You may think of multiple sclerosis as a physical condition, one that injures nerves and results in symptoms such as weakness, fatigue, trouble walking, bladder problems or vision loss. But MS has a profound, lifelong emotional component that includes mood swings, anxiety and depression. “MS is a chronic condition. Dealing with the emotional part of it requires an evolving approach, just like dealing with the neurological part of it,” says Dr. Christopher Stewart, a neuropsychologist and assistant professor at Rush University Medical Center.
[See: Am I Just Sad — or Actually Depressed? ]
The Emotional Link
In MS, your immune system attacks the coating of the nerves (called myelin) as well as the nerve fibers. Damage can occur along the spinal cord and optic nerves, and in the brain. “Damage in areas of the brain associated with mood — such as the prefrontal cortex and the amygdala — may affect emotional processing,” suggests Dr. Peter Arnett, a professor of psychology at Penn State University who’s been studying emotional function in people with MS for 20 years. He says the interruption of nerve signals causes the neurons to misfire, which may lead to irritability and mood swings.
MS is also commonly associated with anxiety disorders — characterized by obsessive worrying or fear that doesn’t go away — and clinical depression, which can include persistent feelings of hopeless or sadness that last for more than two weeks. Treatment guidelines issued in 2014 by the American Academy of Neurology suggest that over a lifetime, up to 54 percent of people with MS will experience depression at some point. “But a lot of people with MS may not yet be diagnosed. At any given time, more than 20 percent of people with MS may have depression,” Arnett says.
It’s unclear why and when depression develops in people with MS. “It depends on the location of the lesions and the amount of brain atrophy (shrinkage) and disruption of pathways in the brain. That explains about 40 percent of depression in MS,” Arnett explains.
The rest, he believes, is associated with how people cope with MS.
[See: Apps to Mind Your Mental Health.]
Cascade of Emotions
Stewart has noticed that people begin coping with MS before it’s even diagnosed. “There’s usually a period where the person starts experiencing some symptoms of MS, but doesn’t know the underlying cause, and that can lead to a lot of anxiety,” Stewart says.
While it can be a relief to finally get a diagnosis, it can also be difficult to come to terms with a chronic condition that will have to be managed for life. “The biggest emotions initially are sadness and mourning. People worry about losing some daily functioning, and how that will affect them at home, in relationships and at work. It can be anxiety-provoking,” Stewart says.
“Some people do better in the adjustment period than others. It depends on the severity of symptoms,” Arnett explains. “But we know that when people use coping strategies to actively address the problem, they’re much better able to function.”
Tools to cope with the emotional side of MS are the same if you’re in the beginning stages of the disease or if you’ve had it for a long time.
Medical Approaches
To treat MS-related depression or anxiety, your doctor will likely start by ruling out or addressing underlying conditions that can contribute to the problem, such as:
— Sleep problems, such as sleep apnea (pauses in breathing during sleep), restless leg syndrome or insomnia
— Side effects from medications, such as steroids, which may induce depression, according to the Multiple Sclerosis Association of America
— Stress
— B12 deficiency
[See: 12 Best Heart-Healthy Diets.]
Some MS symptoms may also fuel depression. A major culprit is fatigue, Arnett notes, which is also one of the biggest MS-related complaints. “If you can treat fatigue with medication or lifestyle changes, that’s something that can improve depression,” he says. “Don’t wait until fatigue builds up and you feel exhausted. Take short breaks throughout the day.”
In severe cases of depression or anxiety, your doctor may prescribe medication, such as a selective serotonin reuptake inhibitor, or SSRI. Examples of SSRIs include fluoxetine (Prozac) or sertraline (Zoloft). These medications increase the availability of a brain chemical called serotonin, which helps regulate mood and anxiety.
Do SSRIs affect people with MS differently than people who do not have brain or nerve damage? “They seem to work just as well, but it depends on the brain of that particular individual,” Arnett says. However, SSRIs may have side effects, such as insomnia, which can fuel fatigue and depression, so it’s important to monitor sleep problems while taking SSRIs.
Strategies to Try at Home
Other ways to keep MS-related emotions in check include the following lifestyle changes or coping strategies that you can employ on your own.
Social support. “Many studies have shown that people who have more social support are less likely to be depressed. Don’t withdraw from your friends. Go out for a cup of coffee, even if it’s difficult. Join a support group. Get involved in an activity you enjoy or get involved in a group where you meet other people,” Arnett suggests.
“You need to find a way to still have relationships. Be flexible. You might not be able to physically run around at the park with your friends or kids, but it doesn’t mean you can’t go to the park,” Stewart adds.
Exercise. “Regular aerobic exercise can treat depression as well as medication or therapy in mild or moderate depression,” Arnett says. He recommends 30 minutes of moderate intensity aerobic exercise per day, such as brisk walking.
Stress relief. “Your mood worsens when you’re stressed. That can manifest in anxiety, nervousness and sadness,” Stewart says. Try deep breathing, meditation or guided imagery.
Volunteering. “This is key,” Stewart says. “It gives you a sense of purpose. Maintaining that sense of purpose will help you get up every day. And again, be flexible. If you were work-oriented, maybe now you can become an advocate for patients with MS. It’s a different kind of purpose than before the diagnosis.”
Does It Work?
Not everyone responds to depression treatment, but that doesn’t mean you should give up. “You need a team willing to continue working with you, even if the first treatment isn’t as effective as you want. Talk often with your MS doctor and also your primary care physician, whom you might see more regularly,” Stewart advises.
“Depression is just as treatable in MS as it is in someone who doesn’t have MS,” Arnett says. “You can’t change lesions in a brain, but you can build up social support or learn more active coping strategies or go through therapy, and that can improve mood. There’s a lot of hope.”
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Managing the Emotional Side of Multiple Sclerosis originally appeared on usnews.com
