Today I speak with Dr. Emine Rabia Koç about the important intersection between mood disorders and patient care in multiple sclerosis. As an associate professor at Uludağ University Faculty of Medicine and a dedicated neurologist, Dr. Koç brings a wealth of knowledge and compassion to the MS community.
In this interview, Dr. Koç discusses the profound impact that mood disorders have on MS treatment and patient well-being. From her personal journey into the field of neuroimmunology to practical advice for patients and caregivers, Dr. Koç provides insights that underscore the importance of comprehensive care strategies that address both the physical and emotional facets of living with MS.
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Table of Contents
Introduction – Who is Emine Rabia Koç?
Thank you for the invitation. I am Emine Rabia Koç, Associate Professor at Uludağ University, Faculty of Medicine, Department of Neurology. Working in the field of neurology is a passion for me. During my neurology residency, neuroimmunology and autoimmune diseases of the nervous system were areas that particularly interested me. After completing my residency, I started working and doing research in this field. The more I learned, the more I loved it, and I continued my education and training in this field. Since 2022, I have been a student in the MS Master program organized in partnership with the University of Dresden and the European Charcot MS Foundation.
I am also an ambassador for the Sumaira Foundation, the voice of NMOSD and MOGAD patients worldwide.
I try to balance my life in this cycle; I am married and have two children. The moments I spend with them are precious to me. I like walking in nature, swimming, cycling, reading books, and visiting different places and cultures in my free time.
Personal motivation for your career choice?
It may sound very traditional, but I have wanted to be a doctor since childhood. As you know, MS mainly affects young adults, so from the moment the disease is diagnosed, you become a part of your patient’s family. You start to share their joy and sorrows with them. You witness their special moments, marriage, birth, and children’s growth. With each new patient, you open the cover of a new book and start a new story. In fact, you write that story together.
The complex yet fascinating approach of neurology, which focuses on the brain and nervous system, offers a unique opportunity to contribute to the well-being of patients with conditions such as MS. While working in this field, I aim to contribute to scientific research, on the one hand, improve the quality of life of patients and to „sign happy ending stories“ with them.
Impact of COVID-19 Pandemic and Support for Future Challenges
How did the COVID-19 lockdown affect mood disorders in MS patients, particularly regarding anxiety, depression, and isolation?
The COVID-19 lockdown significantly impacted the mental health of individuals living with MS. A study highlighted that many MS patients experienced increased stress, anxiety, and depression during this period. Specifically, younger patients, those with progressive MS, and individuals with pre-existing mental health issues were particularly affected.
Coping strategies played a crucial role in determining the mental health outcomes for these patients. Those who employed active coping methods, such as problem-solving, tended to maintain a more positive outlook, while those lacking effective coping skills reported feeling more negatively impacted.
Isolation was a major challenge, leading to feelings of loneliness that exacerbated anxiety and depression. The absence of in-person support from friends and family further contributed to mental health struggles. Although some patients initially managed well, there are concerns that prolonged isolation could lead to worsening mental health issues over time.
In short, the COVID-19 lockdown heightened stress and mental health challenges for many MS patients, with certain demographics being more vulnerable. The need for ongoing support and monitoring is essential to help the MS community cope with the long-term effects of the pandemic.
If a situation like the lockdown were to occur again, what kind of support systems should be in place to help MS patients manage their mood disorders?
In the event of a similar situation occurring again, we should establish alternative support systems, such as telehealth services and online support groups. Additionally, improving access to psychological support services and organizing community events to strengthen social connections will be essential.
What have we learned from the lockdown that can be applied to improve mental health support for MS patients in the future?
For me, one of the most important things we’ve learned is that the pandemic has highlighted the importance of mental health alongside physical health. The effectiveness of remote therapy and support groups was proven, indicating that future mental health services should be more accessible and flexible.
Understanding Mood Disorders in MS
How common are mood disorders like depression, anxiety, and bipolar disorder among MS patients?
