Lydia Chwastiak says it's pretty much trial and error. She published an article in Psychiatr Clin North Am. 2007 Dec;30(4):803-17 called"Psychiatric issues in multiple sclerosis"by LA Chwastiak and DM Ehde ofDepartment of Psychiatry, Yale University School of Medicine.Here's the abstract of the article.MDD and anxiety disorders are highly prevalent among persons who have MS and have been associated with decreased adherence to MS treatment and poorer functional status and quality of life. Effective treatment is available for MDD, but this disorder continues to be underdetected and undertreated by MS providers. Treatment with pharmacotherapy is particularly challenging in this patient population, given the somatic symptom overlap between MS and depression and the increased burden of side effects. Larger randomized, controlled trials are needed to elucidate further the effectiveness of pharmacotherapy and to identify subgroups of patients who would benefit from this type of treatment for depression. There have been few rigorous studies of the prevalence and impact of anxiety disorders, substance use disorders, or serious mental illness such as bipolar disorder or schizophrenia, in MS samples.You might want to write Dr. Chwastiak to see if she has any recommendations. She probably doesn't have time to answer a million emails, but if you're the only one, maybe she can suggest something. Her email is
lydia.chwastiak@yale.eduI don't have MS personally, but my personal experience and that of the zillion people I've talked to leads me to believe that the neurotransmitter-type antidepressants aren't particularly effective except as symptomatic relief for people who have a temporary type of depression because of stressful circumstances. For those who have depression related to MS, lupus, diabetes, etc., or who have recurrent depression over the course of their life, there doesn't seem to be much"there"there. They may have more luck with the tricyclics like Elavil, or with other antidepressants like Dexedrine. In my case, I had a little luck with Ritalin, but it's very harsh as it kicks in and wears off. I had more luck with Dexedrine, but it felt like my head was all packed with cotton balls like a bottle of aspirin, and I couldn't think. And it's a *real* pain trying to get an Rx for Dexedrine filled; they treat you like a criminal. It just isn't worth it.Hope this is of *some* help to you. People without depression think it's just sadness. They have NO idea that the disorder means cognitive problems like confusion, poor memory, inability to think, sleep disorders.I don't know why people tell depressives to just pull themselves up; would they tell a person with a broken leg to simply grit their teeth because crutches are for weaklings? Hang in there. We're not all fools.