Emotional changes

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Having MS is emotionally challenging. In fact, the first thing that you may find yourself doing once you’ve been diagnosed with MS is dealing with the powerful feelings that surface. Apart from these initial emotional reactions, a person may experience emotional symptoms that result directly from damage to the CNS (the same nerve damage that causes cognitive and physical symptoms).

Our initial reaction to the diagnosis of MS

Each individual has a unique personality, so one person’s emotional reaction to MS may be very different from another’s. However, there are some common feelings that you may encounter, such as shock, denial, confusion, anxiety, anger, and relief.

Feelings you may experience…

Shock

  • This is a typical first reaction to a diagnosis of MS
  • Allow yourself to acknowledge your shock, then talk to your friends and family and get some support
  • Once you’ve given yourself space, then learn all you can about living with MS

Denial

  • You may go through a period where you avoid feeling and thinking about your diagnosis and what it may mean to your life
  • This is easy to do with MS, because exacerbations can clear up and leave you feeling like your old self
  • Allow yourself space for a healthy amount of denial (it’s a natural reaction), but don’t get stuck denying that you have MS

Confusion

  • Being told you have MS can be confusing: we all want to know why something like this happens, but, unfortunately, you probably won’t ever find an explanation

Anger

  • Anger is a pretty normal way of reacting to something that threatens to change your life
  • Once you’ve gotten over your initial anger at having been dealt a difficult hand, the challenge will be to find a way of channeling anger in a positive way to become your own best advocate for living with MS

Anxiety

  • Once you’ve accepted that you have MS, you may experience anxiety about your future and the challenges that you face
  • You will be challenged to learn to take each day as it comes: this is the opportunity of a chronic disease like MS, that you learn to live and embrace the present

Relief

  • It may seem impossible that a person would react to MS with relief, but once the air has cleared, and you know the facts about how MS typically progresses and how a person can live a long and full life with MS, you may experience relief
  • This is especially true, when there are many alternate diagnoses that have a much worse prognosis, including Alzheimer’s disease and ALS

 

What are the emotional symptoms or changes most common in MS?

Common emotional symptoms that can occur with MS include:

  • Mood swings or emotional lability
  • Anxiety, including generalized anxiety
  • Pseudobulbar affect, which involves uncontrollable laughter and/or crying
  • Stress
  • Depression

 

Mood swings. This is the most common emotional symptom that happens with MS. The mood swings that occur with MS are much less intense than those seen with the psychiatric illness called bipolar disorder, where a person swings between euphoria and depression. In people with MS, mood swings usually show up as extreme moodiness, irritability, crankiness, and anger. You can have mood swings no matter how severe your MS is, and, they can seem to come out of nowhere.

Anxiety. Anxiety can happen in response to circumstances in life, such as living in a war zone or living with the uncertainty and stress of living with a chronic disease like MS. Different stressors, like financial uncertainty and worry about the future can trigger or worsen anxiety. Anxiety in MS may also be unrelated to any of these circumstances.

Pseudobulbar affect. People with MS can experience periods of uncontrollable laughter and/or crying, known as pseudobulbar affect (PBA), so named for the part of the brain that is affected. Sometimes this symptom is referred to as Involuntary Emotional Expression Disorder (IEED). When crying or laughing from pseudobulbar affect happens, the person feels neither sad nor happy, and the crying or laughing cannot be stopped voluntarily. The symptom can be very embarrassing and upsetting, especially when it happens in a social setting. It is thought that PBA results from damage to nerves in the prefrontal cortex of the brain. This symptom appears in about 1 in 10 people with MS.

Stress. The feeling of stress is common in people with MS, for various reasons. The disease challenges a person to live with quite a bit of uncertainty. There has been a lot of research into the connection between stress and MS, whether stress and its effect on the immune system may have a role in causing MS or whether stress may make a person with MS more likely to have exacerbations or flare-ups. Despite interesting results from individual studies concerning the role of stress in triggering MS, the link between stress and MS remains uncertain.

Depression. Severe depression is also common in people with MS. In fact, more than half of people with MS will have an episode of major depression at some point. Experts have tried to figure out whether some people with MS have a greater risk for depression than others. The risk of depression in MS is independent of disease duration or disability. Since depression is a dangerous condition that can increase a person’s risk for doing harm to him or herself, it is important to be aware of the signs of depression so that it can be diagnosed and treated as quickly as possible.

Major depression: symptoms and diagnosis

Definition
  • Typically involves mood states including grief and sadness
  • Key element that sets it apart from mood swings is that mood state persists over extended period of time
Diagnosis
  • At least 5 of the 9 symptoms below
  • Must include depressed mood or decreased interest
  • Symptoms must have persisted for most of every day for at least 2 weeks

Symptoms of Depression

  • Depressed mood (feeling blue, down-in-the-dumps, hopeless)
  • A significantly reduced level of interest or pleasure in most or all activities
  • Considerable weight loss or gain (5% or more change of weight in a month when not dieting) or change in appetite
  • Frequent thoughts of death or suicide (with or without a specific plan) or attempt of suicide
  • Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia)
  • Behavior that’s agitated or slowed down, which is readily observable by others
  • Feeling fatigued or very low energy
  • Having thoughts of worthlessness or extreme guilt
  • A diminished ability to think, concentrate, or make decisions
  • The list of symptoms for major depression contains many symptoms common in people with MS, making diagnosis difficult.  However, if you notice the symptoms of major depression in yourself or a friend or family member, alert your doctor and ask for an evaluation.

     

    How are emotional problems in people with MS treated?

    The treatment of an emotional problem depends on the nature of the problem. Treatment options for the most common emotional problems that occur with MS inclue medications and counseling.

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