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Multiple sclerosis (MS) symptoms:
depression or mood swings

What is depression?

Depression is a serious condition that appears to be more common in people living with MS. The term "depression" is used broadly when it comes to people with multiple sclerosis. It is often used to describe a wide range of emotions, from feeling down for a few hours one day, to clinical depression, which may last for months. People with MS, as well as their friends and family, need to know that depression, in whatever form, is common.

How does depression affect people with MS?

People living with MS can experience a wide range of emotions including anxiety, fear, anger, frustration, worry, grief, guilt and stress. Feeling emotional is normal when faced with a chronic illness, and there is no right or wrong way to deal with these feelings. However, it's important to understand the difference between feeling down and clinical depression.

You cannot control or prevent depression, but it is very treatable.

While we still do not fully understand the nature of depression in MS, we do know that:

  • Stress is a major factor in depression. The stress of dealing with a diagnosis of a chronic disease and the possibility of disability can bring on depression.
  • The disease process of MS may cause depression. If MS damages areas of the brain that are involved in emotional expression and control, a variety of behavioral changes can result, including depression.
  • Depression may also be associated with MS-related changes that occur in the immune or neuroendocrine systems.
  • Depression can also be a side effect of some medications.

How do I know if I'm having a major depressive episode?

People with MS often go through a period of grieving. They may grieve the losses they experience due to MS, such as walking or working. This mourning may look like depression. However, grief eventually goes away on its own.

Clinical depression is a serious condition that can last from at least two weeks to several months. It produces flare-ups known as "episodes."

Symptoms of depression appear to be more common in people living with MS. Symptoms of depression may also be associated with some MS treatments. If you experience symptoms of depression or have thoughts of death or suicide, contact your doctor immediately.

Symptoms of a major depressive episode:

  • Sadness
  • Loss of interest or pleasure in everyday activities
  • Loss of or increase in appetite
  • Insomnia or sleeping too much
  • Agitation or slowing in behavior
  • Fatigue (feeling of tiredness)
  • Feelings of worthlessness or guilt
  • Problems with thinking or concentration
  • Ongoing thoughts of death or suicide

Dealing with depression

Depression does not mean that you are "weak." You should not feel ashamed about being depressed or feel the need to hide it. You cannot control or prevent depression, but it is very treatable.

Depression can be diagnosed only by a health care professional. Therapy or medication may be needed. A health care professional can treat the condition and prevent an even deeper depression that is harder to treat. It may be necessary to try different medications and different doses before an effective medication, or combination of medications, is found. If you suspect you are suffering from depression, please talk with your health care professional. He or she can get you the help you need.

Dealing with the ups and downs that come with living with MS

There are many strategies you can incorporate into your life to help manage your emotions. Here are some ideas:

  • Talk openly about your feelings so those close to you can learn how best to support you.
  • Allow for two-way communication. Regular family meetings are a good outlet for communication.
  • Reach out to a loved one if you need help.
  • Spend time with others.
  • Get connected to others with MS.
  • Get involved in the community.
  • Find time to relax.
  • Use exercise as an outlet (Always talk to a health care professional before beginning any exercise program.)
  • Watch out for comfort eating which may provide a short-term lift but can provide empty calories that don't offer the nutritional value your body needs.
  • Laugh as much as possible.
  • Try to focus on the positive.

Talk to your health care professional about what strategies may help you manage your emotions.


Rebif® (interferon beta-1a) is used to treat relapsing forms of MS to decrease the frequency of relapses and delay the occurrence of some of the physical disability that is common in people with MS. Rebif is not approved for treatment of chronic progressive MS.

Important safety information

What is the most important information I should know about Rebif?

