Medicine & Research

Physical health and mental well-being have a symbiotic relationship. This is especially the case in multiple sclerosis. As an autoimmune disease that attacks the central nervous system, damage to brain matter can have serious consequences that include depression, anxiety, pseudobulbar affect, and personality changes.

For many years, the mental health symptoms exhibited by people with MS were not being taken as seriously as the physical symptoms. Mental illness was often considered a character failing. In the present we know differently, and the stigma of treatment has lessened considerably. Knowing the connection between MS and mental illness is the first step in improved mental and physical wellness.

Depression

Depression is real and treatable. It is significantly more common in MS than it is in other chronic diseases. It is linked to worsened disease outcomes and can contribute to symptoms such as fatigue, cognitive challenges, sexual problems, and motor skills. Nearly half of people with MS experience episodes of depression, 
compared with around 20 percent of the general population. 

Depression may be partially linked to the neuroinflammatory and neurodegenerative process. In this case there may be no clear or direct cause or event triggering the onset of symptoms, which may appear without warning.

Anxiety

Like depression, anxiety, which is a persistent state of worry or fear, can be a typical emotional response to an MS diagnosis. As an underdiagnosed and undertreated symptom of MS, anxiety is significantly more common in people with MS than in the general public. It may persist after the adjustment period in many people with MS, suggesting a link to the disease itself.

Untreated anxiety can lead to or worsen other mental and physical conditions – such as substance abuse, insomnia, digestive or bowel problems, headaches, fatigue, chronic pain, and suicidal thoughts. In severe cases, it can lead to social isolation, problems functioning at work or school, and decreased quality of life.

Pseudobulbar affect

Pseudobulbar affect is a nervous system disorder characterized by uncontrolled crying or laughing that is disproportionate or inappropriate in the social context, or is not linked to the correct emotion. While the disease mechanisms are poorly understood, it is believed the source of the condition is injury to the neurological pathways controlling emotional expression within the brain.

The outcome of this condition can be a source of embarrassment, social isolation, anxiety, and depression. It is estimated that this condition affects at least 10 percent of individuals with MS. As many as 40 percent of people experiencing symptoms do not discuss the problem with their physician. Early and accurate diagnosis is key so 
appropriate treatment can be provided.

Personality changes

Certain personality changes have been linked with lesions in particular areas of the brain. Though symptoms are relatively rare, personality changes caused by MS can have an  effect on the lives of those experiencing them.

Personality changes may include rapid mood swings, irritability and anger, blunted emotions, euphoria, disinhibited behavior, lack of initiative, and a lack of insight. Personality changes can damage relationships, interfere with work or school, and impair social functioning. The person experiencing personality change may not even be aware their behavior is altered.
 
If a person is unaware that personality changes can be a direct result of lesions in the brain, they may blame themselves or question their own motives if they find themselves behaving uncharacteristically. Knowing MS can cause personality changes is the first step in preventing their effects.

Bipolar disorder 

Bipolar disorder is a condition involving significant shifts in mood, energy levels, and behavior. The prevalence of bipolar disorder is roughly doubled in people with MS compared to the general population. Making a diagnosis of bipolar disorder can be complicated in a person with MS because lesions in certain areas on the brain can cause mania. Personality changes such as disinhibition and emotional lability can be confused with bipolar disorder.

When to get help

Untreated mental health conditions can contribute to a variety of serious health problems. Mental illness causes physical changes that affect bodily functions such as sleep, appetite, digestion, heart rate, and breathing. In people with MS, untreated mental health conditions can worsen fatigue, pain, and cognition.

Having an emotional response to MS is completely natural. This response can happen not only at the time of diagnosis, but every time you need to adjust to a new way MS affects your life. The extent to which those negative emotions will affect a person with MS will vary in the same way the physical symptoms will vary from person to person. 

Ask yourself some key questions such as, has the problem lasted more than a few weeks? Is it affecting my sleep? Is it affecting my appetite? Have my energy levels suddenly changed? Have family or friends commented on a change in my mood or behavior? If so, then it is time to speak to a healthcare provider to address your concerns.

Get help for suicidal thoughts

The risk of suicide among individuals living with MS is at least twice that of the general population. Suicidal thinking is a symptom that can be treated. The risk of suicide is highest in the first few years following diagnosis. Risk factors linked to suicidal thoughts include being younger and earlier disease course. Men are also more likely to commit suicide, which may reflect a lack of social support.

If you are experiencing suicidal thoughts, seek immediate assistance from a mental health provider, or call the National Suicide Prevention Lifeline at 800-273-8255.