It's Not All in Your Head: Anxiety, Depression, Mood Swings, and Multiple Sclerosis

242 Pages·2011·0.93 MB·English

by  Patricia Farrell

IT’S NOT ALL IN YOUR HEAD
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Anxiety, Depression, Mood Swings, and Multiple Sclerosis E
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“ Whether you are newly diagnosed or an MS veteran — better understand yourself from this glimpse into
your MS mind. In this well-researched book, Dr. Farrell provides a clear view of what MS may do to your NOT
emotions and cognitive functions. Her use of real-life examples from people with MS will lead you to
recognize your own resilience.” I
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— JEFFREY N. GINGOLD, author of the award-winning book, Facing the Cognitive Challenges of Multiple
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Sclerosis and Mental Sharpening Stones: Manage the Cognitive Challenges of Multiple Sclerosis. S
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“ In this book, Dr. Farrell offers a comprehensive review of emotional issues commonly experienced in MS… N
has excellent insight into the ongoing emotional adjustment that individuals with MS often face…coping
strategies are designed to help individuals learn to control or manage their emotional challenges and are O
presented in a very practical and comprehensive manner. While this book is written for those with MS, it
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provides a well-rounded review of real-life matters which will be benefi cial to anyone involved in the care

of those with multiple sclerosis.” A
— JULIE BOBHOLZ, MD, Medical College of Wisconsin
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“ Dr. Farrell has integrated a patient focused, comprehensive approach to understanding and managing MS L
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emotional and cognitive problems…readers will fi nd valuable insights to improve their resilience to face the
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challenges of MS. While complex, the book is fi lled with practical messages for people to help themselves N
throughout their journey with MS. While one strategy does not fi t every person in every situation, everyone

will fi nd ways to help them cope and adapt, which will result in a better quality-of-life.” Y
— JACK BURKS, MD, BURKS & ASSOCIATES, Inc., and author of Multiple Sclerosis: Diagnosis, Medical
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Management, and Rehabilitation
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IT'S NOT ALL IN YOUR HEAD is a cognitive-behavioral approach to overcoming R
the depression, anxiety, and stress that goes hand-in-hand with multiple sclerosis.

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Dr. Farrell helps individuals and their families develop a better understanding of
the effects that MS has on mood levels and anxiety, and offers a plan of action. E
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Patricia Farrell is a practicing clinician, medical writer, researcher, educator, and disability
consultant. She is also the WebMD Moderator for Anxiety/Panic; has regularly appeared on
national TV shows including; The Today Show, Good Morning America, Anderson Cooper 360, SA
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Life and Style where she comments weekly on current topics in the news. Dr. Farrell is the Mpr
author of How to Be Your Own Therapist. Her website is a resource for consumers, students, ues
and healthcare professionals seeking information on health, education, and related issues. ltipsio
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11 W. 42nd Street, 15th Floor
New York, NY 10036
www.demoshealth.com
PATRICIA FARRELL, PHD
DISTRIBUTED IN NORTH AMERICA BY PUBLISHERS GROUP WEST
$16.95 COVER DESIGN BY CARLOS MALDONADO
It’s Not All in Your Head

