Multiple sclerosis, or MS, can cause a host of physical symptoms, the best known of which are probably pain, fatigue and vision problems. But the disease — which damages the central nervous system — can also affect mood, memory and overall mental health.
Case in point: “At least 1 in 5 people with MS meet criteria for a depression diagnosis,” Jim Jackson, PsyD, psychologist and professor of medicine at Vanderbilt University School of Medicine, tells LIVESTRONG.com.
It’s true that any chronic illness or news of a diagnosis can cause feelings of depression, grief and social isolation.
But because MS specifically affects the central nervous system — including the home of emotional processing, the brain — it’s possible that the disease itself contributes to depression and other mood disorders, Jackson notes.
If you or a loved one has MS, it’s important to understand the connection between the disease and mental health. Getting informed is a crucial step toward protecting your mental health and quality of life.
The Connection Between MS and Mental Health
“For a long time in the history of MS, we thought the development of [mood disorders] was mainly associated with the uncertainty of navigating the disease,” Luis Manrique-Trujillo, MD, an MS and immunology fellow at Georgetown University Hospital, tells LIVESTRONG.com.
But now, doctors understand there is a connection between mood disorders and MS that goes beyond coping with the emotions of the diagnosis.
Issues like depression, anxiety and extreme irritability commonly crop up in people with MS due to a “complicated interaction between mental health, neurologic inflammation and the psychology of living with a chronic disease,” says James Stark, MD, a neurologist with the International Multiple Sclerosis Management Practice.
A few possible explanations for why MS affects mental health include the following, per Dr. Manrique-Trujillo:
- Some people with MS develop lesions — or sites of inflammation — on the brain. If these lesions develop on the temporal lobes, for example, where mood is processed in the brain, it could affect a person’s mental health.
- MS causes inflammation that can change the brain’s network of neurotransmitters — i.e., the chemical “messengers” of the brain that carry signals throughout the body. These neurotransmitters are important because, unlike the mood-processing temporal lobes, depression and anxiety aren’t localized to one specific part of the brain. Instead, Dr. Stark says both depression and anxiety arise from the more widespread network of neural circuits and neurotransmitters. If MS disrupts these chemical messengers, mental health issues can arise.
There’s also an element of circularity: Depression is one of the most common mental health side effects of MS, per the National Multiple Sclerosis Society (NMSS) — and it, in turn, can make MS symptoms worse.
In fact, a December 2019 study in Neurology found that people with MS and co-morbid depression had a significantly increased risk of their disability worsening.
What’s more, some people with MS may experience something called pseudobulbar affect, “which is characterized by inappropriate emotional responses to the situation at hand,” Dr. Stark says.
Pseudobulbar affect may manifest, for example, as laughing at something sad or feeling uncharacteristically angry during a calm moment, per the MS Society.
6 Tips to Support Your Mental Health With MS
In addition to receiving treatment for the disease itself, there are a few things you can do to help support your mental health while living with MS, including:
“MS often results in social isolation, which can lead to worsening symptoms and, in turn, contribute to more social isolation. It is really a vicious cycle,” Jackson says.
“Having people in your corner is vital, and while this comes naturally for some, it’s a far bigger challenge for others,” he adds.
He suggests starting by being vulnerable and asking others for help. This is crucial, he adds, because other people often aren’t aware of how much those with MS are struggling.
His advice extends to loved ones as well as medical providers. Doctors understand how important social support is for people with conditions like MS, and they can connect you with support groups or patient advocacy organizations.
2. Seek Out Others Who Have MS
Tap into MS associations, support groups and events to connect with other people who have experienced MS firsthand.
“Many people find support groups helpful, and I recommend these as well,” Jackson says. “They offer unique opportunities to be heard, affirmed and understood by people walking down the same winding road. The insights they share and care they extend can be particularly helpful and even transformative.”
3. Be Honest With Your Care Team
It’s also important to keep your doctors updated on your mental and emotional state.
“Your physician needs to know everything that’s going on with your health, including mental health, while managing your care,” Dr. Stark says.
They can consider incorporating psychiatric medications or other interventions. “Your mood may even be affected by a seemingly unrelated treatment you’re prescribed,” he adds.
4. Consider Therapeutic Interventions
Even with a flourishing support network, many people with MS will still need additional tools and resources to improve or maintain their mental health.
In these cases, Dr. Manrique-Trujillo says some people may benefit from both psychotherapy (talk therapy) and/or pharmacotherapy (drug therapy).
Talk therapy can help you learn coping strategies and create a safe environment to voice feelings about your condition.
Cognitive behavioral therapy (CBT) — a type of therapy often used to treat depression, anxiety and substance use disorders — can be especially helpful for those with MS.
In a December 2016 study in BMC Psychiatry, researchers studied the effectiveness of CBT in patients newly diagnosed with MS. After eight weeks of therapy, CBT was found to help a vast number of symptoms, including depression, anxiety, fatigue, pain, sleep quality, social support and quality of life.
All 30 participants in the study reported CBT treatment as “very useful,” and 73 percent reported the treatment had addressed their problems “completely.”
It’s important to note here that a combination of talk and drug therapy offer the best results, Dr. Manrique-Trujillo says.
5. Incorporate Exercise and Lifestyle Changes
There are a number of lifestyle changes you can make to help support your mental health when you have MS.
A nutritious diet, regular social interactions, exercise and good sleep hygiene can all help with managing mental health, Dr. Manrique-Trujillo says.
In fact, a March 2020 study in Contemporary Clinical Trials Communications found that people with MS who participated in physical activity over the course of six months improved their fatigue levels as well as their depression symptoms and severity.
As a result, researchers concluded that physical activity could prove an effective treatment for both fatigue and depression in MS.
6. Nix Alcohol and Stop Smoking
People with MS should also avoid drinking alcohol, as it can temporarily worsen MS symptoms, per the NMSS.
People with MS may turn to alcohol as a way to self-medicate and cope with their emotional symptoms. Anxiety, specifically, can put you at a higher risk of excessive alcohol use, Johns Hopkins Medicine.
If you have MS and drink alcohol regularly or to excess, consider speaking with your doctor for guidance.
Likewise, quitting smoking will benefit not only your overall body, but it may increase the effectiveness of your medications. The NMSS notes that smoking can increase disease activity and disrupt the body’s ability to process certain MS medications and therapies.
MS is a challenging disease to navigate, but with the support of loved ones and doctors, therapeutic intervention and lifestyle changes, it is possible to improve your quality of life.
Keep in mind, whether you experience mental health issues as a result of the disease itself or other circumstantial factors surrounding MS, it’s OK if you’re feeling down and discouraged. Be patient with yourself, know your limits and do the best you can to reach out for help.