What Is the Link Between Depression and Multiple Sclerosis?

People with multiple sclerosis (MS) are more likely than the general population to have depression. This may be related to the actual disease itself — up to 50% of people with any autoimmune disease have symptoms of depression — but it’s likely more complicated than that. 

There’s a lot of overlap between common symptoms of MS and those of mental health problems like depression, making it difficult to tease them out. Here we’ll take a look at the link between depression and MS.

Is depression a symptom of multiple sclerosis?

Yes, in a sense. Experts know that depression is a common feature of MS. Research suggests that at least 1 in 3 people with MS has depression. In some people with MS, depressive symptoms might actually show up before neurological symptoms. But symptoms of depression can happen at any point in the course of MS, and they can also fluctuate over time.

Symptoms of depression can include:

• Sadness 

• Irritability

• Loss of interest in activities that you normally enjoy

• Changes in sleep pattern

• Change in appetite

• Poor concentration 

In addition to depression and neurological problems, people with MS commonly experience the following: 

• Fatigue 

• Poor concentration

• Sleep disturbances

• Chronic pain

• Mood changes

• Cognitive problems, such as word finding and processing information

These symptoms of MS overlap with those of depression. In fact, there can be so much overlap between symptoms that it’s often difficult to determine what’s causing what. 

Regardless of the cause, these symptoms can have a serious effect on quality of life — and they can even make one another worse. For example, higher pain levels are linked to greater fatigue, which is then linked to higher levels of depression in people with MS. Similarly, depression can worsen other symptoms like fatigue and pain.

How does MS cause depression?

It’s not exactly clear why depression is more common in people with MS. Experts believe a combination of factors, including genetics, inflammatory processes, changes in the brain, and social factors, can all contribute to mental health problems. 

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Because depression is common in people with other autoimmune diseases, it might be somehow linked to the disease. Markers of inflammation found in autoimmune diseases have been linked to depression and fatigue. On the other hand, research also suggests that structural changes in the brain could be to blame. 

Grief and multiple sclerosis

MS causes neurological symptoms that affect people’s mobility and ability to care for themselves. As such, people who are faced with a life-changing diagnosis such as MS commonly experience grief. This deep sadness is a natural response to loss. 

Grief may look a bit like depression, but it tends to be short-lived. However, ongoing struggles with stress, uncertainty, and feelings of hopelessness have been linked with depression. So it’s important to be aware of symptoms and how they’re affecting your daily activities.

How to manage depression in MS

Treatment for depression in people with MS is often similar to treatment for depression in anyone else. In other words, treatment relies on therapy and medication. While there are currently no specific guidelines for how to best treat depression in MS, experts generally recommend a combination of approaches:

• Exercise

• Talk therapy

• Medication

• Cognitive therapy for those with cognitive problems due to MS 

Exercise could be especially important for depression in MS because studies show that it may reduce depressive symptoms. Other helpful strategies are to connect with others with MS, and to learn various coping strategies. 

If you have MS and are struggling with symptoms of grief, anxiety, or depression, know that you don’t have to struggle alone. Community resources, whether online or locally, can provide powerful support and information. You can also contact your neurologist to discuss options for therapy and/or medication.  

What is the best antidepressant for MS?

There isn’t a “best” option in terms of medication. Antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used to treat depression in MS. Options include common medications, such as:

• Duloxetine 

• Sertraline

• Fluoxetine

• Paroxetine 

Other antidepressant medications, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), might also be recommended. But they are less commonly used because of possible side effects and drug interactions.

The right option for you will likely depend on your symptoms, other medical problems (if any), and current medications. 

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Written by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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If you need immediate mental health help, contact the National Suicide Prevention Lifeline at 988 or the Crisis Text Line by texting HELLO to 741741. Both are free, confidential, and available 24 hours a day, 7 days a week.