There are a variety of treatments options available for people with MS who experience emotional problems, 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 medications that are effective in treating anxiety. These include select types of benzodiazepines, such as Valium (diazepam) and Xanax (alprazolam), and certain antidepressant medications, 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 don’t seem to work, talk to your doctor about medications that you can take to help you with changes in mood. The anti-seizure medication Depakote (valproic acid), given at a low dose, can be effective in controlling mood swings.
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 medications are effective in resolving PBA, including Elavil (amitriptyline) and Prozac (fluoxetine). Another drug, Sinemet (levodopa), used in Parkinson’s disease, has 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.