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The shifting tides of moods in MS

Depression, anxiety, mood shifts and other emotional symptoms are common in MS.

by Alice G. Walton, PhD

For William Pulliam, 30, of Denver, who was diagnosed with multiple sclerosis in 2002, the sometimes-unpredictable mood changes he experiences are one of the hardest parts of living with the disease. Going to bed in a positive, happy mood is no guarantee that he’ll wake up that way the next morning.

“I’ve got experience with all avenues,” Pulliam says. “I’ve been happy, sad, depressed, angry. It can be completely random. Other times there are triggers.”

Some MS-related mood symptoms may be a result of the disease process, some a reaction to it, and some have a complex set of causes.

The psychological changes that can occur with MS can be difficult to live with, for both the person with MS and his or her family. That said, mood changes are also among the most easily treated aspects of MS, says Deborah Miller, PhD, a social worker at the Mellen Center for Multiple Sclerosis at the Cleveland Clinic.

Depression and anxiety are some of the most common psychological changes. Less frequently, people with MS may have pseudobulbar affect (PBA), a condition that can produce uncontrollable laughing or crying spells that are out of proportion to or disconnected from what people are feeling. And, some people with MS (the number is unknown) experience rapidly shifting moods.

“It’s so important to manage these emotional symptoms,” Dr. Miller says, “because this makes all the difference in how you manage the other symptoms.”

Rosalind Kalb, PhD, vice president of Clinical Care at the National MS Society, and a clinical psychologist, says this is an important point. “People who are very depressed or anxious find it much more difficult to participate actively in their own care.”

Today, treatment for most mood disorders uses a three-pronged approach. “It’s important to recognize that a combination of medication, talk therapy and exercise is most effective,” Dr. Miller says.

If you find yourself experiencing any of these issues, address them with a mental health professional early, so you can arrive at an effective course of treatment—and get on with living and enjoying your life.

Grief is natural
Many people with MS go through a period of grieving after diagnosis—because dealing with the loss of certain capabilities and the uncertainty about the future is a lot to have on anyone’s plate.

“When you’re a young person, starting a career, and your doctor tells you that you have this disease, there are going to be reactive factors,” says Dr. Barbara Giesser, the clinical director of the MS Program at UCLA. “There’s the loss-of-identity factor in the usual family role—perhaps as breadwinner, or caregiver to a child or to an elderly parent. Your self-image changes; some people may have trouble with their body image after an MS diagnosis.” And the unpredictable nature of the disease may be the hardest part to grapple with, she adds.

“Grieving is a normal, healthy process that people need to not squelch,” Dr. Miller stresses.

Many people find it beneficial to meet with a therapist who has experience in this area and who can help you work through grief, whenever it occurs over the course of the disease.

Often, people will grieve not just after diagnosis, but each time they experience significant changes in functional abilities or life roles, says Dr. Kalb. “It may happen over and over, with the ebb and flow of the disease,” she says. “These are losses, just like the loss of a loved one. You feel terribly sad at first, and it gradually lessens.”

The caveat to this, Dr. Miller says, is that in some people, the grieving process can go on for too long, and morph into something else—depression. If you find that you’re still experiencing significant grief after six months, it should be addressed.

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