A diagnosis of multiple sclerosis can have a profound emotional impact. Both the patient and his or her family may have difficulty accepting that an unpredictable and incurable disease will influence the course of their lives. Initially, a lack of knowledge about MS can create even more anxiety. Adjustment takes place slowly, as the patient gathers accurate information about the disease and supportive care begins.

Further down the road, if MS imposes changes upon the patient's lifestyle, emotional adjustment must continue. MS can affect every area of life, including employment, parenting, marriage and recreational or educational pursuits. Changes in these areas can create stress and frustration, impact finances and stimulate intense emotions.

A person with MS needs more than just good medical care. He or she also needs significant emotional support from friends and family, and ideally, a caring professional counselor, and an MS support group as well.

Depression has been called "a normal reaction to an abnormal situation." MS can alter longstanding lifestyle expectations for any patient, and not surprisingly, depression is a common reaction to a diagnosis of MS. Depression that occurs as a reaction to circumstances is a normal part of the way human beings grieve loss. This kind of "reactive" depression is different from depression that results from biochemical causes.

Patients with MS also commonly experience depression as a result of their disease. MS destroys the myelin that covers the nerve fibers deep inside the brain, which can affect emotions. Depression can also occur as a side effect of some medications given for MS. Depression can sometimes arise from a combination of physical, emotional and social factors.

Regardless of the cause of depression, it should always be taken seriously. Medication may be considered as an option, especially when depression lasts more than a few weeks. It is always important to discuss depression with a physician or counselor, and report any suicidal statements to a member of the patient's healthcare team immediately. A referral to a psychotherapist or psychiatrist may be recommended.

Here is a list of many possible symptoms of depression. No one will experience all of these symptoms, and symptoms can vary in intensity or appear sporadically.

Sadness

Loss of interest or pleasure in daily activities

Changes in appetite

Insomnia or oversleeping

Feeling worthless or guilty

Persistent thoughts about death or suicide

Outbursts of rage

Hopelessness

Feeling anxious or empty

Pessimism

Feeling helpless

Loss of sexual desire

Low energy, a sense of being "slowed down"

Restlessness, irritability

Problems with concentration, memory, or decision making

Nagging physical complaints that do not respond to treatment (headaches, digestive problems, pain, and so on)

Depression can intensify some of the physical symptoms of MS, such as fatigue, pain, or sexual dysfunction. Several of the antidepressant medications used to combat depression also coincidentally help alleviate some of the physical pain that accompanies MS.

Drugs commonly prescribed for depression include Elavil, Pamelor, Prozac, Zoloft, Celexa, Paxil and many others. Sometimes medication for anxiety, such as Buspar, is also given. Medications can only be prescribed by a physician, and are sometimes used along with psychotherapy.

Patients treated with corticosteroids may experience mood swings of variable intensity. MS itself can also cause mood swings. In fact, some studies suggest that a person with MS is two to 13 times more likely to experience bipolar disorder, a type of depressive illness characterized by severe mood swings, than a person who does not have the disease. Bipolar illness, formerly known as manic-depression, differs from depression in that the patient experiences extreme "highs" as well as extreme "lows." Intense energy and feelings of elation or being "on top of the world" alternate with periods of depression and feeling worthless. The manic portion of the disorder may include symptoms such as:

Extreme elation

Extreme irritability

Talking faster than normal

Talking louder than normal

Severe insomnia

Increased sexual desire

Lapses in judgment

Inappropriate social behavior

Increased energy

Disconnected, racing thoughts

Grandiose thinking

When bipolar disorder is mistaken for depression, the patient will not receive the proper medication. Bipolar disorder requires treatment for the manic part of the disorder as well as for the depressive part. Without the correct medication, patients are likely to have an increase in episodes and a worsening of the condition. Bipolar illness responds well to the appropriate treatment, however. With proper treatment, however, many people with the disorder can enjoy stable, satisfying relationships and productive work.

MS can damage areas of the brain pathways responsible for emotion. When nerve fibers in these areas become demyelinated, or stripped of their protective coating, patients may experience uncontrollable laughter and inappropriate euphoria, or sudden weeping and despair. These episodes, known as emotional lability or laughing/weeping syndrome, are beyond the control of the patient. Laughing/weeping syndrome is seen in about 5 percent of patients, and usually only in more severe cases. Emotional lability can be treated with the antidepressant, Elavil®.

It is always encouraging to find others who have "been there" and to learn how they and their families cope with problems similar to our own. Foundations and local MS support groups also offer ways to broaden knowledge and build friendships with others who truly understand what it is like to live with MS. Today, other kinds of emotional support are also available to patients, their families and/or caregivers. The World Wide Web has created wonderful support options that were not previously available, such as Web-based chat groups, e-mail newsletters and interactive learning opportunities.

References

First published October 1, 1999
Last updated May 4, 2003
Copyright © 1999 Accordant Health Services, Inc. All Rights Reserved.

Or Find More On:

Back to top of page