b'Medicine & ResearchDDeepprreessssiioonnaannddFFaattiigguueei nPPeeoopplleeWWiitthhMMSSinBy Annette F. Okai, M.D.Depression and fatigue are commonsymptoms that can occur in people with MS.They can occur separately, or sometimestogether. In some cases one can lead to theotherit is not unusual for fatigue to lead todepression or vice versa.Independently, fatigue or depression canbe very disabling. They have the ability toaect a person with MS physically, cognitively, medical conditions such as depression, lowand emotionally. Both symptoms have been thyroid,anemiaorinfections.Healthcareassociated with lower quality of life in people providers usually assess for these conditionswith MS. When they occur together, that and if present, treat accordingly. Someeect may be amplied. medications used to treat MS and its symptomsThe Types of Fatigue can be fatigue inducing and their benet /risk prole have to be assessed when beingThere are dierent types of fatigue that prescribed. Lifestyle factors including nutrition,can occur in people with MS. weight, and deconditioning should also bePrimaryfatigue canbecausedby considered when addressing fatigue. inammation the brain. It is usually worse in CNS stimulants are routinely used tothe afternoon and continues to worsen as the treat fatigue in people with MS, in certaindaygoesby.Eectivediseasemodifying circumstances, the solution is treating thetreatment aimed at reducing inammation underlying cause of fatigue.can help improve this type of fatigue.Identifying DepressionSecondary fatigue is caused by other Depression occurs in about 50 percent offactors, rather than the disease itself. People cases of MS. Some common symptoms ofwith MS can sometimes have diculty sleeping, depression are feeling sad and hopeless,for a variety of reasons. Poor sleep can lead to decreased pleasure in activities, eating disorders,signicant daytime fatigue that can interfere andconcentrationabnormality.Therearewith daily activities. Addressing sleep diculties physicalsymptomsalsoassociated withcan improve the fatigue that results from it. depression, such as lack of energy, disturbedRepeated activity and increased body sleep, and changes in appetite or weight.temperature can also induce fatigue, and thisis treated with rest and cooling. Another Depression is easy to recognize when thesecategoryofsecondaryfatigueisother common symptoms occur on presentation.msfocusmagazine.org 32'