Mood disorders are highly prevalent among MS patients, with significant implications for their overall health and quality of life.
Approximately 30% to 50% of individuals with MS will experience a major depressive episode at some point during their illness. This high rate is attributed to both the challenges of living with a chronic disease and the biological effects of MS itself, which can affect mood regulation.
Anxiety disorders are also prevalent among MS patients, with some experts suggesting that anxiety may be as common as depression. The unpredictability of MS symptoms contributes to heightened anxiety levels, which can severely impact patients’ daily lives.
The prevalence of bipolar disorder in the MS population is higher than in the general public, and it can complicate the management of MS.
We know that mood disorders in MS patients are associated with lower quality of life, increased fatigue, and reduced adherence to treatment. The presence of these disorders can complicate the management of MS and lead to worse health outcomes.
Can you explain the connection between MS and mood disorders, and why MS patients might be more susceptible to these conditions?
Mood disorders are highly prevalent among individuals with MS due to a combination of biological, psychological, and social factors. Here’s a look at these factors:
-MS causes demyelination and lesions in the brain, which can affect areas responsible for mood regulation. These neurological changes can lead to emotional disturbances, such as increased sadness, anxiety, or even euphoria in some cases. Another factor is inflammation. Inflammation in the brain associated with MS may also contribute to mood disorders. This inflammation can affect neurotransmitter systems that are crucial for regulating mood.
The psychological impact of living with MS can exacerbate mood disorders: Receiving an MS diagnosis can lead to feelings of grief, fear, and uncertainty about the future, which can contribute to depression and anxiety.
Also, the physical limitations and changes in lifestyle that come with MS can lead to feelings of helplessness and isolation, further worsening mood disorders.
Recognizing and addressing these mood disorders is vital to improving the overall well-being of people living with MS.
Regular screening and integrated treatment approaches can help effectively manage these challenges.
Clinical Relevance and Treatment Implications
How does understanding a patient's mood disorder influence the overall treatment plan for their MS?
Understanding mood disorders in multiple sclerosis (MS) patients is crucial for developing effective treatment plans. Let’s overview of how mood disorders influence MS treatment:
Holistic Treatment Planning
When healthcare providers recognize mood disorders like depression or anxiety in MS patients, they can create treatment plans that address both neurological and psychological needs. This means that treatment will not only focus on physical symptoms but also aim to improve mental health, which is vital for overall well-being.
Treatment Adherence
Patients with mood disorders often struggle to stick to their treatment plans. For example, depression can lead to feelings of hopelessness and fatigue, making it hard to follow prescribed regimens. By identifying and addressing mood disorders early, doctors can implement strategies to improve adherence, such as counseling or medication for depression or anxiety. This can enhance the effectiveness of MS treatments.
Tailored Interventions
Understanding a patient’s mood disorder allows for personalized interventions that can significantly improve their quality of life. If a patient is depressed, their treatment plan may include antidepressants, therapy, or lifestyle changes to boost mood. If anxiety is present, therapies like cognitive-behavioral therapy (CBT) can help manage symptoms.
Monitoring and Support
Patients with mood disorders may need more frequent check-ins and support.
Quality of Life
Addressing mood disorders can greatly enhance a patient’s quality of life, leading to better social interactions, improved family relationships, and a more positive outlook. If we focus on both the neurological and psychological aspects of MS, we can improve patient outcomes and support their mental health needs.
So, understanding a patient’s mood disorder is essential for creating effective MS treatment plans.
Best Practices and Recommendations
What are some best practices for managing mood disorders in MS patients that you've found effective in your clinical experience?
The most important thing is the multidisciplinary approach; Collaboration among neurologists, psychologists, physiotherapists, and other health professionals to support overall health.
-tailor treatment plans to individual needs,
use antidepressants or anxiolytics effectively,
provide emotional support and coping strategies, such as cognitive behavioral therapy (CBT),
engaging in support groups can reduce feelings of isolation,
regular exercise can improve both physical and mental health by releasing endorphins
meditation, deep breathing exercises, and relaxation strategies to manage stress.
