Ask the Expert – Depression

Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer

Headshot of doctor Barry Hendin, chief medical officer for MSAA
Barry Hendin, MD

Question: How does psychological therapy, either alone or in conjunction with medication, make a difference for someone with MS who is experiencing depression?

Answer: This question highlights the fact that there is more than one approach to treating psychological problems. Anyone may experience depression, but this symptom is more common in people with MS. Much of this is biologically determined, meaning that depression in MS is often caused by changes in the central nervous system (CNS), but we’re also aware that situational problems may occur in anyone’s life, including those with MS.

Antidepressant medications from a psychiatrist (or other appropriate clinician) can be very helpful for the biological aspects of depression. But for many people, an additional benefit may be derived from psychotherapy or “talk therapy” with a psychologist or counselor. This psychological support can help individuals to develop strategies to navigate complex situational issues. 

Beyond these professional interventions, there are several things that people with MS are able to do independently. For many, exercise can reduce depression. For others, mindfulness, yoga, or meditation may be helpful. And for everyone, focusing on the other aspects of wellness, which include maintaining a healthy diet and healthy social relationships, can’t be emphasized enough!

Please note that anxiety may occur along with depression and is also more common in the MS population. Many of the approaches to treating depression are also useful in reducing anxiety, but as with depression, this symptom should be diagnosed by a professional and treated accordingly.

Barry A. Hendin, MD is a neurologist and Director of the Multiple Sclerosis Center of Arizona. He is also Director of the Multiple Sclerosis Clinic at Banner University Medical Center and Clinical Professor of Neurology at the University of Arizona Medical School.

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Ask the Expert – Cognitive Issues

Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer

Headshot of doctor Barry Hendin, chief medical officer for MSAA
Barry Hendin, MD

Question: What strategies can you recommend to help with cognitive issues? 

Answer: First, let’s define cognition. Simply, it is all of the processes involved in learning, remembering, and expressing knowledge. It involves how we perceive, how we think, and how we convey knowledge verbally and nonverbally. 

Although many people with MS, and at all stages of MS, express cognitive symptoms or problems, they are generally mild in nature. The most common complaints that I hear involve difficulties in memory, multitasking, learning new information, and processing speed.

Some cognitive changes may be due to MS itself. Often, however, the problems are due to, or are compounded by, other factors such as poor sleep, medication effect, pain, or depression. The first strategy, therefore, is to assess the contribution of mood, pain, medications, and sleep – and then treat them appropriately. 

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Ask the Expert – Numbness and MS

Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer

Headshot of doctor Barry Hendin, chief medical officer for MSAA

Question: Does new or increased numbness indicate a worsening of MS, and is this symptom typically permanent, or can it subside on its own?

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Ask the Expert – MRI and MS

Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer

Headshot of doctor Barry Hendin, chief medical officer for MSAA

Question: How often is an MRI recommended, and is it still needed when symptoms have not worsened?

Answer: Although there is a wide variation in the use and frequency of magnetic resonance imaging (MRI) testing in neurological practices, it may be helpful to begin by considering why we get MRI scans for people with MS.

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Ask the Expert – Differences in the MS Experience

Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer

Question: Why does each person with MS experience different symptoms?

Answer: It shouldn’t surprise us that everyone experiences their MS differently since we are all unique, but the individual factors producing that uniqueness are worth considering in some detail.

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Ask the Expert – Mental and Emotional Health

Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer

Question: As we enter into the New Year, what strategies do you recommend for positive mental and emotional health?

Answer: Of all the questions I’ve been asked over the past couple of years this is probably the most difficult to answer… and to answer briefly. For some people, positive mental and emotional health comes more easily and naturally. It doesn’t require a strategy or a lot of work. Perhaps it’s the good luck of genetics or a positive and nurturing upbringing. But clearly for some people, happiness is more difficult and requires more work. For the latter and probably much larger group, it does require more work, and more effort, and maybe a strategy. It’s clear to me that the effort is worth undertaking!

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Ask the Expert – COVID-19 and Flu Vaccines

Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer

Headshot of Barry A. Hendin, MD

Question: For individuals with MS who are taking a disease-modifying therapy (DMT) and plan to get both a COVID-19 vaccine as well as a seasonal flu vaccine, do they need to wait a certain amount of time between taking their DMT and between receiving each vaccine?

Answer: We recommend vaccination for COVID-19 and for flu for most people with MS after appropriate discussion with your doctor or primary care provider. The risk of COVID-19, as well as the risk of becoming sick from the flu, generally outweigh any risks associated with vaccination. We also recommend continued safety precautions including masking, handwashing, and avoidance of large indoor gatherings.

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Ask the Expert – MS Relapses

Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer

Question: How do you determine when a relapse is severe enough to be treated with IV steroids versus waiting to see if the relapse will go away on its own? Also, if a patient does not receive IV steroids, what other treatments or changes in lifestyle may be recommended for a less-severe relapse?

Answer: Clinicians vary widely in their threshold for using steroids for relapses… and patients vary widely in their desire to be treated with steroids for relapses. The most common use of steroids is for a relapse that interferes with function. For example, severe vertigo, weakness, or gait dysfunction are common symptoms that can greatly interfere with function.

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