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• Depression is seven times more prevalent in the MS community than the general population.
• Rates of stress are two and a half times higher.
• Anxiety rates are double that of those without MS
• Bipolar disorder is diagnosed in 13 percent of those with MS but only 3 percent of those without receive that diagnosis.
• Mental healthcare is far harder to access than medical care and more costly as insurance copays are higher and many mental health professionals do not take insurance.
• Suicide rates are double in the MS population.
• Comprehensive MS treatment centers see mental health care as a top priority so usually are able to connect the person with MS with care more readily than a neurologist in private practice treating the PWMS.

For more on this topic, I describe the day I devoted to mental healthcare and research in the first 14 minutes of the podcast found here.

The shifting climate of patient/doctor conversations

Another session discussed the need to be an educated patient about your MS and what treatments are available and how to make the most of your visit time with your care team. That conversation starts at eight minutes and 20 seconds into this podcast.

Which meds are right for my MS?

• The interferons and glatiramer acetate are the safest medications on the market to treat MS and all reduce relapse rates by about a third over the rates in those with relapsing forms of MS who are not on medication.
• All of the oral medications carry a potential of more additional problems than any of the injectable medications. These potential problems include but are not limited to cancers, birth defects in offspring of the person taking the medications and (with two of the orals) a risk of developing PML, a potentially fatal brain infection.
• The infusible medications are all more effective at reducing relapse rates and damage to the central nervous system than either the injectable or oral medications currently on the market. These medications do come with an small risk for PML, various cancers, thyroid problems (with Alemtuzemab) but, if used early in the course of a very active disease process, appear to stop most of the activity and keep it quiet for years if not permanently in the individual who receives them.
• All people with MS will do better on medication than those not taking anything as far as disease progression, silent damage to the CNS and brain atrophy. Lifestyle changes help but are not as effective as getting on and staying on a disease-modifying therapy.

None of these meds are appropriate for every individual living with MS so it is important to learn what you can about the action of each of these medications and decide what, for you, are the important benefits or risks with each of them. All of these medications are expensive with the annual costs of each running between $70,000 and $100,000 per year. Private insurances cover the cost of most of them with the drug companies picking up the cost of copays for the individual but in those persons on Medicare, all of the self-administered medications have a 40 percent copay which could be an average of $3000 out of pocket each month for those. 

While there are foundations out there that have monies to assist persons to cover these costs, they all have income limits above which they cannot provide this help. This is making infusible medication the only viable option for some people for whom this is their health insurance plan. For these reasons, it is important that each individual is able to have an open dialogue with the members of their healthcare team to come up with a safe affordable plan to receive the care that is needed.

Lifestyle changes give better outcomes

• There is no one diet that has been found to be better than another but omission of sugar, lowering of salt intake, consuming less food with preservative in it all help to reduce fatigue and inflammation and affect the damage to the CNS. A focus on more fresh fruits and vegetables is stressed.
• Smoking is huge in the negative effect it has on those with MS. Smokers progress far more rapidly than those who do not smoke, or do not live with smokers.
• Exercise not only helps to improve fatigue but it prevents falls and improves endurance. Newer research is also strongly suggesting that it improves cognition.
• Connectedness in the form of being in the workforce, having family, volunteering, having an active spiritual life all reduce fatigue, depression and other health issues. Even changing one thing in this cluster helps. Support groups, adult day care and hobbies are all good ways to improve things for many individuals.

I also attended sessions on the use of medical cannabis for MS, integrative health and research progress as it pertains to myelin repair, stem cell therapies, and progress being made towards preventing and ultimately finding a cure for MS but some of that will have to wait for the next installment. Watch this space in the coming weeks for more on these topics.