Depression, Anxiety and Myasthenia Gravis

Depression and anxiety are common in people living with myasthenia gravis (MG). MG is an autoimmune condition that causes certain muscles to become weak. The muscles are weak because the body attacks places where nerves and muscles communicate.¹

This weakness often gets better after rest but can be unpredictable. This can make it hard to join in regular activities and follow through on plans. Many people with MG feel strongest in the morning and weaker by the end of the day. Or, the muscle weakness may come and go from one moment to another or one day to another.

Several studies have found that:^1-3

• Rates of depression increase as the disease MG gets more severe
• People with MG and depression tend to be younger than those who are not depressed
• People with MG who are depressed tend to have higher levels of chronic stress
• Depression and anxiety are common in people with a chronic illness

Signs of anxiety

The symptoms of depression and anxiety may overlap, but there are differences between the 2 conditions. The mental and physical signs of anxiety last for at least 6 months and may include:^4,5

• Constant or obsessive worrying
• Restlessness
• Irritability
• Muscle tension
• Headaches
• Sweating
• Difficulty concentrating
• Trouble falling asleep or staying asleep
• Fatigue
• Trembling
• Startling easily

Signs of depression

Depression is complex and can include many physical and mental symptoms. The general rule is that if you have 5 or more of the following symptoms for 2 weeks or longer, you should ask for help:^3,5

• Sadness
• Loss of energy
• Feelings of hopelessness or worthlessness
• Loss of enjoyment in things you once liked
• Problems concentrating
• Uncontrolled crying
• Trouble making decisions
• Irritability
• Sleeping more than usual
• Trouble falling asleep or staying asleep
• Stomach pains or other digestive issues
• Loss of interest in sex
• Headaches
• Thoughts of suicide or suicide attempts

Causes in people with MG

There are many things that play a role in why people with myasthenia gravis sometimes become depressed or anxious. These reasons include:^1,6

• Lack of good quality sleep due to sleep apnea and other sleep issues
• Missing activities once enjoyed
• Inability to work
• Isolation
• Worry about healthcare costs
• Feeling dependent on others

Steroids are a common treatment for autoimmune conditions like MG. Steroids help calm the immune system and prevent it from attacking healthy tissue. Traditionally, long-term use has been linked to depression and anxiety. However, newer studies have found that long-term steroid use may not be tied to depression or anxiety in people with MG.^2,6

Treatment

It is important to treat depression and anxiety in people with MG because these conditions can make MG symptoms worse and decrease quality of life.^1,6

However, treating depression or anxiety with drugs can be tricky in people with MG. A few antidepressants may make MG symptoms worse or do not work well. This also means that therapy and lifestyle changes play an important role in managing depression and anxiety in people with myasthenia gravis. Some common non-drug options for treating depression and anxiety include:^3-5

• Daily exercise (if possible)
• Spending time outdoors
• Spending time with people you enjoy
• Listening to music
• Relaxation techniques
• Cognitive behavioral therapy or biofeedback
• Practice good sleep habits

It can be hard to tell the difference between depression, anxiety, and the general side effects of myasthenia gravis, such as tiredness or sleep troubles. That is why it is important to be open about how you are feeling with your care team.