Rebif will not cure multiple sclerosis (MS) but it has been shown to decrease the number of flare-ups and slow the occurrence of some of the physical disability that is common in people with MS. Rebif can cause serious side effects, so before you start taking Rebif, you should talk with your doctor about the possible benefits of Rebif and its possible side effects to decide if Rebif is right for you. Potential serious side effects include:

  • Depression. Some patients treated with interferons, including Rebif, have become seriously depressed (feeling sad). Some patients have thought about killing themselves and a few have committed suicide. Depression (a sinking of spirits or sadness) is not uncommon in people with multiple sclerosis. However, if you are feeling noticeably sadder or helpless, or feel like hurting yourself or others, you should tell a family member or friend right away and call your doctor as soon as possible. Your doctor may ask that you stop using Rebif. You should also tell your doctor if you have ever had any mental illness, including depression, and if you take any medications for depression
  • Liver problems. Your liver may be affected by taking Rebif and a few patients have developed severe liver injury. Your health care provider may ask you to have regular blood tests to make sure that your liver is working properly. If your skin or the whites of your eyes become yellow or if you are bruising easily you should call your doctor right away
  • Risk to pregnancy. If you become pregnant while taking Rebif you should call your doctor right away. Rebif may cause you to lose your baby (miscarry) or may cause harm to your unborn child. You and your doctor will need to decide whether the potential benefit of taking Rebif is greater than the risks are to your unborn child
  • Allergic reactions. Some patients taking Rebif have had severe allergic reactions leading to difficulty breathing and loss of consciousness. Allergic reactions can happen after your first dose or may not happen until after you have taken Rebif many times. Less severe allergic reactions, such as itching, flushing or skin bumps, can also happen at any time. If you think you are having an allergic reaction, stop using Rebif immediately and call your doctor
  • Injection-site problems. Rebif may cause redness, pain or swelling at the place where an injection was given. Some patients have developed skin infections or areas of severe skin damage (necrosis) requiring treatment by a doctor. If one of your injection sites becomes swollen and painful or the area looks infected and it doesn’t heal within a few days, you should call your doctor. For more information, please see Medication Guide

Who should not take Rebif?

Do not take Rebif if you:

  • Have had an allergic reaction, such as difficulty breathing, flushing, or hives, to another interferon beta or to human albumin

If you have any of the following conditions or serious medical problems, you should tell your doctor before taking Rebif:

  • Depression (a sinking feeling or sadness), anxiety (feeling uneasy or fearful for no reason), or trouble sleeping
  • Liver diseases
  • Problems with your thyroid gland
  • Blood problems, such as bleeding or bruising easily, and anemia (low red blood cells) or low white blood cells
  • Epilepsy
  • Are planning to become pregnant

Tell your doctor about all medicines you take, including prescription and non-prescription medicines, vitamins and herbal supplements. Rebif and other medicines may affect each other, causing serious side effects. Talk to your doctor before you take any new medicines.

What are the possible side effects of Rebif?

  • Flu-like symptoms (fever, chills, sweating, muscle aches and tiredness)
  • Skin reactions. Soreness, redness, pain, bruising, or swelling may occur at the place of injection
  • Depression and anxiety. Some patients taking interferons have become very depressed and/or anxious
  • Liver problems
  • Abdominal pain
  • Blood problems. You may have a drop in the levels of infection-fighting blood cells, red blood cells or cells that help to form blood clots. If the drop in levels is severe, it can lessen your ability to fight infections, make you feel tired or sluggish or cause you to bruise or bleed easily
  • Thyroid problems. Your thyroid function may change. Symptoms of changes in the function of your thyroid include feeling cold or hot all the time, change in your weight (gain or loss) without a change in your diet or amount of exercise you are getting
  • Severe allergic reactions. Allergic reactions are rare and may be associated with difficulty in breathing and loss of consciousness, which require immediate medical attention

Let your doctor know if you have any of these symptoms or feel sad, tired, hot or cold, or experience hives, rashes, bruising, yellowing of the skin, or a change in body weight (gain or loss).

Refer to the Instructions for Use that comes with the Rebif® Rebidose® (interferon beta-1a) autoinjector.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call

This information is not intended to replace discussions with your doctor. For additional information about Rebif, please consult the Prescribing Information and Medication Guide and talk to your doctor. You can also visit www.rebif.com or call toll-free 1-877-447-3243. Rebif is available by prescription only.

MS LifeLines is an educational support service for people living with MS and their families. Speakers and MS LifeLines Ambassadors who participate in Talk MS or in live events are sponsored by EMD Serono, Inc. and Pfizer Inc. Rebif, Rebif Rebidose, Rebiject II, MS LifeLines, and the Rebif logo are registered trademarks of EMD Serono, Inc. or its affiliates.

Brought to you by EMD Serono, Inc. and Pfizer Inc, the co-marketers of Rebif in the US.

This information is intended only for residents of the United States.