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I find myself depressed most of the time these days.
I now exercise several times a week and that was
helping, but now I'm back to being constantly depressed.
Nothing interests me anymore. This has been going on
intermittently (but getting worse) for a couple of years
now. Maybe it's time to consider taking something for it.

What medications have others found to work well?
I'm just starting to look into this and am wondering
about the side effects they may have. I wanted to
get some opinions from others before talking to the
neuro. Any thoughts, opinions, experiences, or
pointers to good web sites would all be appreciated.

I would be interested in this, too. My husband has become very depressed for the last 2 1/2 months and he was given effexor for his original anxiety, but I can say I think that was a very bad choice of drug for an MS patient. He had one pill, then stopped...
I then considered Odd duck's idea of desepramine, but reading the side effects, it says not to use with people who have bladder retention...well, who doesn't have this problem with MS... We are going to try homeopathy and abx and supplements (large doses of fish oil, etc) for now, but haven't got the abx yet, and haven't had enough time with the others....and of course, there is a situation causing this depression, so without getting rid of his work, I don't know if anything will help

Some natural approaches at the bottom for you to look over.

What causes depression?
Depression may also be caused by numerous biochemical and physiological factors. If you are depressed for no apparent reason, or if depression following a loss does not begin to improve after a few weeks, you should seek medical attention.

A state-licensed N.D. (naturopathic physician) or an M.D. who practices orthomolecular or functional medicine can help you verify that none of the following factors - any of which can negatively affect brain chemistry - is contributing to your depression. For more information on locating a qualified physician in your area, contact the American Association of Naturopathic Physicians. Physicians who practice orthomolecular and functional medicine can be located via www.healthcomm.com and www.drwhitaker.com.

It's not all in your head

Any of the following can cause biochemical imbalances in brain chemistry that can result in depression:




A nutritionally poor diet. Refined foods; pesticides, chemicals, additives in foods; excess sugar and caffeine consumption. A diet largely composed of refined foods does not provide the nutrients necessary for proper functioning of numerous bodily systems, including the brain and nervous system. In susceptible individuals, pesticide residues and food additives can be neurotoxic. Just one example - the chemical, aspartame (trade name, NutraSweet) has been shown to alter brain chemistry in sensitive individuals to the point of causing epileptic seizures.

Foods to which you are allergic or intolerant. For example, wheat protein has been shown to alter brain chemistry in sensitive individuals, inducing brain fog and/or depression.

Hormonal imbalances. Normal functioning of endocrine can be disrupted by stress, environmental toxins, diet, excessive exercise. For example, women are at much higher risk for depression at certain reproductive points, such as menstruation, menopause and immediately after giving birth.

Stress. Excessive flight or fight responses, the Type A personality, free-floating hostility ? all result in the frequent secretion of stress hormones. Stress not only suppresses the immune system, but can affect brain chemistry in susceptible individuals, disrupting normal serotonin signaling and leading to depression.

Excessive or insufficient sleep. Most people need eight hours each night. Consistently getting several hours more or less than your optimal sleep needs can disrupt circadian rhythms, leaving you feeling groggy, foggy, depressed. Bright light ? lights from street lamps, rooms adjoining your bedroom, even light from a digital alarm clock that shines in your face ? can disrupt melatonin production leading to sleep disturbances and depression.

Lack of exercise. Non-exercisers are three times more likely to experience depression than regular exercisers. Exercise increases not only dopamine but endorphins ? neurotransmitters that create a sense of well-being.

Environmental toxins. Solvents and heavy metals such as aluminum, cadmium, mercury and lead are neurotoxins. Example: "Silver" dental amalgams contain mercury and may be neurotoxic in susceptible individuals.

Intestinal parasites. Parasitic infection can cause mental/emotional symptoms including brain fog, feelings of impending doom and depression.

Candidiasis - an overgrowth of yeast in the gut. Excessive consumption of sugar or refined carbohydrates can stimulate overgrowth of candida. The yeast's metabolic byproducts can affect brain chemistry.

Hypothyroidism. Thyroid hormones regulate metabolism in every cell of the body. Low levels of thyroid hormone can cause exhaustion and depression. Other signs of an underactive thyroid include hair loss, obesity, edema, infertility, irregular menstrual bleeding, fibrocystic disease, chronic fatigue and reduced immune function.

