51 msfocusmagazine.org symptomatic problems associated with MS, including depression. A lack of consistency, or adherence, can happen for many reasons. Unfortunately, people with MS suffering from depression are less likely to be adherent in taking their DMTs. According to Dr. Thrower, this is something that he commonly sees in clinical practice. It’s thought that this inconsistencycan lead to increased symptoms of depression. For this reason, Dr. Thrower suggests that patients have an open dialogue with their treating clinicians regarding adherence with DMTs and the effects of depression on adherence. This should not be a one-way conversation. According to Dr. Thrower, clinicians should also be initiating this discussion with patients. In the early 2000s, when injectable beta- interferon DMTs were approved by the FDA their use was linked with depression and increased rates of suicide. The initial concern arose from clinical trial datawhere fourpatients attempted suicide. With the high prevalence rates of depression in patients with MS, many clinicians felt that it was difficult to draw meaningful conclusions from this data. Historically speaking, clinicians have limited the use of these beta-interferon DMTs in those who are experiencing major depressive disorders. More recent studies have found little evidence suggesting a causal link between the beta-interferon DMTs and depression. It is important to note that the beta- interferon DMTs are not the only DMTs that have been associated with depression. Mitoxantrone (Novantrone®) , which is rarely used as a treatment of MS, natalizumab (Tysabri®), and daclizumab (Zinbryta®) have also been linked with depression. The effect of antidepressants There are a plethora of antidepressant medications approved for use in the U.S. As with all medications, adherence and open communication are keys to success. These products simply are not effective if you do not take them. The positive effects are not always immediate – it can take up to two months for the benefits to be attained. Because all medications have side effects, you are again encouraged to have open dialogue with your prescribing clinicians. It is important to under- stand that finding the “best anti-depressant” may be a trial and error approach. With its high prevalence and high treat- ability, depression is a symptom for which all people with MS should be screened. If you have experienced changes in your mood that might be depression talk to your healthcare team. There is help for MS-related depression. Identifying Depression Depressionisamooddisordercharacterized bythepresenceoffiveormoreofthefollowing symptoms for at least two weeks: • Asadmoodformostofthedayormostdays • Aloss of pleasure or interest in one’s usual activities • Sleeping problems • Fatigue • Changes in thinking and motion – either a slowing down of thought and reduced motion, or racing thoughts and restless motion.Changesinweight–eitherreduced appetite with weight loss or increased appetite with weight gain • Negative self-image • Feelings of guilt and self-blame • Reduced concentration and • Suicidal thinking. If you are having an emotional crisis or experiencing suicidal thoughts, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255).