Can MS cause depression?
Up to 50% of people with MS may develop major depressive disorder at some point. In other words, they are about three times more likely to develop depression than the general population.
Doctors have long believed that depression is a common response to life stress in people with MS. But there is growing evidence that the disease alters the brain and immune system, affecting how a person feels and behaves.
„As research progressed, as understanding grew, and as treatments improved, we realized that it was actually part of the disease itself,“ Stoll says. „This is more than just reactive depression.“
Michelle Heil, 40, discovered she had relapsing-remitting MS in her late 30s. She is completing two years of treatment with a drug that targets specific white blood cells. These white blood cells play an important role in her MS. For now, the lesions are confined to her brain.
Heil, who was diagnosed with bipolar disorder 20 years ago, said she has recently noticed an increase in the following symptoms of depression:
- lack of motivation and energy
- have little interest in leaving the house
- Difficulty paying attention to multiple things
- sleep problems
- Feeling depressed or irritable
Along with a neurologist, Heil is seeing a psychiatrist and therapist. She encourages her others to do the same, but she understands that focusing on their own happiness takes effort on her part.
„When you have multiple sclerosis, you don't have as much energy to put into it, so you put that energy into getting through the day,“ she says. “Mental health gets sidelined.”
Unmanaged depression can make it difficult to start and continue MS treatment. You are also more likely to experience other health problems, such as:
- Inflammation and immune system problems
- vascular disease
- Heart disease
- suicidal thoughts
- death for any reason
Tell your doctor if you have symptoms of depression. If you think you may be injured, seek immediate medical attention.
Can MS cause anxiety?
Stoll likens life with MS to the stress of living through the COVID-19 pandemic. It's unpredictable.
„That big unknown is something MS patients deal with every day,“ Stoll says. „And part of the treatment for this disease, and for anxiety and depression, is coaching[MS patients]through this uncertain world.“
For example, if there is damage to the spinal cord, Stoll says, the skin can look like it's not actually there. That can cause feelings of anxiety. „Imagine standing in a group of people talking at a cocktail party and holding your stomach to keep your guts from falling out.“
A few years before her diagnosis, Ms Heil „suddenly“ started having severe anxiety. Her symptoms got so bad that she had to take time off from work. She thought it was stress. But she thinks it might have been something else. A hug from MS.
„It felt like I was being hugged by a giant bear and I couldn't breathe. It felt like I was having a panic attack,“ Heil said. „But perhaps I was having a flare-up and that's how the symptoms manifested.“
Stoll says that, similar to depression, the „brain reworking and rewiring“ that can occur in MS may be part of the cause of anxiety. However, it can also be due to life events. Your doctor can help you understand the differences and find treatments to address what you're most concerned about.
Can MS cause other emotional changes?
Some people with MS have adjustment disorders that make it very difficult for them to adapt to stressful changes in their lives. And they are about twice as likely to be diagnosed with bipolar disorder than the general population.
You or your family may notice that you become moody or angry easily. It can be caused by changes in the brain, stress, or mood problems such as depression.
Heil says she has difficulty controlling her emotional reactions. „When I get angry about something, I get so angry that I basically can't speak or function,“ she says. „I feel like my brain short-circuited and I just start crying. I have an incredibly short temper.“
Although less common, MS brain lesions can cause pseudobulbar palsy (PBA). „It's an inappropriate feeling,“ Stoll said. „Some people cry for no reason, but after a few minutes or an hour they laugh and become ecstatic for no reason or with minimal stimulation.“
PBA can look like depression, mood swings, or bipolar disorder. However, they tend to occur more suddenly than mood disorders. Some people liken their emotional outbursts to seizures. Although talk therapy does not seem to be effective, there are medications available to treat PBA.
Where can I get treatment for depression and anxiety?
You can start with your doctor. Check for other medications or health problems that may be causing your symptoms. However, a neurologist may be able to provide better MS-related care.
Ask your doctor to refer you to a rehabilitation psychologist who treats people with MS.
A therapist can help you accept your diagnosis and find ways to deal with your problems head on. A method called cognitive behavioral therapy (CBT) may help relieve pain, fatigue, anxiety, and depression.
Stoll regularly refers MS patients for counseling. Antidepressants can also be of great help. There are also depression medications that can be used to treat nerve pain, headaches, and sleep disorders.
“As an MS specialist, I like two-in-one drugs.”
For Heil, mental health treatment is as important as annual brain scans and MS treatment. However, her health condition is still developing.
“No one is offering a handbook on how to do this, like a top 10 list that is guaranteed to make your life easier if you have MS.”