or psychological approaches are also recommended for mild to moderate depression. They help you identify and overcome negative thought patterns associated with depression. They are effective in MS but access on the NHS is patchy.

Your GP can refer you to local talking therapies available on the NHS. In some areas you can self-refer.

Cognitive behavioural therapy (CBT) teaches you coping skills for different situations. The focus is on how your thoughts affect your feelings and actions. CBT can help you learn to overcome negative thoughts. It is effective for treating less severe cases of depression in MS. It can take some time for referral to a psychologist, but online courses can help.

Counselling helps you to think about the problems you are experiencing in your life. You then identify ways of overcoming or managing them. Counselling is different from other psychological approaches. The therapist has a more passive role and provides more of a listening approach.

Other talking therapies include psychotherapy, family therapy, couples therapy and group therapy. They may be available from your local MS Therapy Centre.

Details of where to find local NHS talking therapies for anxiety and depression can be found on the NHS website.

Read more about talking therapies


Your doctor may suggest trying an antidepressant. They are used for moderate to severe depression. They may also be prescribed if other treatments haven’t been effective. There are lots of different antidepressants available. They vary in the way they work. One type might not work for you, but another could help. Sometimes you need to try a few options to find the right one for you.

At first, you will usually be given the lowest possible dose of the drug you choose. You’re unlikely to see any benefit immediately. It can take around four weeks for antidepressants to take effect.

You should be reviewed on a regular basis to check whether the drug and dose you are taking are effective. You might need to increase your dose or change treatment if you are not seeing any benefit. If you’re experiencing intolerable side-effects, you might consider switching to an alternative treatment.

Some people may start to feel better after a short period of time but don’t stop taking your medication without talking to your health professionals. Stopping too soon could result in your depression coming back. You may also experience withdrawal symptoms if you stop taking them suddenly.

Antidepressants work by raising the levels of neurotransmitters which boost mood. There are different classes of antidepressant which all work slightly differently. Some only boost the good mood chemical serotonin; others also increase levels of noradrenaline.

The most used drugs are selective serotonin reuptake inhibitors (SSRIs). Examples include fluoxetine (Prozac) and paroxetine (Seroxat) and citalopram (Cipramil). 

Another older class of drugs known as tricyclic antidepressants (TCAs)  are sometimes used. These include imipramine (Imipramil) and amitriptyline (Triptafen). Both of these are also used in MS at lower doses to treat neuropathic (nerve) pain, even in the absence of depression.

Severe complicated depression

In rare circumstances these standard treatments may be ineffective. For example if you have had persistent and repeated episodes of severe depression which has resulted in severe self-neglect. Or if you are thought to be a major risk to people close to you. If this is the case, you may be referred to specialist mental health services. They can offer a tailored programme of treatments in either an inpatient or outpatient setting.

If depression comes back

Depression can reoccur. So, it is helpful to recognise if you are beginning to feel low again. This might help prevent further episodes. 

Think about signs to look out for if you start to get low again. Mine were things like not contacting friends, not bothering with my appearance and shutting myself away.

You could try keeping a diary or using an app to track your social activity, exercise and sleep patterns. You might spot some changes that reflect your drop in mood. Using strategies that have helped you before, such as CBT, could help you stay well.

Find out more

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