Researchers found that mood and anxiety disorders were associated with a higher disability score among MS patients over an average of 10 years of follow-up.
In MS, the immune system attacks the myelin, which is the protective coating that encompasses the nerves of the central nervous system (CNS). This, in turn, leads to the formation of lesions or scars. Depending on what part of the CNS is involved – the brain, spinal cord, and/or optic nerves – a wide range of symptoms can result.
In addition to the physical symptoms that MS presents, the disease may also impact emotional health, triggering mood swings. However, the relationship between MS and emotions remains unrecognized most of the time. This is because it is easy to see the physical challenges of the disease, but in comparison, the emotional challenges of MS are far less visible on the outside.
The emotional rollercoaster of MS
MS mood swings can occur at any time, resulting in an overwhelming inability to control one’s emotions. Some of the most common mood swings in MS include the following:
- Grief – Grieving over any type of loss is considered to be a normal and healthy process. Most individuals with MS grieve over changes brought about by the disease. Such changes may include the inability to walk, the inability to work, or the inability to engage in certain leisure activities. As difficult as the process may be, it is the first step towards learning how to adapt to the changes and move forward with one’s life.
- Worry, fear, irritability, and anxiety - Worry, fear, irritability, and anxiety are all normal responses in the face of unpredictability. When faced with the difficult challenges of MS, it is only natural that such emotions take over. An understanding and supportive environment can help to ease their hold throughout the course of the disease.
- Depression - Depression is one of the most common symptoms of MS. The term applies to various emotional states, including feeling unhappy for several hours to experiencing severe clinical depression that may last for several months. Typically, treatment by a mental health professional is required and support groups may also be helpful.
At first, it may be quite difficult to adjust to a diagnosis such as MS – one that is unpredictable and carries a risk of progressing over time to a certain level of physical disability. However, failure to understand and acknowledge the disease only adds to the stress. For instance, depression is a major risk factor for suicide. The main reason why the risk of suicide among individuals with MS is so high is due to undiagnosed and under-treated depression.
In addition to the emotional responses brought about by MS, demyelination and damage to nerve fibers in the brain can also increase the risk of emotional instability. Emotions involve two different parts of the brain – one part creates emotional responses and the other part controls them. The formation of MS lesions in these parts of the brain can lead to problems with self-control, resulting in uncontrollable crying, laughing, or other emotions. These problems may even become more frequent as MS progresses.
MS mood swings and disability: what’s the connection?
According to a recent study, psychiatric disorders were associated with subsequent neurologic severity in MS patients. The researchers found that mood and anxiety disorders were associated with a higher disability score among MS patients over an average of 10 years of follow-up. “These findings emphasize the importance of using a systematic approach to identify psychiatric comorbidity in people with MS and to ensure effective treatment” said Ruth Ann Marrie, associate professor of medicine at the University of Manitoba, and fellow colleagues.
For the study, the researchers used MS-specific clinical and population-based health administrative databases in both British Columbia and Nova Scotia. They gathered data on individuals ages 18 or older diagnosed with MS from 1993 to 2004 in British Columbia or from 1992 to 2010 in Nova Scotia. In order to define psychiatric comorbidities, the researchers then created a widespread definition of mood or anxiety disorders, including depression, bipolar disorder, and anxiety. All of the disorders required 5 or more physician claims or one or more hospital claims within a five-year time frame. The first claim for a psychiatric comorbidity was considered as the date of diagnosis.
The research team also explored the effects of depression, bipolar disorder, and anxiety individually. Over an average of 10.5 years, they followed 2,312 cases of adult-onset MS. 76% of the patients were women and 92% had a relapsing course of the disease. During the follow-up period, 35.8% of the patients met the definition of mood or anxiety disorder and 43.5% met the definition before their MS even began. Depression was the most common diagnosis (37%), followed by anxiety (22.1%) and bipolar disorder (5.1%). Overall, these disorders were associated with a higher disability score on the Expanded Disability Status Scale (EDSS).
When the researchers looked at each psychiatric diagnosis individually, only depression stood out for its significantly higher disability score on the EDSS. “MS is an unpredictable and distressing condition and these data highlight that it puts people at risk for mental health difficulties, which in turn appear to hasten the progression of MS itself” said Rona Moss-Morris, a professor at King’s College in London, who was not involved in the study. “An integrated treatment approach is needed for MS, where patients are routinely screened for the possibility of comorbid mood disorder, and where indicated, offered appropriate treatment, including evidenced-based talking therapies such as cognitive behavioral therapy” she added.
It was determined that cognitive behavioral therapy should be tailored to the specific obstacles associated with MS. “Providers of talking therapies to people with MS need to be trained in how to adapt cognitive behavioral therapy in this context. They also need to recognize that many patients with MS see their low mood as a result of the challenges of the illness, rather than a primary mental health disorder” said professor Moss-Morris. In any case, further research is necessary.
Living with MS: care, management, and support
The first approach to managing MS mood swings is to talk openly and honestly with one’s doctor or a mental health professional. It is important to try to understand the reasons behind the mood swings by getting to the root cause of one’s emotions. This may be done by:
- Taking medications such as anti-depressants, anti-anxiety medications or mood stabilizers;
- Undergoing counseling sessions with a trained mental health professional;
- Turning to a friend or family member for comfort and support;
- Delegating tasks to other individuals;
- Trying out deep breathing, yoga, or mindful meditation;
- Finding additional support, such as joining an MS support group;
Mood swings are quite common in individuals with MS and for this reason, they should not be brushed off as irrelevant. Staying both physically and mentally active can help to regulate the MS rollercoaster.