SAD (Seasonal Affective Disorder) - depression caused by lack of exposure to sunlight in susceptible individuals. SAD typically occurs in winter in northern latitudes, especially in frequently overcast locations, e.g., Seattle. If daily exposure to at least 15 minutes of natural sunlight is not an option in your area, consider using full-spectrum lights in rooms where you spend the most time.

Hypoglycemia. Low blood sugar deprives the brain, one of your most fuel-hungry organs, of glucose. Usually due to inappropriate diet.

Drugs - Prescription drugs, such as antihistamines, anti-hypertensives, anti-inflammatory agents, birth control pills, corticosteriods, tranquilizers, sedatives and antidepressants, have all been found to cause depression in susceptible individuals. In terms of legal drugs, alcohol is a brain depressant, increases adrenal hormone output, interferes with many brain processes, and disrupts normal sleep cycles. Nicotine stimulates adrenal hormone secretion, including cortisol. Caffeine causes anxiety, panic disorders, depression, nervousness, palpitations, irritability and recurrent headache in sensitive individuals.

Imbalances in the levels of neurotransmitters. When the level of serotonin, the brain's mood-elevating and tranquilizing neurotransmitter, is too low, depression results. This is the biochemical derangement that antidepressant drugs try to control, but these drugs should be your last resort for numerous reasons. Antidepressant drugs take over a normal function of the body. They do nothing to correct the real underlying cause of the problem.
The real question is: "WHY are serotonin levels too low?" An imbalance in neurotransmitters may be caused by any of the above biochemical and physiological causes of depression. An imbalance in neurotransmitters is NOT due to a Prozac deficiency! Antidepressant drugs have serious, sometimes deadly, side-effects. Safe, effective natural alternatives are available that help the body re-establish normal neurotransmitter balance.

http://www.locateadoc.com/articles.cfm/search/103

Depression
A link between food and mood can be traced to neurotransmitter activity in the brain. Complex carbohydrates as well as certain food components such as folate (folic acid), magnesium, niacin, omega-3 fatty acids, selenium, and tryptophan may decrease symptoms of depression.
Mega-Recipes
We believe that it's possible to manage and/or improve certain conditions through what you eat. When we create "Mega-Recipes" for an ailment, we strive to include the maximum number of the nutrients that are shown to have benefit for that ailment. We also expect the Mega-Recipe to contain at least 25% of recommended intakes for those nutrients. See the list of recipes that have met our criteria for this ailment.



What You Should Eat & Why


complex carbohydrates
Consuming foods that are high in tryptophan along with foods high in complex carbohydrates will help enhance the proper absorption of typtophan more effectively. Carboydrates may also boost serotonin activity in the brain. Foods that are often referred to as "comfort foods" tend to be high in complex carbohydrates.
Leading Food Sources of complex carbohydrates: Broccoli, Rice, brown, Potatoes, Blackberries, Pasta, wheat, Squash, winter

folic acid
Because folic acid is often deficient in people who are depressed, getting more of this vitamin through foods may help. The vitamin appears to have the ability to reduce the high levels of homocysteine associated with depression.
Leading Food Sources of folic acid: Asparagus, Beets, Spinach, Avocados, Brussels sprouts, Bok choy, Cabbage, Savoy, Beans, dried, Chick-peas, Soybeans, Lentils, Oranges, Peas, fresh, Turkey, Broccoli

magnesium
Magnesium is a mineral that may ease symptoms of depression by acting as a muscle relaxant.
Leading Food Sources of magnesium: Spinach, Chocolate, Pumpkin seeds, Oysters, Sunflower seeds, Brazil nuts, Amaranth, Buckwheat, Avocados, Quinoa, Almonds, Barley

niacin
Based on niacin's well-recognized role in promoting sound nerve cell function, some experts recommend this B vitamin for relieving depression as well as feelings of anxiety and panic. Most B-vitamin complexes contain niacin in sufficient amounts for this purpose; they also offer the mood-enhancing benefits of other B vitamins.
Leading Food Sources of niacin: Rice, brown, Chicken, Pomegranates, Tuna, Lamb, Wheat, Turkey

omega-3 fatty acids
Certain omega-3 fatty acids may be beneficial for depression. Docosahexaenoic acid (DHA) is an omega 3 long chain polyunsaturated fatty acid that is the building block of human brain tissue. Low levels of DHA have been associated with depression.
Leading Food Sources of omega-3 fatty acids: Salmon, Trout, Tuna

