Medicine & Research

Depression and Fatigue in People With MS

By Annette F. Okai, M.D.

Depression and fatigue are common symptoms that can occur in people with MS. They can occur separately, or sometimes together. In some cases one can lead to the other – it is not unusual for fatigue to lead to depression or vice versa.

Independently, fatigue or depression can be very disabling. They have the ability to affect a person with MS physically, cognitively, and emotionally. Both symptoms have been associated with lower quality of life in people with MS. When they occur together, that effect may be amplified.

The Types of Fatigue

Primary fatigue can be caused by inflammation the brain. It is usually worse in the afternoon and continues to worsen as the day goes by. Effective disease modifying treatment aimed at reducing inflammation can help improve this type of fatigue.

Secondary fatigue is caused by other factors, rather than the disease itself. People with MS can sometimes have difficulty sleeping, for a variety of reasons. Poor sleep can lead to significant daytime fatigue that can interfere with daily activities. Addressing sleep difficulties can improve the fatigue that results from it. Repeated activity and increased body temperature can also induce fatigue, and this is treated with rest and cooling. Another category of secondary fatigue is other medical conditions such as depression, low thyroid, anemia or infections. Healthcare providers usually assess for these conditions and if present, treat accordingly. Some medications used to treat MS and its symptoms can be fatigue inducing and their benefit / risk profile have to be assessed when being prescribed. Lifestyle factors including nutrition, weight, and deconditioning should also be considered when addressing fatigue.

CNS stimulants are routinely used to treat fatigue in people with MS, in certain circumstances, the solution is treating the underlying cause of fatigue.

Identifying Depression

Depression occurs in about 50 percent of cases of MS. Some common symptoms of depression are feeling sad and hopeless, decreased pleasure in activities, eating disorders, and concentration abnormality. There are physical symptoms also associated with depression, such as lack of energy, disturbed sleep, and changes in appetite or weight.

Depression is easy to recognize when these common symptoms occur on presentation. But it may present as fatigue, which is common in MS, and mask the diagnosis. It is important to provide as much information and discuss symptoms in detail with your healthcare provider to aid in timely intervention.

Discerning the Difference

There is a correlation with fatigue and depression. Fatigue is a common presenting symptom of depression that can linger even when treated. Fatigue can cause depression, and depression can cause increased fatigue. Physical, cognitive, and emotional symptoms are effects of both symptoms. A poor sleep pattern can lead to fatigue and depression. Sometimes it is difficult to tell one from the other. (One important clue can be that people with depression often feel very tired but aren’t interested in doing any activity, regardless of the task or the required amount of effort. On the other hand, those with fatigue usually want to engage in activities, but just feel too tired to do so.)

While there is still much to learn about the relationship of depression and fatigue, what is known is that both fatigue and depression are independently associated with lower quality of life, and both can exist and in people with MS and heighten symptoms of the other. As a person with MS, it is important to take control and take steps to combat the effects of these symptoms by engaging in physical activity, healthy eating, and practicing proper sleep hygiene. Working with your healthcare provider to treat other underlying causes goes a long way in controlling the effects on quality of life.

Is it Just The Blues?

We all have down periods. How do you know if you may be depressed? Clinical depression is defined as having five or more of the following symptoms for two weeks or more. However, if you have any of these symptoms persistently, it’s still wise to mention them to your doctor.

  • A sad mood for most of the day or most days
  • A loss of pleasure or interest in one’s usual activities
  • Sleeping problems
  • Fatigue
  • Changes in thinking – difficulty thinking or racing thoughts
  • Changes in motion – either reduced motion or restless motion.
  • Changes in weight – either reduced appetite with weight loss or increased appetite with weight gain
  • Negative self-image
  • Feelings of guilt and self-blame
  • Changes in your ability to concentrate
  • Suicidal thinking.