Managing Anxiety, Mood Changes, and Other MS Emotional Symptoms
Reviewed by: HU Medical Review Board | Last reviewed: April 2023 | Last updated: May 2023
There are a variety of treatments options available for people with multiple sclerosis (MS) who experience emotional symptoms, including anxiety, mood swings, pseudobulbar affect (PBA), and stress.
Since anxiety typically occurs as a response to certain circumstances in life, which, for a person with MS may include the uncertainty of having a chronic, debilitating illness, treatment approaches that address those life circumstances may be particularly useful. These typically include psychotherapy, counseling, or stress reduction training. These interventions can help a person understand the source of stress and develop ways to handle that stress.
In addition to non-drug interventions, there are some medicines that are effective in treating anxiety. These include select types of benzodiazepines, such as Valium (diazepam) and Xanax (alprazolam), and certain antidepressant medicines, such as Zoloft (sertraline), Paxil (paroxetine), and Effexor (venlafaxine).
A variety of strategies can be used by people living with MS to help them cope with the mood swings resulting from neurologic damage. Talking about mood changes with your friends and family members can give you more control over them and help the people who give you support better understand what you are going through and how they can help.
Developing awareness of triggers for your mood changes can also give you more control over those changes. For instance, if you find that you get irritable in particular situations, you may be able to avoid those situations or use deep breathing or other calming strategies to help you better cope with the situation. You may also find that getting exercise helps you when it comes to mood swings in general. Several studies have shown the benefits of exercise on mood in people with MS.1
If these approaches do not seem to work, talk to your doctor about medicines that you can take to help you with changes in mood. The anti-seizure medicine Depakote (valproic acid), given at a low dose, can be effective in controlling mood swings, as well as some selective serotonin reuptake inhibitors (SSRI) drugs.
Episodes of uncontrolled laughing or crying can result from MS-related CNS damage. Several drugs are useful in treating this problem. Recently, a drug called Neudexta (dextromethorphan/quinidine) was approved by the FDA for treatment of PBA in people with MS. A number of tricyclic antidepressant medicines are effective in resolving PBA, including Elavil (amitriptyline) and Norpramin (desipramine). Other drugs like Sinemet (levodopa), used in Parkinson’s disease, and Prozac (fluoxetine) have been shown to be useful in treating PBA.
The best way to acquire skills to help you reduce stress is to work directly with a professional trained in strategies for stress reduction. Other resources that may be useful include psychotherapy, counseling, support groups, peer counseling, exercise, and self-help books. Once you’ve learned stress reduction skills from someone trained in strategies for dealing with stress, you can practice those skills on your own and return to that professional periodically as needed to brush up your skills.
These are just a few possible strategies that you can use to help with MS emotional and mental health symptoms. Talk with your doctor for more specific information about the medicines listed on this page. Your doctor can help determine if a medicine can help you and explain possible side effects and dosages.
Before beginning treatment for MS, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.