Authors
Meghan Beier , Neuropsychologist
Mental Health and MS: Understanding Resilience
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2 May 2025 | ~4:57 Engagement Time
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It’s especially important to consider mental health when living with multiple sclerosis (MS). We know that people with MS experience higher rates of mental health challenges, including depression and anxiety, compared to the general population. While depression often gets much of the spotlight, this month, we’re turning our attention to anxiety.
Anxiety is a universal emotion. Almost every person will experience anxiety at times. It’s characterized by worry, fear, and a sense of unease. Anxiety is often accompanied by physical sensations like a racing heart, sweating, nausea, or muscle tension. It’s normal to experience occasional anxiety, especially during stressful life events. However, additional support may be helpful if you experience any of the following: anxiety interferes with your relationships, hobbies, activities you enjoy, your job, when it is difficult to control, or when it’s showing up almost every day. That support can range from working with a mental health professional to using practical coping strategies (we’ll explore more of these later in the article).
If you live with MS, anxiety may show up more frequently, more intensely, and in unexpected ways. Some symptoms of anxiety overlap with MS symptoms: restlessness, fatigue, difficulty concentrating, muscle tension, and sleep disturbances. It can be hard to know which condition is causing which symptom, or whether it’s both. And to complicate matters, anxiety and MS can interact with each other in ways that amplify both physical and emotional challenges.
Let’s take a deeper look at the connection between MS and anxiety.
Living with Chronic Uncertainty.
MS is unpredictable. People often don’t know how they’ll feel day to day, or even hour to hour. This lack of clarity can lead to anxiety about how to manage symptoms, how others will respond, or what the future may hold. This lack of clarity can often lead to increased vigilance (or monitoring symptoms closely) in an effort to gain back a sense of control.
Biological Factors.
Anxiety isn’t just about living with uncertainty. In MS, lesions, inflammation, and brain atrophy (shrinking) in certain areas, such as the frontal lobe, have been linked to higher levels of anxiety. These structural and chemical changes can impact how a person experiences and processes emotions.
Treatment Side Effects.
Some medications used to manage the symptoms of multiple sclerosis, such as high-dose steroids, can lead to mood swings, insomnia, and increased anxiety for some people. Beyond the medications themselves, fear of side effects, needle phobia, or anxiety about going to a medical appointment (often called “white coat syndrome”) can trigger intense emotional and physical responses.
Life Stressors and Role Changes
Being diagnosed with MS can bring about changes in employment, parenting roles, or social relationships. These shifts can be painful and disorienting, and often come with feelings of grief, frustration, or isolation. These painful experiences can contribute to or worsen existing anxiety.
Preexisting Mental Health or Genetic Vulnerability.
It’s also important to recognize that not all anxiety stems directly from MS. Some people with MS have a prior history of anxiety, a family history of mental health conditions, or personality traits that make them more vulnerable to stress and worry. MS can heighten these existing tendencies and bring them to the surface.
As we’ve reviewed so far, multiple sclerosis can trigger specific thoughts and fears, including things like fear of progression, concern about being able to fulfill responsibilities, or navigating a healthcare system. These are specific to MS.
Generalized anxiety disorder (GAD), on the other hand, can be found in all people, those with and without MS. Generalized anxiety disorder is characterized by chronic and excessive worry across many areas of life, not always tied to a specific cause.
Of note, if you are experiencing anxiety, rather they trying to determine your exact diagnosis, or where it comes from (lean on your medical team to help with those questions), it’s more important to recognize if anxiety is interfering with your daily life and finding support strategies that work for you.
A common question asked by people with MS is how to tell the difference between tingling caused by MS and tingling caused by anxiety.
Tingling in MS is typically the result of damage to the nervous system, such as demyelination, that disrupts how messages travel along nerve pathways. These sensations may be persistent, show up in the same location each time, or be triggered by factors like heat, cold, exercise, or infections (often referred to as pseudo-exacerbations).
Tingling from Anxiety, on the other hand, is often related to hyperventilation or a heightened stress response. When we’re anxious, we may breathe rapidly or tense our muscles, which can reduce blood flow or overstimulate certain nerves. This can lead to a “pins and needles” feeling, especially in the hands, feet, or face.
The key differences are that MS-related tingling tends to last longer and appear in consistent or predictable patterns. Anxiety-related tingling is usually short-lived and often fades as the body returns to a calmer state.
The good news is that anxiety is highly treatable. In fact, it’s one of the conditions most responsive to psychotherapy, or talk therapy. Additionally, lifestyle factors, such as regular exercise and quality sleep, can play a significant role in managing and reducing anxiety symptoms.
Psychotherapy
There are different types of therapy, and the best fit often depends on the kind of anxiety you’re experiencing. For example:
It can be helpful to work with a therapist who specializes in anxiety, so they can recommend the approach best suited to your individual needs.
For milder anxiety, there are also effective strategies you can try on your own. Reputable self-help books—like those in the Treatments That Work series—offer evidence-based guidance. There are also apps that incorporate CBT or mindfulness, as well as online resources like Can Do MS or My MSToolkit.
Relaxation techniques such as deep breathing, progressive muscle relaxation, and guided imagery can also be powerful tools.
One helpful tip: practice these techniques when you’re already feeling calm, so they’re easier to use during stressful moments.
Anxiety is a common experience and often a normal reaction to extraordinary life circumstances. But that doesn’t mean you have to live with it unmanaged, especially when it’s interfering with your quality of life. This Mental Health Month, take a moment to check in with yourself. Support is always within reach, and your emotional well-being deserves just as much care as your physical health.
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