What advice would you give to MS patients who are struggling with mood disorders and their caregivers?
I can give some important advice for both MS patients and their caregivers. Managing life with MS can be challenging, and it’s crucial to have strategies to support both the patients and those who care for them.
First, for MS patients:
- Don’t Isolate Yourself: Living with MS can feel lonely at times. Connecting with support groups and people who have similar experiences can help alleviate these feelings and make you feel more supported.
- Share Your Feelings: It can be hard to open up about your emotions, but doing so can lighten your burden. Talking to a trusted friend, family member, or therapist can be very helpful.
- Set Small Goals: Make daily life more manageable by setting small, achievable goals. This can boost your sense of accomplishment and motivation.
- Take Care of Yourself: Paying attention to your physical health positively impacts your emotional well-being. Regular exercise, a balanced diet, and adequate rest are crucial for your overall health.
- Be Kind to Yourself: Practice self-compassion. Respect the challenges you face and encourage yourself through difficult times.
Now, for caregivers:
- Don’t Neglect Yourself: It’s important to prioritize your own health and well-being. Taking care of your own needs helps you be a more effective caregiver.
- Seek Support: Joining caregiver support groups or seeking counseling can help you manage stress and share experiences with others in similar situations.
- Take Time for Yourself: Engage in activities and hobbies you enjoy to recharge and maintain your own well-being.
- Communicate Openly: Maintain honest and supportive communication with the person you’re caring for. Sharing feelings and working together can foster mutual understanding and support.
- Be Patient and Understanding: Understanding the challenges of MS can enhance your ability to provide compassionate care. Recognizing the patient’s feelings and needs strengthens your support.
Both patients and caregivers can navigate this journey more effectively by supporting each other and staying strong together. By being there for one another, you can make this process easier both physically and emotionally.
Screening and Assessment
Who among the MS patient population might benefit most from being tested for mood disorders, including bipolar disorder?
We have a neuropsychologist in our clinic who screens every newly diagnosed patient for mood disorders from the very beginning. We repeat these screening tests every six months. If there is any deterioration in these tests, we consult our patients with our psychiatrists and direct their treatment with a multidisciplinary approach.
Is there a short questionnaire or screening tool that can help identify MS patients who may be experiencing mood disorders, such as bipolar disorder, and should seek further evaluation?
Oh yes, but remember, these scales are only used for screening, not diagnosis.
Quickfire Q&A Session
Complete the sentence: "For me, multiple sclerosis is...."
For me, MS is a puzzle with many pieces still missing.
What development would you like to see in the field of multiple sclerosis in the next 5 years?
I would like to see advancements in personalized medicine for MS
I would like to see the identification of reliable biomarkers that can predict disease progression and treatment response.
I hope that we will yield new therapies promoting remyelination and neuroprotection.
I hope for improved accessibility to MS treatments and resources worldwide.
Farewell
Finally, what message of hope or encouragement would you like to share with the listeners?
Be hopeful and patient.
To everyone living with MS, I want to emphasize that you are not alone in this journey.
There is a vibrant community of support out there, and advancements in research and treatment are happening every day.
Embrace your strength, seek out connections, and remember that every small step forward counts.
Your experience matters, and together we can continue to push for a brighter future.
How and where can interested people follow your research activities?
If you’re interested in following my research activities, you can find updates on my work through my university’s website and social media platforms. I also regularly share insights and findings on LinkedIn (Emine Rabia Koç),instagram(drkocrabia) where I engage with the MS community. I encourage everyone to stay connected, as collaboration and communication are key to advancing our understanding of MS.
Many thanks to Rabia for giving us some insight views into the interaction of mood disorders and MS and for all her efforts that contribute in better health outcomes for her patients.
See you soon and try to make the best out of your life,
Nele
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