Managing the Emotional Side of Multiple Sclerosis

You may think of multiple sclerosis as a physical condition, one that injures nerves and results in symptoms such as weakness, fatigue, trouble walking, bladder problems or vision loss. But MS has a profound, lifelong emotional component that includes mood swings, anxiety and depression. “MS is a chronic condition. Dealing with the emotional part of it requires an evolving approach, just like dealing with the neurological part of it,” says Dr. Christopher Stewart, a neuropsychologist and assistant professor at Rush University Medical Center.

[See: Am I Just Sad – or Actually Depressed?]

The Emotional Link

In MS, your immune system attacks the coating of the nerves (called myelin) as well as the nerve fibers. Damage can occur along the spinal cord and optic nerves, and in the brain. “Damage in areas of the brain associated with mood – such as the prefrontal cortex and the amygdala – may affect emotional processing,” suggests Dr. Peter Arnett, a professor of psychology at Penn State University who’s been studying emotional function in people with MS for 20 years. He says the interruption of nerve signals causes the neurons to misfire, which may lead to irritability and mood swings.

MS is also commonly associated with anxiety disorders – characterized by obsessive worrying or fear that doesn’t go away – and clinical depression, which can include persistent feelings of hopelessness or sadness that last for more than two weeks. Treatment guidelines issued in 2014 by the American Academy of Neurology suggest that over a lifetime, up to 54 percent of people with MS will experience depression at some point. “But a lot of people with MS may not yet be diagnosed. At any given time, more than 20 percent of people with MS may have depression,” Arnett says.

It’s unclear why and when depression develops in people with MS. “It depends on the location of the lesions and the amount of brain atrophy (shrinkage) and disruption of pathways in the brain. That explains about 40 percent of depression in MS,” Arnett explains.

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