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The Medication Solution Assists in Restoring Emotional Health

By: Ellen Whipple Guthrie, Pharm.D.

Emotional problems, such as depression and anxiety, are very common in people with MS and can negatively impact their health and well-being. More than 50 percent of people with MS experience one of these mood changes at some point during their illness, according to MSF Medical Advisor Ben W. Thrower, M.D. Yet many people with MS who suffer from emotional problems do not disclose these struggles to their physicians.

“This is unfortunate because many good products exist to help patients suffering from depression and anxiety,” explained Thrower in a recent interview with MSFocus.

The treating physician will assess whether medication is indicated, but frequently, counseling is recommended as well, especially when anxiety is the primary complaint. Anxiety is something that people with MS often experience. It can be related to the normal course of events or be due to specific problems related or unrelated to the MS diagnosis. All anxiety does not require medications. In many cases anxiety can be minimized without drugs if the person with MS can understand what is causing anxiety.

Fatigue can also cause anxiousness. Therefore, people with MS need to learn how to effectively manage their fatigue. When a diagnosis of MS causes anxiety, becoming educated about the disease, joining a support group, or talking with a professional can help.

If medication is necessary, expect to have regular appointments with the physician who prescribed the medication, especially when starting a new treatment. This allows the physician to assess whether the medication is working and to identify adverse effects. In some cases, doses may be increased or decreased.  The “perfect medication” in the “perfect dosage” is rarely prescribed the first time. Clearly, the successful treatment of depression requires patience and cooperation from both the prescribing physician and patient.

The Medications for Emotions

Various classes of medications exist to treat depression. The selective serotonin reuptake inhibiters (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), and tricyclic antidepressants are the most commonly prescribed antidepressants for MS-related depression. However, it can take up to eight weeks for all of these products to reach their full therapeutic potential.

The SSRIs:   These include Prozac® (fluoxetine), Zoloft® (sertraline), Celexa® (citalopram), Paxil® (paroxetine), and Lexapro® (escitalopram). They are the commonly used first-line agents for depression and many anxiety disorders. Prozac® and Zoloft® are probably two of the most commonly prescribed SSRIs for depression in MS, since they also treat MS-related fatigue.

Common side effects associated with SSRIs include sexual dysfunction, nausea, nervousness and insomnia, agitation, and decreased sweating with increased body temperature. Generally, these lessen with time. Data suggests that Lexapro® is associated with less sexual dysfunction than the other SSRIs; for this reason, it is commonly prescribed for male patients suffering from MS-related depression. 

The tricyclic antidepressants:  These include Elavil® (amitriptyline), Tofranil® (imipramine), and Pamelor® (nortriptyline) and have been available the longest. These products are not commonly used as first-line agents for depression because they can cause some annoying adverse effects such as dry mouth, constipation, bladder problems, sexual dysfunction, blurred vision, dizziness, drowsiness, and increased heart rate. These can make other MS symptoms feel worse. For treatment-resistant depression, the tricyclic antidepressants are commonly used alone or in combination with other medications. 

The SSNRIs: Effexor® (venlafaxine) and Cymbalta® (duloxetine) belong to this class of drugs. Data suggests that these products may be more effective in treating severe depression and depression resistant to other medications than the SSRI antidepressants and tricyclic antidepressants. Effexor® can also be used to treat hot flashes in women. For this reason, Effexor® is popular with post-menopausal women. 

Since Cymbalta® can also be used to treat neuropathic pain, it is a good choice for someone suffering from both depression and neuropathic pain. The most common adverse effects associated with the SSNRIs include changes in appetite, weight, and sleep; drowsiness, dizziness, fatigue, headache, nausea and vomiting, and sexual dysfunction. Generally, sexual dysfunction is milder with the SSNRIs compared to the SSRIs. 

The benzodiazepine drugs:  These include Valium® (diazepam), Ativan® (lorazepam), and Xanax (alprazolam) and are commonly used to treat anxiety on a short-term basis. Usually, these medications are only prescribed when non-drug measures are not effective. These products can be habit-forming and can decrease cognition. For this reason, they should not be used long-term. The SSRI anti-depressants are commonly used to treat anxiety that needs to be treated long-term. 

NOTE:  Some patients use alternative therapies to treat depression and anxiety. As with any other medication, be sure to let your doctor and pharmacist know that you are using these medications. As with traditional medications, alternative therapies have side effects also and can interact with medications. 

Ellen Guthrie received her doctorate of pharmacy degree from the University of Georgia College of Pharmacy in 1994 and has been a medical advisor with the MSF since 2002.  She is an assistant clinical professor at the University of Georgia College of Pharmacy, where she lectures primarily on MS.  She practices pharmacy at Children’s Healthcare of Atlanta, where she is a pediatric pharmacist. She is a member of the American Pharmaceutical Association, the Atlanta Academy of Institutional Pharmacists, and the Consortium of MS Centers.

 (Last reviewed 10/2009)



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