Depression, Anxiety, and MS: What’s the Connection?

When people talk about common symptoms of multiple sclerosis (MS), they usually mention issues like vision problems, tingling and numbness, and fatigue. Mental health disorders such as depression and anxiety should also be on the list.

Causes of Depression and Anxiety in Multiple Sclerosis

Researchers don’t yet fully understand why depression is so common in MS, but many factors seem to play a role, according to the NMSS. These include:

• The reaction to difficult life situations or stresses, such as an MS diagnosis
• Major transitions, such as exacerbations of symptoms, or when a significant change in function or abilities occurs
• The disease itself; MS damage can parts of the brain that are involved in emotional expression and control, causing behavioral changes
• MS-related changes that occur in the immune or neuroendocrine systems, which can be accompanied by mood changes
• Side effects of medications, such as corticosteroids and possibly interferon medications

The Normal Grief and Anxiety of a Chronic Illness

Being diagnosed with any serious chronic illness qualifies as a life crisis, and feeling grief, or having anxious, worried feelings, are natural human reactions to such a crisis.

Although grief usually gets better on its own without treatment, counseling, self-help groups, and other support systems can be helpful. Support groups may also help you deal with normal anxiety and distress that may be caused by MS.

Symptoms of Depression

Depression symptoms include:

• Sadness or irritability
• Loss of interest or joy in daily activities
• Changes in appetite
• Sleep disturbances
• Agitation or slowing in behavior
• Fatigue
• Feelings of worthlessness or guilt
• Problems with thinking or concentration
• Persistent thoughts of death or suicide

Symptoms of Anxiety

People with an anxiety disorder often have intense, excessive, and persistent worry and fear about everyday situations. These feelings affect daily activities, are difficult to control, are out of proportion to the actual danger, and can last for a long period of time.

• Feeling nervous, restless, or tense
• A sense of impending danger, panic, or doom
• Increased heart rate
• Breathing rapidly
• Sweating
• Trembling
• Feeling weak or tired
• Trouble concentrating or thinking about anything else other than what you are presently worried about
• Difficulty sleeping
• Gastrointestinal (GI) problems
• Difficulty controlling worry
• The urge to avoid things that trigger anxiety
• Panic attacks

Do You Have Depression or Anxiety?

According to the NMSS, your answers to the following two questions can help you figure out if you are experiencing normal grief that commonly occurs with MS, or clinical depression:

• During the past two weeks, have you often felt down, depressed, or hopeless?
• During the past two weeks, have you had little interest or pleasure in doing things?

If you answered yes to either or both of these questions, you may be depressed. For a more detailed look at possible signs or symptoms of depression, you can get a free, confidential screening through Mental Health America. Your healthcare provider can also diagnose you or refer you to a mental health professional.

You can also contact an MS Navigator online or at 800-344-4867 during standard business hours for help finding a mental health professional near you.

If you answered no to these questions, but your mood is low, you may be experiencing grief or other emotional changes.

To screen for anxiety, a self-administered test called the GAD-7 (GAD stands for generalized anxiety disorder) can help you assess whether you’re experiencing minimal, mild, moderate, or severe anxiety. Again, check in with your doctor, who can help you get a diagnosis and connect you with a behavioral health professional.

Treatment for Depression and Anxiety

Depression requires treatment from a mental health professional, who may prescribe an antidepressant medication or other types of medication to stabilize your mood, and recommend other therapies.

Medication

• Selective serotonin reuptake inhibitors, including fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro)
• Serotonin and norepinephrine reuptake inhibitors, including duloxetine (Cymbalta, Drizalma Sprinkle), venlafaxine (Effexor XR), desvenlafaxine (Pristiq), and levomilnacipran (Fetzima)
• Atypical antidepressants, including trazodone, mirtazapine (Remeron), vortioxetine (Trintellix), vilazodone (Viibryd), and bupropion (Forfivo XL, Wellbutrin SR)

• Antidepressants
• The anti-anxiety medication buspirone
• Sedatives and beta-blockers (used for heart conditions) in the short term to control physical symptoms of anxiety

Psychotherapy

Lifestyle Approaches

The Value of Ongoing Support for Depression and Anxiety in MS

Since the stress and uncertainty of living with MS don’t really go away, making sure you have a good support system in place is essential. Connecting with MS support groups and people who are going through something similar can help you cope with the emotional challenges of living with the condition.

The Takeaway

• Depression and anxiety are common in people with MS, and both conditions are treatable with medication, psychotherapy, and lifestyle approaches.
• If you've been feeling consistently down, depressed, or hopeless for more than two weeks, or have little interest in doing things, talk to your healthcare provider about getting properly diagnosed and treated.
• Ongoing support through therapy, support groups, and continued treatment can help prevent a relapse of depression or anxiety, and provide coping strategies for the challenges of living with MS.