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I have never been on antidepressant meds but my husband has tried a few. It's my understanding that side effects differ for different people. He first went on Zoloft and that made him too spacy and tired. He liked Lexipro better, but it lowered his libido. Now he's on generic Prozac and he says it's working well. He's doing this in combination with therapy, and working hard on deeper personal issues, but it's possible he will never be "cured" of depression. But it is treatable, and we're thankful for that.

I think it's fabulous that you're exercising. Keep it up! And I think it's great that you're going to ask your dr. about treatment options for your depression. It means you care about yourself and others in your life. I've seen firsthand what depression can do to someone and to their relationships with others, and I've seen the positive difference that medication can make. Life truly is too short...you deserve to live it.

carolsue

I then considered Odd duck's idea of desepramine, but reading the side effects, it says not to use with people who have bladder retention

No, that might not necessarily be a good idea to take desipramine as an anti-depressant in MS. The dose to provide any efficacy for depression would have to be way too high, which would probably exacerbate other symptoms of MS.

The dosage of desipramine to help MS (as per my previous research) is very low, hence it would not work to provide ANY relief from depression. Desipramine is a strong tri-cyclic, and it also affects the immune system greatly (among having other MOAs, such as gene therapy type of effects, etc). Again, taking a high dose of desipramine that would be required in order to help depression would be way too interactive with any other immune-modulating therapy, thereby making it too risky to combine.

As a non-medical person, I'd think for depression in MS, taking something like strictly a serotonin agonist would be best, such as fluoxetine or something.

Or even try something like Wellbutrin (buproprion), which again is something else altogether: "WELLBUTRIN (bupropion hydrochloride), an antidepressant of the aminoketone class, is chemically unrelated to tricyclic, tetracyclic, selective serotonin re-uptake inhibitor, or other known antidepressant agents."

But I'd say NOT to take a tri-cyclic for treatment of depression in MS.

In any event, only your individual physician would know what might be best.

Deb

EDIT: Oh, yep. I see where Prozac (i.e. fluoxetine) was just mentioned above, also.

Sometime in the past year I attended an MS Society of Canada Education session entitled 'Mind Matters'.

One of the points made (and published) is that "About 50% of people with MS will develop depressive symptoms at some point during their lifetime."

The key concept that I came away with from this session was that such depression should be treated. It is serious and requires medical intervention.

The other key point was that when it does occur, it is not necessarily a permanent thing. It is usually transitory although a depressive period can be prolonged.

They also pointed out that there have been no significant studies of the drugs commonly used to treat depression in the MS patient community so the advice of other MS patients who have been treated for depression can be invaluable.

I have suffered from depression like most MSers but was prescribed an antidepressant for my neuropathic pain. Probably would have been given one sooner had I mentioned the depression to my neuro. The med was Cymbalta and it didn't seem to help my pain but to be honest, it really did help my depression. I eventually went off the med. for two reasons. First it really depressed my sex drive. That might not have been such a bad thing since I am a 43 year old male with two kids and no time for sex anyway but that is anyother issue. The second reason is that I am a compulsive worrier. That is not always a bad thing because it gives me the motivation to handle my problems and challenges. On Cymbalta, I just seemed to lose that kick and just became to complacent. To each his/her own.

Just a couple of links I found - I haven't tried either yet but very interested in trying the anxiety treatment.

www.amorym.com

www.seredyn.com

The first one is for Depression and the second link is for anxiety.

Jill

I suffered from depression for years before getting a diagnosis of MS. Not that this particular diagnosis helped, but once I found out I had MS, I decided to stop trying to fight the depression on my own without medication. I kinda figured MS might mean a whole slew of new medications to deal with, so what the heck.

