Mindfulness Helps to Reduce Depression, Fatigue in MS Patients

Among people with multiple sclerosis (MS), mindfulness — paying attention to the present moment in a purposeful and nonjudgmental manner — is associated with reduced depression, which also leads to a decrease in fatigue, a small study reports.

The study involved 69 relapsing-remitting MS patients from an outpatient clinic in Germany who were evaluated using self-assessment tools following mindfulness-based interventions.

“The results suggest that mindfulness might be particularly relevant to counteract depression in MS which in turn can reduce fatigue,” the investigators wrote.

The team noted that it remained to be studied whether such practices would help patients who primarily experience fatigue without symptoms of depression.

“Further research on the feasibility and effectiveness of treatment approaches for ameliorating fatigue in the absence of depressive symptoms is warranted,” they wrote.

The study, “Trait mindfulness is primarily associated with depression and not with fatigue in multiple sclerosis (MS): implications for mindfulness-based interventions,” was published in BMC Neurology.

Depression and fatigue are common in people with MS. While fatigue results from MS-related chronic inflammation and neuronal damage, depression is caused by psychological and social factors that may not be directly related to MS.

Both depression and fatigue may be managed through mindfulness-based interventions, which are designed to boost mental well-being by purposefully staying present in the moment and acknowledging one’s feelings in an honest but nonjudgmental way. Trait mindfulness is defined as a permanent state of paying attention to the present moment in all aspects of life.

Hypothesizing that depression mediates the association between mindfulness and fatigue, a team of German researchers now explored the relationship between trait mindfulness, depression, and fatigue in MS patients. 

A total of 69 patients (73.9% female) were recruited from an outpatient clinic in Bayreuth, near the country’s eastern border, and evaluated using three self-assessment tools. These were the Center for Epidemiological Studies Depression Scale, the Wuerzburger Fatigue Inventory for Multiple Sclerosis, and the German short version of the Freiburg Mindfulness Inventory.

Among the participants, the mean age was 40.1, and the mean time since diagnosis was 7.1 years. At the study’s start, the median Expanded Disability Status Scale level was 2, reflecting minimal disability, and 85.5% of patients were taking disease-modifying therapies.

The results showed that greater use and acceptance of trait mindfulness by patients were moderately associated with reduced depressive symptoms and weakly associated with reduced physical and cognitive fatigue.

“The results of the current study are generally compatible with the hypothesis that trait mindfulness may alleviate suffering from fatigue by decreasing depressive symptoms,” the researchers wrote.

An analysis of the mechanism driving the association between mindfulness and cognitive fatigue indicated that depression functions as a significant mediator of that relationship. What that means is that mindfulness does not appear to directly reduce fatigue. Instead, it only does so indirectly through the reduction of symptoms of depression.

“It may be suggested that the central target of [mindfulness-based interventions] should be the reduction of depressive symptoms and not of fatigue per se. Trait mindfulness might reduce depression which in turn might help to effectively cope with the psychological stress caused by fatigue,” the research team concluded.

The study may have been limited, according to the researchers, by its observational nature, the lack of an objective pain assessment, the inclusion of patients with relatively mild MS symptoms, and the assumptions that other psychological and social factors are not directly contributing to fatigue and depression in MS patients.