Anxiety and depression are commonly experienced by patients with Lambert-Eaton myasthenic syndrome (LEMS), a rare autoimmune disorder.
In LEMS, the body mistakenly produces autoantibodies against calcium channels found on nerve cell endings, which affects signaling at the neuromuscular junctions (the point where nerve cells meet muscles). This causes weakness in the muscles of the arms, legs, shoulders, and hips. LEMS also affects the function of the autonomic nervous system that controls involuntary activities such as sweating, blood pressure, and breathing.
Signs of anxiety and depression
Anxiety can make a person feel tense, restless, and apprehensive. The physical signs of anxiety include increased heart rate, shortness of breath, headaches, insomnia, fatigue, upset stomach, frequent urination, and diarrhea.
Signs of depression include changes in appetite, lack of interest in normal activities, lack of concentration, loss of energy, feelings of hopelessness and sadness, agitation, physical aches and pains, and, in severe cases, suicidal thoughts.
Causes of anxiety and depression
Anxiety and depression are common in LEMS patients for a variety of reasons, including:
- The chronic nature of LEMS can be depressing for the patients because it affects daily activities. Many trips to the hospital for testing, treatments, or emergencies can increase stress levels, and cause high levels of anxiety and depression.
- Nearly half of LEMS patients have cancer, especially small-cell lung cancer. In such cases, having cancer can itself cause anxiety and depression, and compound the patients’ feelings about their LEMS diagnosis.
- LEMS patients experience fatigue, sleep disturbances, and pain, all of which can cause anxiety and depression.
- Several research studies have associated altered immune function (as in the case of LEMS), including changes in the levels of various immune signaling molecules called cytokines, with increased depression and anxiety.
- Medications, especially corticosteroids, can have side effects that include increased anxiety and depression. Therefore, these medications should only be used in severe cases when patients don’t respond to other treatments.
Management of anxiety and depression
Certain treatment options can help manage anxiety and depression, and are summarized below.
Psychotherapy involves sessions with a trained therapist whose goal is to recognize the patient’s negative thoughts and teach coping strategies. An important aspect of psychotherapy for LEMS patients is to understand the different aspects of the disease, treatments available, and signs of relapse. Connecting with other LEMS patients through support groups can also help.
Several types of medications are available to treat anxiety and depression. However, since LEMS patients are already undergoing therapy to manage their disease symptoms, the choice of treatment for anxiety and depression needs to be determined by the patient’s physician.
The different medications include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRIs), monoamine oxidase inhibitors (MAOIs), and Remeron (mirtazapine).
SSRIs are the most commonly used antidepressants that increase levels of serotonin, a natural chemical molecule that acts as a neurotransmitter in the brain.
SNRIs are the second most commonly used antidepressants that increase the levels of serotonin and norepinephrine in the brain.
The side effects of SSRIs and SNRIs include insomnia and nausea, among others.
NDRIs work by increasing the levels of dopamine and norepinephrine in the brain. They may cause anxiety in some patients but are effective in treating anxiety in others.
MAOIs are commonly available antidepressants that are used when other medications do not work.
Remeron is a medication that targets nerve cell receptor proteins that specifically bind either serotonin or norepinephrine in the brain. Therefore, the activity of several brain circuits is indirectly increased by its use, thereby helping to alleviate depression. Side effects of Remeron include weight gain, drowsiness, and constipation.
Aerobic exercise can help reduce mild depression by increasing the levels of endorphins in the body, which stimulate the action of norepinephrine in the brain. Yoga can also alleviate anxiety and depression through physical postures, meditation, and breathing exercises.
In acupuncture, thin sterile needles are inserted into the body at certain points that are believed to help the body’s flow of energy. It is touted as a method to relieve stress, anxiety, and depression.
Last updated: Sept. 18, 2019
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