I asked my neuro for Effexor because my aunt has used it successfully and I heard there's some logic to taking what works for a relative. After finding a psychiatrist who by chance also happens to be a neurologist (go figure!), we switched me to Zoloft. She said Effexor is not the first choice she'd make, given its heavy-duty nature. She did, however, want me on an antidepressant to try to alleviate potential depression side effects from the Avonex I will be starting shortly. (Makes sense to me.)

We started very gradually on Zoloft, breaking pills in half so I could begin at 12.5 mg, then 25 mg, then 37.5 mg, then 50 mg, 75, 100 over a period of almost two months.

Zoloft has worked well for me, however, not perfectly. Luckily, it's had no sexual side effects or any other except one--when I got to the higher doses (I take the pills at night before bed), I noticed I'd feel kind of shaky/tremory the next morning for a few hours, so we backed down to 50 mg.

In doing some research, I found that there are tests you can take to try to help diagnose which medicines work best for you and in what dosage. These fall under the category of pharmacogenetics and/or pharmacogenomics testing, so keep in mind that this is a very new science which studies what the media is calling personalized medicine, a very, very new field. I have no idea if these tests actually work as promised but those I looked at claim to be able to help you more readily identify which serotonin uptake inhibitors might perform best for your body chemistry. The tests I found were not cheap--I believe they ran around $600. I didn't bookmark them because I decided against them, but if you're curious, do a few searches on "pharmacogenetics tests" and you'll probably find them. This link talks about drug interactions in general based on one of the major cytochromes, CY450:

http://www.theberries.ns.ca/Archives/cyp450.html

All in all, here's what I'd suggest. Everyone is different. You usually have to experiment with a doctor's help to find the antidepressant that works for you. It can take a while to feel the effects, so don't give up. Ideally, find a psychiatrist who has some experience treating patients with chronic illnesses like MS, so he/she will understand how this can be different for you as a patient than others. Ask them to start you gradually, like I did, so your body has time to adjust. If you're really concerned, explore the tests I mentioned, however, as I said, it's a new science and I'm not sure it's worth the expense.

But definitely get treatment. You'll probably feel better just for taking an action that makes you feel like you've taken control. I did--in fact, reading your post made me realize that I'd forgotten to take my pill so I just took it and felt better. I also feel better typing this message to you because it's allowing me to help someone else. I, too, am feeling depression a bit these days, even with treatment.

I'm coming up on my 39th birthday which in and of itself isn't the depressing issue--the issue that's depressing me is that two weeks after my birthday last year, almost to the day, I came down with a virus that resulted in my initial diagnosis of optic neuritis, followed by MS. So almost Year One after diagnosis. But again, when I can share with you and others and be helpful, get outside myself, I feel better.

Also, and apologies to everyone here because this may sound antithetical to the purpose of this board and my very own posting, but sometimes, you have to just get away from the MS support sites and information. It's a delicate balancing act between reaching out to others like me who understand what you're facing, looking for support from us, and just getting the hell away from it all for a while. That's why you see me in and out of here every so often. I need y'all, and I also need to get away from MS at times too. That means skipping the research and the postings for a while. (In fact, if my husband saw I was posting again, he'd kick my butt!)

I wish you the best.

Yes, I agree. One has to step back and take a break from reading these posts ever so often. I am undx with all the symptoms for over 2 years now and find the posts helpful but have to step back when all the info becomes too much. Do find it keeps me sane to know others are out there though. A big thank you to all for the on going info. Linda

hi all, i know this string is old, but to anyone who is new here and looking at depression issues, i ran across this page while searching the forum for niacin, and the whole SAD/full spectrum lighting thing struck me - there has been a lot of discussion recently in the 'natural approach' forum regarding the beneficial and preventative effects of vitamin D status in MS and other diseases.

the dietary measures listed above did not specifically have a D category, so you might want to add that if you are depressed. (although the listed omega-3 food sources are rich in D)

but also, get out in the sun with no sunscreen for say 10-30 minutes per day (go for the longest if you're darker skinned and/or older), as naked as is feasible! (can u imagine a bunch of naked ms-ers throughout the streets of the (temperate) world lmao!) and when you can't get daily sun, then supplement with cholecalciferol, probably MORE than the recommended daily, since your serum levels of vitamin D are likely to be low.

