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The Goldman Consensus Statement on Depression in Multiple Sclerosis

Following review and approval by the National Multiple Sclerosis Society’s National Clinical Advisory Board, the “Goldman Consensus Statement on Depression in MS” was published in 2005 in the journal Multiple Sclerosis (volume 11, pp. 328–337). This document grew out of a concern among MS specialists about the lack of recognition and inadequate treatment of this serious condition.

The Goldman Consensus Group, made up of experts in the field of MS and psychiatry, has provided recommendations for the recognition, diagnosis, and management of depression. Tell your physician about this statement and discuss any changes in your mood. Your doctor or the National MS Society (800-344-4867; 800-FIGHT-MS) can refer you to mental health specialists with expertise in MS.

Seeking help for depression doesn’t mean that you’re giving in to it. Instead, it means you’re strong enough to take charge of your well-being. Because the research shows that depression doesn’t just clear up by itself, the sooner you begin to take care of it, the sooner you’re going to feel better.

The consensus among mental health specialists is that the best treatment for severe depression is a combination of antidepressant medication and psychotherapy. Even though each has been shown to provide some benefit, the combination is thought to be the most beneficial. And believe it or not, research has shown that exercise improves mood as well.

Here are a few key things to remember about antidepressant medication:

  • Several antidepressants treat both depression and anxiety — which is a common combination in MS because of the chronic, unpredictable nature of the disease. So be sure to let your doctor know if you feel as though you’ve been hit with the double whammy.

  • Antidepressant medication can take up to four to six weeks to have a noticeable effect.

  • If you stop taking your medication as soon as you feel better, the depression (and anxiety if you’re dealing with that too) is likely to return. Stay on your medication until your doctor recommends otherwise.

  • The antidepressant medications currently on the market (and there are about a zillion) work differently and have different side effects. So finding the medication and dosage that work best for you may take a few months.

  • Even though neurologists, primary care physicians, gynecologists, nurse practitioners, and physician assistants can prescribe antidepressant medications, they generally don’t have specialized training or expertise in this area. Psychiatrists have the expertise to identify the best medication or combination of medications to meet your needs. They’ll monitor your mood on an ongoing basis to ensure the treatment is working. It’s not enough to feel better; the goal is to feel good.

  • Psychiatrists who are familiar with MS are ideal if you need a prescription for an antidepressant. Second best is the psychiatrist who’s willing to learn about your MS and talk to your neurologist. Getting good treatment for your depression doesn’t help much if the side effects of the medication make your MS symptoms worse (for example, some medications may increase your fatigue).

  • Because you may be taking several other medications for your MS, make sure to provide a complete list of those medications to the person who is prescribing an antidepressant medication for you.

  • Virtually all of the available antidepressant medications have sexual side effects, with Wellbutrin (bupropion) being the least problematic in this regard. If you’re severely depressed, you may not care much about sex right now.

    Or, if your MS is interfering with your sexual function, you may figure that one more hit in that area doesn’t really matter. But, if sexual activity is important in your life, be sure to discuss this with the person who’s prescribing antidepressant medication for you.

    As soon as your depression is treated, you may find yourself getting that old spark back and feeling more like being intimate again. After your mood is stabilized, the doctor can recommend strategies — such as changing the timing of your medication — to minimize the impact on your sexual activities.

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