Patients with multiple sclerosis may be at a higher risk of developing mental health conditions.
Although physical changes are the most commonly known symptoms of multiple sclerosis (MS), the cognitive effects of the disease can have an equally devastating toll on the body. Patients with MS may be more likely to develop emotional and mental health symptoms that can severely impact quality of life.
In a recent article published by John Hopkins Medicine, Megan Beier, PhD, rehabilitation neuropsychologist, discussed the most common mood and mental health problems experienced by patients with MS.
Current statistics indicate that up to half of patients with MS develop depression and up to 40% of caregivers and spouses experience the condition as well, according to Dr Beier. Caregivers may develop depression due to role changes, financial concerns, and cognitive changes in loved ones with MS.
The link between depression and MS has been known for decades; however, it is currently underdiagnosed and undertreated, Dr Beier noted. Although it may be assumed that patients develop depression due to their MS diagnosis, recent studies have suggested it is instead a symptom of the autoimmune disease, according to the article.
“For persons with relapsing-remitting MS, early in the disease, depression appears to be linked to inflammatory processes. Later, in the secondary-progressive phase, unhelpful thoughts, such as feelings of guilt, worthlessness or hopelessness are more frequent,” Dr Beier said. “So the depression in this case is thought to be more reactive—linked to frustrations with lifestyle changes or loss of function.”
For most patients with MS, depression can be managed with antidepressants and cognitive behavioral therapy, according to the article.
About half of patients with MS who develop depression also experience anxiety, but it can also occur in the absence of depression, according to Dr Beier. Patients with anxiety may reduce their social interactions and the condition could also impact cognitive skills. These individuals are likely to have increased alcohol use and experience higher pain, according to the article.
Anxiety is closely linked to the uncertainty of MS and its symptoms, especially relapses.
“You never know if there is going to be an exacerbation, how severe the symptoms will be if an exacerbation occurs or if MS symptoms will progress over time,” Dr Beier said.
A coping mechanism for anxiety is avoidance. In the case of patients with MS, avoiding the source of anxiety may result in patients skipping physician appointments, not leaving the house, and not partaking in enjoyable activities, according to the article.
Patients may choose to undergo behavioral therapy that increases confidence or acceptance and commitment therapy.
“We identify what is most valuable to a person and then find a way to pursue that value despite their MS symptoms,” Dr Beier said.
3. Pseudobulbar Affect
The pseudobulbar affect is a condition that is characterized as a disconnect between how you feel and express emotions, according to the article. Patients may cry without being sad or upset.
Dr Beier said that this occurs due to communication between parts of the brain becoming derailed. In MS, the pseudobulbar affect can result from brain lesions and overall atrophy of the brain. Steroid use for treatment of MS may also exacerbate the condition, according to the article.
Unlike other cognitive conditions, the pseudobulbar affect cannot be treated with talk therapy, making proper diagnosis important. The condition can be modified with antidepressants and other targeted therapies.