Depression is unlikely to play a role in making disability progression worse in people with multiple sclerosis (MS), a new study published in Scientific Reports has found.
Researchers from Swansea University, University of Cambridge and Queen Mary University of London conducted the UK-wide study to find out if depression and/or anxiety put people with MS at greater risk of disability progression. The team analysed data from 862 people with MS using information from the MS Society-funded UK MS Register.
They found that what appeared to be a link between early depression and subsequently reaching a higher level of disability, disappeared when they took into account the earlier level of disability. Rather than depression impacting disability worsening, these results are likely to reflect the significant challenges of living with MS, with greater disability causing people to feel more depressed. There was no link between anxiety and subsequent disability progression.
More than 130,000 people live with MS in the UK, and tens of thousands who have the progressive forms have little to stop their MS getting worse. The speed at which progression happens varies a lot, and it’s not yet possible to predict exactly what puts someone at greater risk. MS is relentless and painful, and anxiety and depressionare common in people with the condition. Previous studies in Canada and Sweden1,2 found people with MS and depression were more likely to reach disability milestones than those without depression.
In this new study, over a third (43.3%) of people who progressed to needing a walking stick had reported feeling depressed early in the course of their MS, compared to less than one quarter (22.4%) of people who were able to walk without a stick. Crucially however this difference was lost when they took into account people’s initial level of disability.
While it also suggests depression may be a result of more advanced disability rather than a cause, the researchers acknowledge there could be other explanations for their results. For example, there could be a common factor increasing the risk of both physical disability and depression, such as more brain lesions.
There was a high incidence of depressive symptoms in this study, with more than a quarter (25.6%) of people scoring highly for depression, and more than 40% scoring highly for anxiety. This highlights the importance of identifying and treating depression and anxiety in people with MS and follows the launch of a new set of recommendations for change. For the first time ever, the MS Society along with five other MS charities, including the MS Trust, are working together to ensure people with MS get access to the mental health and wellbeing support they need.
JJ, from London, was diagnosed with relapsing MS in 2011 and her mental health has been impacted ever since. She says: “Just when I start to feel mentally OK MS reminds me it’s still here and I’m not OK. When I was diagnosed I wasn’t offered any mental health support and it’s only recently that I have sought that support for myself. My symptoms are stress triggered and so if I’m stressed about my MS it will trigger my MS and vice versa so it’s a vicious circle. It was after a particularly bad MS relapse that it hit home how bad my mental health was.
“It feels like there is a severe lack of support for people with MS and a lack of information about how MS might affect your mental health. I felt relatively fine at the beginning and I was a bit naïve and I wish there had been more support to prepare me for what was coming and the realities of living with MS. I think it’s important to encourage people to speak more openly about how they feel – good or bad. We don’t need to be strong for other people, we need to put ourselves first.”
Dr Emma Gray, Assistant Director of Research at the MS Society, says: “MS is relentless and painful, and depression affects around half of all people with the condition at some time. Learning that experiencing depression may not cause someone’s MS to get worse will be reassuring for some people. And knowing high levels of disability might have a major impact on mental health is further evidence that depression in people with MS cannot be ignored.
“This research strengthens the case for prioritising mental health support and we’ve committed to raise funds for COMPASS-MS. This study will assess a new therapist-supported digital programme to treat distress in MS. It has the potential to help people with MS across the UK who are experiencing symptoms of anxiety and depression.”
Dr Benjamin Jacobs, one of the co-authors on the study, says: “Our study shows that depression is common in MS, particularly in people who have a more disabling course. Recognising and treating depression in MS is unlikely to affect the disease itself, but may have an important positive impact on quality of life.”
The data for this study was analysed at the UK MS Register Datathon – an interactive course to introduce early career MS researchers to Big Data.
If you are an early career researcher then who is interested in learning about how to R in big data then for more information visit https://ukmsregister.org/DataAcademy