It’s Not All in Your Head
Anxiety, Depression, Mood Swings, and Multiple Sclerosis
Patricia Farrell, PhD
NEW YORK
Acquisitions Editor:Noreen Henson
Cover Design: Carlos Maldonado
Compositor:Absolute Service, Inc.
Printer: Hamilton Printing Company
Visit our Web site at www.demoshealth.com
© Patricia Farrell. All rights reserved. This book is protected by copyright. No part of it
may be reproduced, stored in a retrieval system, or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise, without the
prior written permission of the publisher.
Medical information provided by Demos Health, in the absence of a visit with a health
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designed to replace a physician’s independent judgment about the appropriateness or
risks of a procedure or therapy for a given patient. Our purpose is to provide you with
information that will help you make your own health care decisions.
The information and opinions provided here are believed to be accurate and sound,
based on the best judgment available to the authors, editors, and publisher, but readers
who fail to consult appropriate health authorities assume the risk of any injuries. The
publisher is not responsible for errors or omissions. The editors and publisher wel-
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Library of Congress Cataloging-in-Publication Data
Farrell, Patricia.
It’s not all in your head : anxiety, depression, mood swings, and multiple sclerosis /
Patricia Farrell.
p. cm.
Includes index.
ISBN 978-1-932603-95-8
1. Multiple sclerosis—Psychological aspects. 2. Multiple sclerosis—Patients—Mental
health. 3. Multiple sclerosis—Complications. 4. Depression, Mental. 5. Anxiety. I. Title.
RC377.F37 2011
616.8'34--dc22
2010038314
Special discounts on bulk quantities of Demos Health books are available to cor-
porations, professional associations, pharmaceutical companies, health care
organizations, and other qualifying groups. For details, please contact:
Special Sales Department
Demos Medical Publishing
11 W. 42nd Street
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Phone: [phone] or 212–683–0072
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Made in the United States of America
10 11 12 13 5 4 3 2 1
Contents
Preface ix
Acknowledgments xiii
1. Multiple Sclerosis Made Simple 1
The Symptoms 2
What Is Multiple Sclerosis? 5
The Three Major Components 6
Anger and Multiple Sclerosis 10
Depression, Anxiety, and Mood Swings 11
Initial Screening for Depression 13
Memory Impairment 13
The Social Side of Multiple Sclerosis 14
Further Reading 15
2. The Mind–Body Connection 17
Psychoneuroimmunology 18
The Immune System 20
Helplessness 22
The Immune System and Depression 24
A Century of Discovery 25
Stress and the Immune System 26
Exercise and Brain Function 28
Lifestyle Changes 30
Depression and Multiple Sclerosis 31
Depression Prior to Diagnosis 32
Further Reading 34
v
vi CONTENTS
3. Riding the Rollercoaster of Multiple Sclerosis 35
Resilience and Illness 36
Resilience-Building Behaviors 42
The Four Phases of Acceptance 43
Sarah, a Young Career Woman 46
Anna, a Homemaker/Senior Citizen 50
William, a Mid-career Professional 53
Stephanie, a College Student 56
Barbara, Wife and Mother 61
Maintaining a Positive Attitude 68
Spouse, Family, Friends, and Caregivers 69
Further Reading 70
4. The “Ugly Twins” of Depression and Anxiety 71
Depression: The Biological Connection 74
Depression and “Moral Failure” 76
Handling the Depression and Diagnosis 77
A Missed Diagnosis 78
Depression Self-Test 80
Stress and Depression 85
Fighting Depression 87
The Psychological Component 90
Anxiety’s Role 94
Further Reading 97
5. Learning to Help Yourself 99
The 11 Most Effective Self-Help Techniques 100
Further Reading 131
6. Handling Guilt and Maintaining Resilience 135
Seeking Psychotherapy 137
The Initial Diagnosis 138
The Road to Resilience 139
Further Reading 143
7. Maximizing Memory to Combat Depression 145
The Five Factors Involved in Memory 146
Sleep Hygiene 149
Anxiety, Pain, Sleep, and Medication 150
Everyday Memory Problems 155
10 Tips for Improving Memory 158
CONTENTS vii
Self-Generated Memories 164
Avoid Repetition as a Memory Aid 166
A Partner’s Role 168
Remoralization 169
Further Reading 170
8. Coping Strategies for Everyday 173
The Social Readjustment Rating Scale 173
Stress/Resolution List 176
The Gentle Art of Persuasion 180
Quality of Life 181
Learning “Interviewing” Skills 184
The Four Accusations 185
Your Role as Your Medical Advocate 187
Regaining Self-Esteem and Pride 190
Retirement and Purpose 191
Positive Relationships 193
Discussing Your Diagnosis 194
Retrieving Good From Bad 195
Attitude Is Everything 197
Maintaining Hope 198
Further Reading 199
9. The Future Is Bright 201
Following the Research 203
Joining the Fight 204
Further Reading 205
Appendix A The Social Readjustment Rating Scale 207
Appendix B Quality of Life Scale 209
Appendix C Daily Exercise Chart 211
Resources 213
Index 215

Preface
This book is intended for anyone with a diagnosis of multiple sclerosis
(MS) who has to live with the anxiety and depression from it as well.
When researching this book, one statement I came across really
summed up the relevance of testing and of getting a definitive diagno-
sis on depression. It was the researcher’s opinion that only one ques-
tion was needed and that was, “Are you depressed?” It was simple and
to the point and 94% of the people who responded “Yes” were, in fact,
found to be depressed upon further evaluation.
I have had many years of direct clinical and research experience
and have been fortunate to have been trained by some exceptional pro-
fessionals. This training has led me to understand that we are each
truly the best judges of our own illnesses. So you are the best person to
answer the question “Are you depressed?”
As one physician with whom I worked said to a patient, “You know
your body best.” It may not always seem that way to others, but our
experience of our lives is unique and, therefore, cannot be categorized
into a set of numbers and test results.
In this book, you’ll see several people I interviewed who knew their
bodies, but had to try very hard to convince professionals that there
was “something wrong” before they got their diagnosis of MS. It is a
tribute to their courage and motivation to work toward health and, I
hope, an inspiration for readers. As you’ll see, sometimes you just have
to trust your instincts.
I believe that if you wish to take several tests to get an “official”
diagnosis of depression and/or anxiety, this can be accomplished quite
easily on the Internet. Some of the self-test sites out there are sup-
ported by well-known, major medical and research institutions, and I
ix