Multiple Sclerosis: Can lifestyle affect depression risk?

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Dr James O’Malley

New research published today in BMC Psychiatry has suggested lifestyle factors can play a role in depression risk for people with MS. In this guest post Dr James O’Malley, Research Communications Officer at the MS Society (UK) tells us more about MS and its association with depression.

Multiple sclerosis (MS) is a neurological condition that affects over 2 million people worldwide. In MS, the protective protein and lipid layer of myelin that insulates nerve fibres is damaged by the immune system. This damage interferes with the messages sent along the fibres from the brain to the body, and can result in a wide range of symptoms, from loss of coordination and balance, to paralysis.

While the body has some capacity to repair myelin damage at the early stages of MS, continued attacks can eventually lead to myelin loss and nerve fibre destruction. This can result in more severe and permanent disability for people with progressive forms of MS.

At the MS Society, we are contacted on a daily basis by people facing the emotional and psychological impact of life with this condition, and unsurprisingly, many tell us that they experience feelings of depression and anxiety. Studies looking at levels of depression among people with MS have reported rates of between 20-50% – levels two to five times higher than that of the general population.

Indeed, we know that depression and anxiety levels are high among people with MS in the UK. Data from the UK MS Register, established and supported by the MS Society, revealed that of more than 4000 people surveyed, 54% reported feelings of anxiety, and 47% reported depression.

Further research using the Register also identified a link between higher levels of disability and increased reporting of anxiety and depression in people with MS.

A new study by Taylor et al., published in BMC Psychiatry, has highlighted potential lifestyle risk factors for depression in people with MS. This study surveyed depression risk among almost 2,500 people from over 50 different countries on factors commonly linked to MS, such as fatigue and levels of disability, but also other aspects like exercise levels and diet supplementation.

Just over 30% of respondents to this study reported depression as a comorbidity, and of these, about 70% were receiving treatment for this condition. Interestingly, it was found that people diagnosed at a younger age had a higher chance of screening positive for depression, suggesting therapeutic support might be particularly useful for young people at the point of diagnosis.

There also appears to be an association between depression and increased disability, with those unemployed or retired due to disability twice as likely to screen positive for depression. Worryingly, research from the UK MS Register identified that the level of employment among people with MS was around 40% up to five years after diagnosis, but this dropped to just over 15% up to 14 years after diagnosis.

Taylor et al. also report intriguing results about the relationship between various lifestyle factors and depression among people with MS. Consumption of vitamin D, omega 3 or flaxseed oil supplements correlated with a lower risk of depression, as did higher levels of exercise, better diet and never having smoked.

This may suggest that dietary interventions can influence the risk of depression among people with MS, and indeed there is growing evidence that a balanced diet can mitigate depression even among the general population. The MS Society recommends that in general it is important to maintain a healthy lifestyle.

Although exercise can be more challenging for people with reduced mobility, in line with evidence from other studies, research we have funded demonstrated that exercise programmes tailored for people with MS result in improved quality of life and other social benefits.

There is some evidence to suggest that exercise can also have a beneficial influence on fatigue in people with MS, and significantly, Taylor et al report that people with clinically significant levels of this symptom were nine times more likely to also be identified with depression.

Cognitive behavioural therapy has been successfully used as a fatigue management tool for people with MS, with some studies also showing that this type of intervention not only benefits fatigue, but can also reduce levels of depression among participants.

This new study highlights a number of factors which may influence the risk of depression in people with MS. Some of these factors, like diet supplementation, require further investigation to tease out their direct impact on this condition.

However, other aspects may be more straightforward to deal with, such as the increased risk of depression among the unemployed and those with lower levels of social support.

This research is crucial in highlighting the issues faced by people with MS, and gives organisations like ours a mandate to ensure that effective psychological and therapeutic support to prevent and alleviate depression is developed and implemented.

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