Depression and MS: A Strategic Approach. Dr Sally Shaw Psychologist Webinar - September 2017

Transcription

1 Depression and MS: A Strategic Approach Dr Sally Shaw Psychologist Webinar - September 2017

2 Overview of Presentation Let s not forget happiness Depression what it looks like Important considerations in Multiple Sclerosis Screening for depression in PwMS Goldman Consensus : Treating depression in MS Let s be Strategic in preventing/identifying/managing depression in MS Looking at Problem Focussed Coping (different to fixing the problem)

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5 Depression general population Leading cause of disability worldwide. 1 in 5 women in Australia will experience depression. 1 in 8 men in Australia will experience depression. Types of Depression: Major Depressive Disorder (MDD)/Clinical Depression Melancholia (movements slow down/loss of pleasure in everything) Psychotic Depression (will include hallucinations/paranoia/delusions) Antenatal and Postnatal Depression Bipolar Disorder (Manic Depression) Australian Bureau of Statistics. (2008) National Survey of Mental Health and Wellbeing: Summary of Results, Cat. no. (4326.0). Canberra: ABS. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. (2013)

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7 Identifying as Depressed Can be liberating I know what the problem is now, and that it can be treated! Can be devastating I don t want to be depressed

8 Causes of Depressive Symptoms in MS Syndrome Major Depressive Disorder, must meet 5 of 9 predetermined criteria, including poor concentration and impaired memory, fatigue and altered sleep patterns Mood disorder Adjustment Disorder observes symptoms of depression as a result of reacting to the diagnosis or subsequent challenges (contributing factors include level of disability, social support) Depressive Disorder due to a Medical Condition Mechanistic view that depression could be an expression of underlying brain damage caused by MS Feinstein, A., Magalhaes, S., Richard, J., Audet, B. & Moore, C. (2014) The link between multiple sclerosis and depression. Neurology, 10,

9 Cause of Depression in MS? Multifactorial psychological, social and neurobiological.?immunologic &genetic factors also What Else Contributes? Perceptions of present state of illness Level of uncertainty about new symptoms and the future Poor coping skills, resilience, personal resources

10 Depression in MS Lifetime prevalence of depression in MS patients is around 50% Women more likely to be diagnosed with depression than men Largest contributor to decrease in QOL among PwMS Increase risk of suicide in PwMS Increase the severity of some symptoms of MS Fatigue Cognitive impairment Decrease adherence to medication regimes, incl DMT adherence 226 women with MS, 40% had moderate to severe depression. Two thirds of women were NOT being treated (Mohammadi et al., 2015)

11 Screening for Depression General Population Kessler Psychological Distress Scale (K10)

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13 Simple Screening for depression in PwMS 2 Questions; during the past two weeks, have you often been bothered by feeling down, depressed or hopeless? (mood) during the past two weeks, have you often been bothered by little interest or pleasure in doing things? (anhedonia) Mohr, D.C., Hart, S.L., Julian, J. & Tasch, E.S. (2007). Screening for depression among patients with multiple sclerosis: two questions may be enough. Multiple Sclerosis, 13;

14 Goldman Consensus re Treatment Integrated psychopharmacological & psychotherapeutic approach is best Combination of antidepressant medication and cognitive behavioural therapy (CBT) are superior to either in isolation DO NOT UNDERESTIMATE IMPORTANCE OF Exercise Sense of purpose and achievement Effective coping style

15 Strategic Management of Depression A Focus on Coping styles Depression is more than a failure of coping with psychosocial challenges, but a review of coping strategies can be enormously beneficial. Coping strategies can be protective factor against depression, as well as beneficial in the identification and treatment of depression

16 Problem Focussed Coping vs Emotion Focussed (avoidant) Coping style Emotion Focussed Coping Seems well suited for stressors that seem uncontrollable grief v chronic illness Examples of positive and negative emotion focussed coping strategies Problem Focussed Coping Identifying the fundamental cause of the stress in an objective manner Usually involves problem solving, time management and strategy development

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18 Strategic Thinking Early in Disease Manage MS Build Resilience Work on increasing problem focussed coping (together with a level of positive emotion focussed coping strategies) There is a time for both!

19 References Feinstein, A., Magalhaes, S., Richard, J., Audet, B. & Moore, C. (2014) The link between multiple sclerosis and depression. Neurology, 10, Fitzgerald, C. & Patten, S. (2008) Is multiple sclerosis patient depressed, stressed, or both? Current Psychiatry 7(4), Goldman Consensus Group. (2005) The Goldman Consensus statement on depression in multiple sclerosis. Multiple Sclerosis, 11, Hind, D., Cotter, J., Thake, A., Bradburn, M., Cooper, C., Isaac, C. & House, A. (2014) Cognitive Behavioural Therapy for the treatment of depression in people with Multiple Sclerosis: A systematic review and meta-analysis. BMC Psychiatry 14:5. Koch, M.W., Patten, S., Berzins, S., Zhornitsky, S., Greenfield, J., Wall, W. & Metz, L.M. (2015) Depression in multiple sclerosis: a long term longitudinal study. Multiple Sclerosis Journal, 21(1), Mohr, D.C., Hart, S.L., Julian, L. & Tasch, E.S. (2007) Screening for depression among patients with multiple sclerosis: two questions may be enough. Multiple Sclerosis, 13, Shadday, A. (2007). Understanding and Treating Depression in Multiple Sclerosis. Multiple Sclerosis Association of America.

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