check out the following: (good ol' vieth-y!!)

http://www.pubmedcentral.nih.gov/articl ... &tools=bot

Nutr J. 2004; 3: 8.
Published online 2004 July 19. doi: 10.1186/1475-2891-3-8.
Copyright © 2004 Vieth et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients
Reinhold Vieth,1 Samantha Kimball,1 Amanda Hu,1 and Paul G Walfish2,3

1Department of Laboratory Medicine and Pathology, University of Toronto, Canada
2Department of Medicine, Pediatrics, and Otolaryngology, University of Toronto, Canada
3Medicine and Endocrine Oncology Program, Mount Sinai Hospital, Toronto, Canada

Corresponding author.
Reinhold Vieth: rvieth@mtsinai.on.ca; Samantha Kimball: skimball@uoguelph.ca; Amanda Hu: amanda.hu@utoronto.ca; Paul G Walfish: walfish@mshri.on.ca
Received March 23, 2004; Accepted July 19, 2004.

Abstract
Background
For adults, vitamin D intake of 100 mcg (4000 IU)/day is physiologic and safe. The adequate intake (AI) for older adults is 15 mcg (600 IU)/day, but there has been no report focusing on use of this dose.


Methods
We compared effects of these doses on biochemical responses and sense of wellbeing in a blinded, randomized trial. In Study 1, 64 outpatients (recruited if summer 2001 25(OH)D <61 nmol/L) were given 15 or 100 mcg/day vitamin D in December 2001. Biochemical responses were followed at subsequent visits that were part of clinical care; 37 patients completed a wellbeing questionnaire in December 2001 and February 2002. Subjects for Study 2 were recruited if their 25(OH)D was <51 nmol/L in summer 2001. 66 outpatients were given vitamin D; 51 completed a wellbeing questionnaire in both December 2002 and February 2003.


Results
In Study 1, basal summer 25-hydroxyvitamin D [25(OH)D] averaged 48 ± 9 (SD) nmol/L. Supplementation for more than 6 months produced mean 25(OH)D levels of 79 ± 30 nmol/L for the 15 mcg/day group, and 112 ± 41 nmol/L for the 100 mcg/day group. Both doses lowered plasma parathyroid hormone with no effect on plasma calcium. Between December and February, wellbeing score improved more for the 100-mcg/day group than for the lower-dosed group (1-tail Mann-Whitney p = 0.036). In Study 2, 25(OH)D averaged 39 ± 9 nmol/L, and winter wellbeing scores improved with both doses of vitamin D (two-tail p < 0.001).


Conclusion
The highest AI for vitamin D brought summertime 25(OH)D to >40 nmol/L, lowered PTH, and its use was associated with improved wellbeing. The 100 mcg/day dose produced greater responses. Since it was ethically necessary to provide a meaningful dose of vitamin D to these insufficient patients, we cannot rule out a placebo wellbeing response, particularly for those on the lower dose. This work confirms the safety and efficacy of both 15 and 100 mcg/day vitamin D3 in patients who needed additional vitamin D.

full article text available at
http://www.pubmedcentral.nih.gov/articl ... &tools=bot

I just posted a comment on the question of niacin, and then saw this thread as well. Although I am, of course, totally desperately freaked out by the possibility of having MS, I think my general mood (ex. the number of times I lock myself in a washroom closet to cry) has been better since viral incident/diagnosis. I think its the supplements, I noticed a change about six weeks after starting them. My guess is that for me the key ones are vitD, folic acid, niacin, selenium, but I'm pretty committed to continuing th whole lot.

Just as a followup, I've been seeing a very good therapist for a few months now and it has made a dramatic improvement in my mood. I do still get depressed sometimes but I usually bounce back now even before the next therapy session. I didn't think it would do any good but was willing to give it a try, and I am so grateful that I did.

I had to stop Lexapro because of the side effects, but never even started the Wellbutrin because the therapy was enough by itself.

I removed my post

Dave, this is not a religious forum, but a scientific one. Your opinions are valuable in their own right, but please do not bump up 3 week old threads to espouse your beliefs.