Mental Health in Multiple Sclerosis: An Unnerving Aspect of the Disease

A concerted effort is needed from healthcare providers to educate the community about mental health symptoms such as stress, fear, anxiety, and depression in MS and how to address them. From the very beginning of diagnosis, people living with MS need to know that just like the physical symptoms, the cognitive and mental symptoms can also progress and worsen over time. As such, mental health should be part of the earliest conversations in the clinical plan.

One of the most unsettling components of MS is not knowing how the disease will impact the future. For most people living with MS, the symptoms they experience from their disease will likely change over time, but MS affects every person differently.

Some may experience mild symptoms, while others may experience worsening physical and cognitive disabilities that greatly impact daily life. It is this unpredictable nature of MS that makes living with the disease unnerving.

Facing the unknown can lead to a wide range of emotions and can even progress to a mental disorder. Sadness, anxiety, anger, irritation, stress, and fear are common reactions.¹ Disconcerting questions start to arise and weigh heavily on the minds of people living with MS.

While MS indirectly can lead to depression, anxiety, and other mental health conditions, research shows there may also be a direct link. Damage to the brain can be measured by the number of MS lesions or white patches seen on MRI scans. These brain scans are one of the first steps doctors take to diagnose MS and assess the extent of damage. The symptoms a person experiences with MS depend on the area of the brain where the damage occurs. This explains why the symptoms of MS can vary so greatly from person to person.

If someone with MS has damage in the frontal part of the brain, which controls executive functions and emotional regulation, this can impact the way a person feels or reacts, regardless of their personality. It can explain how one might experience symptoms of depression and cognitive dysfunction or brain fog, that were not present before the onset of MS.^{9, 10, 11}

In other words, the disease itself can be the direct cause of mental health issues for some people.

The hidden scars of MS can negatively impact a person’s overall well-being. Too often, people living with the disease may not recognize the subtle changes taking place, but those close to them do, underscoring the vital role of care partners and family members.

“Somebody living with MS might not notice the cognitive problems or changes in emotions they are experiencing, but care partners are able to pick up on them,” says Montague. “Care partners have amazing insights about what is really going on. They are the ones interacting with the person every day, whereas neurologists often see their patients only once every six months. It’s important to think about how care partners are engaged and part of the clinical discussion as they can help bridge the gap between appointments.”

While MS presents challenges, it’s important to support and prioritize the mental health of everyone impacted by the disease, including care partners and family members.  Recognizing and managing the emotional aspects of MS – for everyone impacted – is just as important as managing the disease itself.