The chicken and the egg

So, which came first? Depression or fatigue? Am I depressed because I’m always tired due to MS and can’t realize my potential, or am I tired because it is one of the symptoms of depression?

I barely remember what it’s like to not be tired. When I was 18 I had glandular fever for two weeks. The blood tests came back positive for the Epstein-Barr virus (which is suspected to be connected with MS) and for at least six months after the fever my antibody count remained high. That was the first time I experienced severe fatigue. I lost a lot of weight. I did recover, but I remember telling a friend a year or two later that I had never felt the same after that, like the fatigue mono brought with it had never left me.

On the other hand I thought fatigue was normal because I suffered from insomnia. I remember when I was 15, roughly a year after I experienced being depressed for the first time, waking up in the middle of the night and not being able to fall back to sleep. This pattern remains the same to date. If I wake up, either due to a nightmare, noise, light or even for no apparent reason, unless I’m medicated, I probably won’t sleep. This began at 15 and only at 28, after years of trying everything you can possibly imagine, I went to see a psychiatrist and started taking meds.

With those meds my sleep became sound. But around six months later I noticed that, even sleeping like a baby, I would still wake up tired. That was the first time it occurred to me that something could be really wrong. But I didn’t have to dwell on that thought for long because months later I was diagnosed with MS and told fatigue is one of the main symptoms of this condition.

So I’m confused. Depression can cause insomnia and fatigue. Insomnia obviously causes fatigue. MS causes fatigue. And fatigue, in turn, can cause depression. MS drugs can also cause depression. Antidepressants can leave you groggy and with no energy. All these intertwine. And as much as I try to trace back bits and pieces of my life in search for clues, memories fade – and are not so reliable.

I stopped taking fluoxetine this weekend and I immediately noticed a difference in my sleep, as it is lighter. But today I started taking my first prescribed drug for fatigue, amantadine. My MS specialist prescribed it a couple of years ago but I never tried it because I was taking so many meds at the time I worried about possible interactions. I hope I will be able in a few weeks time to tell what it feels like to not treat depression and treat fatigue instead. Will there be any difference?

In the meantime I will be spending January tying loose ends from 2014, including college (only a month to finish my final paper!) and the switch from Copaxone to Tysabri (how hard can it be? Apparently very hard for the NHS).

I wish you all a very good year, with good health on top of all. 🙂

Epstein-Barr Virus Connection to MS

I had mononucleosis when I was 18, during my freshman year in college. For two weeks, I had sore throat, temperature, and the lymph nodes in my neck were swollen. The blood tests confirmed it was indeed mono, and for several months after my initial symptoms the antibody count remained high, suggesting my body was still fighting the infection.

I never gave it much thought, although I remember two or three years later, still in college, telling a friend of mine that I felt my energy levels never went back to normal after that. It’s like the fatigue that comes with mono never left me, and it’s still with me today.

When I was diagnosed with ms and started reading about it, the connection with the Epstein-Barr virus came up, and I felt that it made sense, at least considering my history. It’s not that everyone infected with the virus will develop ms, but being infected with it under certain circumstances (i. e., as an adult) and combined with other variables (genetic predisposition, chronic stress, etc) may produce such outcome.

Recent research has been shedding even more light on this connection.  A 2012 study proves “the virus is involved in a manner more sophisticated and subtle than previously imagined, and may offer new ways to treat or prevent the disease.”

Even more recently a new study pointed out that ms relapses occur when the Epstein-Barr virus is active.

More interestingly, scientists came up with the hypothesis that ms could be caused by a retrovirus. Retroviruses are remnants of viral infections caught by our ancestors that are passed on through our genes. They are called “fossil viruses” and up until recently they were thought to be harmless. However, research has revealed some retroviruses may play a role in several autoimmune diseases.

Based on these pieces of evidence, scientists are looking at new and promising treatments for multiple sclerosis and other disabling conditions. So who knows what possible future therapies may be in store for us?

Links to the articles: