Are you depressed? Please download the Beck Depression Inventory and assess yourself. #ClinicSpeak #MSBlog #MSResearch
“The article below complements my post yesterday on loneliness and social isolation; it confirms that pwMS are at increased risk of both attempted suicide and completed suicide. Men are more successful at committing suicide than women. These are rather depressing figures, but as MS is strongly associated with depression they are not surprising. What can be done about it? All pwMS should be screened for depression and suicidal ideation, or suicidal thoughts, and if they are found to be at risk they should be offered help. Easier said than done? In a recent audit of our service a glaring omission was the patchy screening for depression in our MS clinics. I have included the Beck Depression inventory that you can download and score yourself. If you find you are depressed please see your GP, neurologist or MS CNS.”
Brenner et al. Multiple sclerosis and risk of attempted and completed suicide – a cohort study. Eur J Neurol. 2016 Apr 27.
METHODS: A total of 29 617 Swedish MS patients were identified through the Swedish Patient Register and matched with 296 164 people without MS from the general population. Cox regression analysis estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for the association of MS with attempted and completed suicide, with adjustment for age, sex, education and calendar period.
RESULTS: The adjusted HR for attempted suicide amongst MS patients is 2.18 (95% CI 1.97-2.43) compared with the general population cohort. For completed suicide the HR is 1.87 (95% CI 1.53-2.30). In both groups women are at higher risk of attempting suicide, whilst men are at higher risk of completing suicide. Education level is inversely associated with completed suicide amongst the non-MS cohort (0.68, 0.51-0.91), but not amongst MS patients (1.10, 0.60-2.04).
CONCLUSION: Multiple sclerosis patients are at higher risk of both attempted and completed suicide. No evidence was found of an inverse association between educational level and risk of completed suicide amongst MS patients.
“The article below complements my post yesterday on loneliness and social isolation; it confirms that pwMS are at increased risk of both attempted suicide and completed suicide. Men are more successful at committing suicide than women. These are rather depressing figures, but as MS is strongly associated with depression they are not surprising. What can be done about it? All pwMS should be screened for depression and suicidal ideation, or suicidal thoughts, and if they are found to be at risk they should be offered help. Easier said than done? In a recent audit of our service a glaring omission was the patchy screening for depression in our MS clinics. I have included the Beck Depression inventory that you can download and score yourself. If you find you are depressed please see your GP, neurologist or MS CNS.”
Brenner et al. Multiple sclerosis and risk of attempted and completed suicide – a cohort study. Eur J Neurol. 2016 Apr 27.
BACKGROUND AND PURPOSE: Patients with multiple sclerosis (MS) are known to have an elevated suicide risk, but attempted suicide is incompletely investigated. The relation between education level and suicidality has not been investigated in MS patients. Our objective was to estimate attempted suicide and completed suicide risks amongst MS patients.
METHODS: A total of 29 617 Swedish MS patients were identified through the Swedish Patient Register and matched with 296 164 people without MS from the general population. Cox regression analysis estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for the association of MS with attempted and completed suicide, with adjustment for age, sex, education and calendar period.
RESULTS: The adjusted HR for attempted suicide amongst MS patients is 2.18 (95% CI 1.97-2.43) compared with the general population cohort. For completed suicide the HR is 1.87 (95% CI 1.53-2.30). In both groups women are at higher risk of attempting suicide, whilst men are at higher risk of completing suicide. Education level is inversely associated with completed suicide amongst the non-MS cohort (0.68, 0.51-0.91), but not amongst MS patients (1.10, 0.60-2.04).
CONCLUSION: Multiple sclerosis patients are at higher risk of both attempted and completed suicide. No evidence was found of an inverse association between educational level and risk of completed suicide amongst MS patients.
At its worse MS takes away everything – dreams, hopes, work, hobbies, love. Individuals with MS will make a call on when to call it a day. Sitting in an electric wheelchair looking out of a window and realising (i) what you have lost and (ii) the worse is still to come can focus the mind. It's up to MSers to decide if it is time to finish off the life which has been so cruel to them. Prog G has noted before that most MSers consider EDSS 8, 9 to be a state worse than death. Now if researchers / neuros could offer patients neuroprotection to stabilise them or repair drugs to help get some function back…. But they can't. My last cat was put to sleep by the vet to stop the suffering from the disease it had. When I get to EDSS 7-8 I hope to find a vet to offer the same compassion as my cat received.
I have seen so many people with MS utter "I'm so depressed, MS causes depression". And it does – I'm not questioning that. But some depression is natural – by definition any chronic illness will cause depression. When my partner was treated for cancer, the clinic had a relationship with a psychologist who saw patients from the clinic. There was an understanding that patients diagnosed and undergoing treatment will face depression. Psychological intervention was available but wasn’t touted as a cure – there was an understanding that depression is a natural part of the process. I think doctors feel helpless in face of depression and will often send patients for treatment (ie. Psychologist or psychiatrist) for lack of anything better to do. It can only help and keeps them employed, right? I think a lot of the time is a label designed to put a difficult problem into someone else’s lap. I know a ‘non compliant’ MS patient who was called irrational by the patient’s neuro and told to see a psychiatrist… there may have been factors for each of those outburst by the neuro (the neuro could have been recommending neuropsychiatrist for pain issues because the neuro felt helpless and believed the patient would benefit from it, the neuro could have called the patient irrational because the neuro was frustrated at patient’s insistence on choosing the patient’s own preference for DMD) – but all of that was lost in name calling and proximity and tone of the words and the appointment. The patient is now compliant and the neuro I’m sure feeling accomplished and relieved. Everyone is happy it seems but the patient who is questioning their own sanity.Bojana
You know, the Swedish angle of this approach is most interesting as those of North European, protestant descent have higher rates of suicide than say their Mediterranean counterparts. This has a lot to do with differing religions, community support, climates, family dynamics, and social expectations (marriage, children, communion).I reckon the South Asian diaspora residing in the UK has a more admirable approach to living with MS as their value systems are more social and less individualistic. Family networks and support are a big deal. I know a guy with MS whose sister refurbished her entire house to accommodate his needs (at huge expense and remortgages) so that he can live with her family when his disability becomes too much for their elderly parents. They are British-Pakistani.Suicide is a seriously complex area and not a binary issue.
I had suicidal thoughts when used Rebif 44a… Quickly my doctor decided to change the medication, and depression and thoughts are gone…
I was watching an NHS hospital made video today and it said people can self refer to NHS mental health teams, also family members can do this. It said you don't need to be referred by a GP although that is an option. If MSers ask their GP or neurologist to be referred then at least there should be a record of the request but it is good to know there are other options. Is this the same at Barts? thanks