Depression and its Impact in Multiple Sclerosis

Most of us know that depression is a very common symptom of multiple sclerosis (MS). What people may not know, perhaps because the topic is rarely discussed at dinner parties, is that suicide is one of the leading causes of early death in people with MS.

For this reason, I was interested in the presentation at ECTRIMS 2015 of the Swedish study entitled, “Multiple sclerosis and risk of completed and attempted suicide – a national cohort study. ”  To be clear in our definitions, “completed suicide” is that which results in death and “attempted suicide” is that which does not.

The researchers identified over 29,000 people with MS listed in the patient registry of Sweden. They matched each of these to people without MS who were the same age, gender, education level, and from the same region of Sweden. They then looked at comparisons of cause of death and suicide attempts.

This is what they found:

  • Over twice as many people (2.18 times) with MS attempted (unsuccessfully) to commit suicide as people without MS.
  • A smaller proportion (1.87 times as many) people with MS committed suicide.
  • Men were 60% more likely to commit suicide than women.
  • Women were 30% more likely to attempt suicide than men.
  • Risk for suicide was highest among 18-40 years olds and lowest among those 66 years and older.

It was no surprise that in this study, depression was the most important risk factor for both attempted and completed suicide.

The research group postulated that the lower risk for suicide among elderly people could be explained by higher physical or cognitive impairment, which may prevent their ability to commit suicide, although this was not examined in the study.

Interestingly, among people without MS, people with a higher education were 30% less likely to commit suicide than those with a lower level of education. Among people with MS, however, people with a higher education were actually slightly more likely (10% more) to commit suicide.

Compared with the general population, people with MS were more likely to use pills than other forms of suicide, perhaps because they had easier access to pills than to guns or other methods.

A comprehensive paper looking at 13 studies of suicide in people with MS was published in 2012 and found that the Swedes are not unusual, as most studies have documented a higher suicide rate in patients with MS compared to the general population. Across the studies, suicide in people with MS was associated with several risk factors, including severity of depression, social isolation, younger age, having a progressive form of MS, lower income, earlier disease course, higher levels of physical disability, and not driving.

I asked if assisted suicide or euthanasia was included in the study, and was told that this was not specifically looked at. I assume that it is excluded from the data, as I found the following information on a website about assisted suicide laws: “While it is correct that Sweden has no law specifically proscribing assisted suicide, the prosecutors might charge an assister with manslaughter - and do. In 1979 the Swedish right-to-die leader Berit Hedeby went to prison for a year for helping a man with MS to die.” (The assisted dying organization, Dignitas, is located in Switzerland, not Sweden.)

Bottom Line: Depression is a very common symptom of MS. As the research shows, it is the key risk factor for suicide. It therefore is extremely important to be alert to the the warning signs of depression, as depression is one of the MS symptoms that can actually be successfully treated.

I learned that it’s important to keep tabs on how you are feeling by asking yourself the following questions:

  1. During the past two weeks, have you often felt down, depressed or hopeless?
  2. During the past two weeks, have you had little interest or pleasure in doing things?

If you answer “yes” to either of these questions, you may be depressed and need to seek help. I also learned that depression is not a sign of weakness and it is not your fault. It CAN be treated successfully. Talk to your doctor openly and honestly about how you are feeling – you owe it to yourself and those who love and care about you.

To connect with a National MS Society Navigator for help, information, or assistance finding a mental health professional in your area, call 1-800-344-4867 or fill out this form.

If you are having thoughts about harming yourself or feel you are at risk of hurting yourself or someone else, call the National Crisis Hotline at 1-800-273-TALK (8255) or text "ANSWER" to 839863.

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Julie Stachowiak, PhD

Julie is the author of the Multiple Sclerosis Manifesto, the winner of the 2009 ForeWord Book of the Year Award in the Health Category. She is an epidemiologist who is also a person living with MS, Julie has an in-depth understanding about current research and scientific developments around MS. She also has first-hand knowledge of the frustrations and anxiety surrounding the disease, as she had MS for at least 15 years before receiving a diagnosis in 2003 and has had several relapses since her diagnosis.