Multiple sclerosis (MS)  affects everyone differently. If you or your loved one has MS, you are probably familiar with symptoms such as difficulty walking, fatigue, and numbness or tingling. These and other physical symptoms can be severe and limiting. However, emotional changes and mental health challenges can be just as (if not more) disabling.

Rehabilitation neuropsychologist Meghan Beier, Ph.D. , discusses three common mood and mental health concerns for people with MS and how to address them.

1. Depression

Depression  can occur in up to 50 percent of MS patients and is three times more common than in the general population. Up to 40 percent of support partners, such as caregivers and spouses, may also experience depression at some point in life. Household role changes and financial concerns, as well as depression and cognitive symptoms in the person with MS, are all factors that may contribute to caregiver distress.

Depression was identified in connection with multiple sclerosis back in the 1870s by the French neurologist Jean-Martin Charcot. However, it hasn’t been studied and seriously addressed by physicians until recent decades. Despite a better understanding of depression’s impact, it is still frequently underdiagnosed and undertreated in people with MS.

Depression in MS: a symptom or a reaction?

“It is easy to assume that people with a chronic illness like MS will inevitably become depressed,” says Beier. This incorrect assumption relies on the idea that depression is a reaction to MS. While this is possible, recent research has discovered that depression may also be a symptom.

“For persons with relapsing-remitting MS, early in the disease, depression appears to be linked to inflammatory processes. Later, in the secondary-progressive phase, unhelpful thoughts, such as feelings of guilt, worthlessness or hopelessness are more frequent. So the depression in this case is thought to be more reactive — linked to frustrations with lifestyle changes or loss of function,” explains Beier.

How to Address MS-Related Depression

Depression, together with anxiety, may worsen thoughts of suicide and shouldn’t be left untreated. In most cases, it can be effectively managed with a combination of antidepressants and cognitive behavioral therapy. This type of therapy focuses on identifying and shifting thoughts, beliefs and behaviors that may contribute to emotional distress.

2. Anxiety

Approximately half of people who have MS and depression also experience anxiety. But anxiety can also occur independently without depression. Anxiety disorders are three times more common in MS than in the general population. Anxiety has been linked to decreased social interaction, increased risk of excessive alcohol use, increased levels of pain and may even impact cognitive skills such as how fast your brain processes information.

Causes of MS-Related Anxiety

When it comes to living with multiple sclerosis, anxiety often stems from the uncertainty over what the next day will bring. In relapsing-remitting MS, the flare-ups can occur unexpectedly. “You never know if there is going to be an exacerbation, how severe the symptoms will be if an exacerbation occurs or if MS symptoms will progress over time,” says Beier. It can be difficult not to worry, especially if you have many responsibilities around caring for your health, family or children and work.

The Danger of Anxiety: Avoidance Behaviors

If you’ve ever experienced anxiety, you know it can make daily life difficult. One way some people deal with anxiety is by avoiding its source. When you get anxious about getting dizzy while driving, your instinct may be to avoid getting in the car. Or if you are afraid of having a bowel accident in public, not leaving the house may seem like a good solution. These avoidance behaviors could make you skip a doctor’s appointment, reduce your time with friends or stop you from doing what you enjoy.

“People who have both MS and anxiety are more likely to have suicidal thoughts,” adds Beier. Although data varies, it is estimated that up to 15 percent of people with MS die of suicide. If you notice avoidance behaviors, or anxiety that is impacting daily life, it’s important to start a conversation with a doctor.

Addressing MS-Related Anxiety

The treatment for anxiety includes behavioral therapy and exposure exercises to help build confidence and tolerance. Another avenue is acceptance and commitment therapy (ACT). “We identify what is most valuable to a person and then find a way to pursue that value despite their MS symptoms,” says Beier. Talk therapy and medications help address specific causes of anxiety.

3. Pseudobulbar Affect

Pseudobulbar affect is a condition rooted in a disconnect between how you feel and express emotions. If you have this condition, you may start crying suddenly, although you don’t feel sad or upset. Or you may start laughing uncontrollably over something that you don’t even find that funny.

This happens due to the breakdown in communication between the front and the back of the brain. In people with MS, brain lesions that disrupt the functioning of neurotransmitters may cause this breakdown. It may also result from the overall atrophy of the brain in later stages of MS. Steroid use can increase the risk of developing pseudobulbar affect, and reducing or stopping steroids may make it go away.

Distinguishing Pseudobulbar Affect from Other Conditions

Pseudobulbar affect can sometimes be confused with conditions such as depression, mood swings and bipolar disorder. The inappropriate outbursts of emotion can also be a source of embarrassment and anxiety.

It’s important to have this condition properly diagnosed because, unlike depression or anxiety, it can’t be treated with talk therapy or counseling. Certain antidepressants or a specially manufactured drug targeting a certain chemical in your nervous system can be used to treat pseudobulbar affect.

Don’t Be Afraid to Talk to Your Doctor

If you have MS and think you may have depression, anxiety or pseudobulbar affect, talk to your primary care physician about your symptoms. They can refer you to a rehabilitation psychologist specializing in MS or another specialist who can help.

If you are a support partner of someone with MS, watch for signs of depression and anxiety both in your loved one and in yourself. They may not always be obvious and can often look like irritability, anger or a growing detachment from social life.

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