The shifting tides of moods in MS

High anxiety
Studies have found that more than 35 percent of people with MS have some type of anxiety disorder, which is higher than the general population. Within this 35 percent, the majority of people have generalized anxiety disorder, though obsessive-compulsive disorder and panic disorder are also well represented. Women are more likely to have anxiety than men; the same is true for depressed mood. Pontillo experienced anxiety along with her depression.

“I was having a lot of panic attacks. One part of my brain was like, ‘You’re in danger,’ and another was telling me to stop freaking out.”Like other psychological issues, anxiety can be treated in a number of ways, which will vary from person to person.

Many antidepressant medications effectively treat both depression and anxiety. Specific anti-anxiety medications can work well for short periods of time, but carry the risk of dependence. CBT and other forms of psychotherapy can be very effective for anxiety disorders. And yoga and meditation can help calm the nervous system and reduce activity in the parts of the brain that govern the stress response. Your doctor or mental health professional can help you find the right combination of treatments for you.

Fickle feelings
Some people with MS may have swift and dramatic shifts in their moods, sometimes called emotional lability. “This is incredibly common,” says Dr. Miller, although no precise figures are available. For some people, this symptom shows up as an increased level of irritability. Other people may experience quick changes in temper, going from happy to angry or upbeat to sad, or almost any other combination. “It’s like when a person is covered with black-and-blue marks—everywhere you touch them, it hurts. Emotionally, they’re raw,” says Dr. Kalb.

Dr. Miller points out that while this kind of emotional lability often happens in response to outside events, it can also happen spontaneously without any apparent triggers. “That’s why family members often say they feel like they’re always walking on eggshells,” she says.

But the brain is complex, and many other psychiatric and medical conditions could lead to such mood symptoms, and the distinction among them can be difficult.

“Frequent and intense changes in mood need a thorough psychiatric evaluation,” says Dr. Minden, “to determine the cause and recommend treatment.”

Medications can also produce changes in mood. For example, high doses of corticosteroids, which may be prescribed to manage MS relapses or optic neuritis, have been associated with significant mood changes in some people. However, this phenomenon can usually be prevented by taking lithium along with the corticosteroid treatment,

Dr. Minden says. Be sure to discuss this with your physician, and to give a complete personal and family history of depressed mood, bipolar disorder and other mental conditions before taking corticosteroids.

Managing mood shifts
After you have a frank discussion with your doctor, he or she may refer you for a psychiatric evaluation to determine whether your symptoms are part of the course of MS, or caused by something else.

Once you understand what is happening and decide on a course of treatment, communicating with family and friends becomes key. That way, they won’t take any episodes of mood change personally, and may help you work through them.

“I recommend that the family talk together about how to manage these mood shifts in advance, when things are calm, and then follow that plan,” says Dr. Miller. In addition, psychotherapy and medication may help, as they do with other MS-related emotional changes. Your doctor can help determine the right approach for you.