Fatigue a critical driver in Depression?

Wellbeing an interesting concept, a condition or state of being, basically absent from "debilitating work/life stressors" or repetitive stress induced mental / physical ill-health.

Sooo, when in the "chain of causation" of an unmitigated ill-health incident does it become an industrial accident, a crime of contributory negligence of the employer or employee failing to report or address the hazards and risks of a non-communicable disease ??

What is depression?

Depression is a constant feeling of sadness or low mood. Everyone feels sad or down at times but clinical depression is different. It is constantly present and interferes with your everyday activities. Depression can be mild, moderate or severe, depending on how much it affects your life, and you can experience different levels of depression at different times.

If you are depressed you often lose pleasure in things that were once enjoyable, you may give up usual activities such as hobbies and lose interest in seeing friends and family. Some people even feel that life is no longer worth living and have thoughts of suicide.

What causes depression?

Generally, depression is thought to involve changes in brain chemistry that lead to feelings of low mood. Anyone can develop depression at any time in their life without any apparent cause or reason. It is not due to an inability to cope with life, or a weakness or failure of any sort.

Below are some of the experiences that can lead to depression.

Life events

You might be more at risk of developing depression if:

• you have experienced a stressful life event such as a relationship break-down or a bereavement
• you have a family history of depression
• you are a woman who has recently given birth
• you are socially isolated
• you have drug or alcohol problems

All these life events are just as likely whether presenteeism, preexisting dis-ease, MS or not.

Living with MS

The challenges of living with multiple sclerosis can also lead to depression. Living with uncertainty, feeling helpless, experiencing loss of opportunity and the social isolation or stigma that disability may bring can all be factors for developing depression. Increased levels of stress and experiencing symptoms such as poor sleep, chronic pain and overwhelming fatigue can also be contributing factors. Pain and depression tend to amplify each other in MS, so it's important to tackle both with your treatment.

In MS, the relationship between disability and depression is not straightforward. Sometimes depression may start up early in the MS disease course, perhaps around the time someone is coming to terms with the diagnosis. Alternatively, depression may begin later, after having lived with MS for many years. However, many people with MS or severe disability never develop depression.

Site of MS lesions

Studies have shown that depression can also occur as a result of MS itself, because if MS lesions happen to occur in areas of the brain that are associated with mood they can lead to depression.

Side effects of drugs used to treat other MS symptoms

Some drugs prescribed to treat MS can also contribute to depression. These include steroids used to treat MS relapses, muscle relaxants used to treat spasticity and spasms and some disease modifying drugs.

How many people get depression?

Around half of all people with multiple sclerosis will experience depression at some time in their life. This is three times higher than for the general population. Part of this extra risk comes from MS damaging nerves in the brain, and part comes from the experience of living with a complex disease.

People with MS are likely to experience chronic depression, with symptoms lasting a long time, even several years. In MS, depression is unlikely to go away on its own, due to the underlying lesions, but it is very treatable, so get help as soon as you can.

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

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

Recognise it

Clinical depression can be difficult to identify and you may not always be able to recognise depression in yourself, although your family and friends might have noticed changes in you. Your GP, MS nurse or neurologist may also recognise the signs of depression. There is no simple test such as a blood test to find out if you are depressed. Your health professionals rely on descriptions of the symptoms you are experiencing and the effect it is having on your life.

Recognising depression when you have MS can be difficult as you may already have some of the symptoms usually associated with depression such as fatigue, poor concentration and sleep problems. In the absence of infection or relapse, changes or worsening in those symptoms could be a flag for concern.

Signs of depression include:

• low mood all the time for at least two weeks
• negative thoughts about yourself and the future
• not being able to take pleasure in routine things that you have previously enjoyed such as eating, watching TV or talking to friends
• thoughts of suicide

It has also been suggested that in MS, depression causes increased problems with thinking, feeling irritable, frustrated and discouraged.

Talk about it

It is important to let people around you know how you feel. It can be hard to talk about how you are feeling and the stigma that is sometimes associated with mental health problems can also act as a barrier to discussions.

Depression can interfere with your ability to concentrate and so can affect work performance. This may be perceived as laziness or incompetence by your work colleagues if they are unaware of the situation. Can you tell a colleague, HR person or manager about your depression, so that you can get support at work?

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

Get help with it

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

Simply describing the symptoms of depression cannot capture the enormous impact it can have - it can affect personal, social and professional aspects of your life. Depression may make you want to withdraw from intimate or social relationships, family and friends may not recognise that this is due to the condition and may misunderstand this as rejection or disinterest, which in turn can lead to a lack of empathy or sensitivity towards you - this can feed in to the depression and lead to further social withdrawal.

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

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 and you may think friends and family would be better off if you weren’t around. Whilst many people think about suicide, few go on to carry this out. If you are having thoughts of suicide or you find yourself severely down, the Samaritans(link is external) provide a free 24 hour telephone line in the UK and Republic of Ireland on 116 123 and can help you through 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?