40 msfocusmagazine.org Several years after an initial diagnosis, those with relapsing-remitting MS may stop having relapses and will experience a gradual increase of their particular MS symptoms. Thisisoftenthesignofatransitiontosecondary progressive MS. However, because no two people with MS are the same, individual disease progression will vary, and will also depend on other factors, such as: which symptoms were present earlier, how early and effective MS disease-modifying therapies have been, and whether your symptoms can be managed with available treatments. Some symptoms worsen because of the production of new lesions, whereas others worsen over time because of neuronal damage during the disease course once relapses have ceased. Regardless of your disease course, many MS symptoms don’t simply create physical challenges, but emotional ones, as well. Depressionisoneofthemostwidelyreported emotional MS symptoms. Approximately 50 percent of those with MS experience episodes of depression, regardless of their disease course. While most with MS will experience “low” or “bad” days, the highest frequency of depression in the MS community is among thosewhohavehadapriorhistoryofdepression. Also, the highest rates of depression are prevalent within the first year of diagnosis and in those younger than 35. Anxietyisanotherwidelyreportedemotional challenge among the MS population, and it is easytoseewhy.MSsymptomsareunpredictable and can wreak havoc with your need to plan and prepare for life and tasks of daily living. And with advancing age, we experience a greater need to plan and prepare. The highest rates of anxiety are correlated with younger age, when the effects of the disease and its management are still new. Grief is another prevalent emotional challenge for the MS community. It is defined as a profound sadness in response to change or loss. It is not only present with the loss of a loved one, but is also a natural reaction to any change that threatens one’s sense of self. With chronic illness, it is typical to grieve initially with the diagnosis and then feel moments of loss again whenever a symptom returns or affects your functioning. Grief is considered to be a necessary first step in The Emotional Challenges of MS Over Time: Key Factors by Dr. Miriam Franco, Psy.D., MSCS Symptom Management