Roz Kalb , Psychologist
3 May 2022 | ~6:00 Engagement Time
Mood changes and MS are intertwined in complex ways.
Some changes are caused directly by the MS disease process and related changes in the brain. Others are a reaction to the losses and stresses that are part of life with a chronic, unpredictable illness. And some may be a combination of the two.
In this article, we’ll look at the kinds of mood changes that can occur, why they matter, and what can be done to manage them.
Grief is a normal, healthy response to loss. Whether it’s the loss of a loved one or the loss of one’s identity, physical and/or cognitive abilities, or favorite activities, the process of mourning that loss involves intense grieving followed by gradual healing and adaptation.
Each person experiences grief differently, but feelings of sadness, emptiness, longing, and anger are common. At different points in time, you might deny the loss, rage at the loss, or cry over it – all are normal and expected.
You may even try to “bargain” your way around it, with thoughts like, “OK – I can handle it if my walking is impaired, but please don’t mess with my mind…” or “I can live with the numbness and tingling, but don’t I need to be able to see!?”
Grief will ebb and flow over the course of the disease.
It will likely recur each time that the disease takes away something that’s important to you – a favorite activity, a job, a new physical or cognitive symptom, or, perhaps, a relationship.
Beginning with the words, “You have multiple sclerosis,” the grieving process allows you to let go of the picture you had of yourself before your diagnosis and allows you to begin figuring out how to move forward with your life.
This is one of the most common symptoms of MS.
It is related to changes in the brain and immune system as well as to life circumstances. It deserves as much of your attention and your MS provider as any other symptom of MS – a thorough evaluation and appropriate treatment.
Left untreated, depression can make your other symptoms feel worse (particularly fatigue, pain, and cognitive issues), interfere with your relationships, sleep, productivity, and quality of life. Untreated depression an also be life-threatening.
Just as common as depression, anxiety often gets far less attention. You might hear, “Well, you have MS – who wouldn’t be anxious?”
However, severe anxiety can be as disabling as severe depression and deserves the same careful care. If anxiety interferes with your sleep, productivity at home or work, or your ease of mind, it’s important to let your healthcare provider know about it.
Feelings of irritability or feeling “moody” can be related to depression or occur on its own. People describe it as feeling prickly, hyper-sensitive, hyper-reactive, cranky (and family members describe it in similar ways!).
We know that some people who are depressed appear more irritable than sad, so you may not know exactly what’s going on. A mental health professional can help you sort out what’s what with these feelings.
PBA occurs in about 10% of people with MS and other neurological diseases like Parkinson’s disease or stroke. It involves episodes of uncontrolled crying or laughing that are unrelated to the person’s mood.
A person might laugh at inappropriate times (e.g., a funeral, job interview, a fight with one’s partner) or cry for no known reason. These uncontrollable episodes can be embarrassing and confusing to the person with MS and family members, friends, and colleagues.
Reporting them to your provider is the first step to managing them. And the good news is that this neurological symptom has an FDA-approved medication to treat it!
How we feel emotionally affects every aspect of our lives – how tired or energized we feel, how motivated we are to initiate and complete tasks, how we communicate and interact with others, how our bodies feel.
Checking on your mood is a bit like taking your pulse. If your mood is out of whack, you can take steps to get it back on track.
If you’re not sure what’s happening with your mood, try keeping a journal for a week or two. Track your emotional ups and downs and think about whether there seems to be trigger when changes occur. Sharing this with your MS provider and/or a mental health professional will help them to help you figure out what’s going on.
Remember – mood changes are common in MS and nothing to be embarrassed about.
Like all good toolboxes, this one should include a variety of tools for solving different types of problems. Your healthcare team can help you identify the best tools for you.
Since depression is so common in MS, a screening at the time of diagnosis can help you identify depression early or establish a baseline for later comparisons. Periodic screening can identify significant depression at any time and start you on the road to treatment and recovery.
This is just as important as reporting any other symptoms of MS. Your provider may recommend a treatment or refer you to a mental health professional. You can also contact the National MS Society (1-800-344-4867) and request a referral to someone in your area.
Free, online, confidential mental health screening for depression, anxiety, and other mood changes is also available here. You can take the online screening test and get a printout to share with your MS provider.
Like a three-legged stool, these three treatment approaches work better together.
Medication to manage depression, anxiety, and other mood changes can be very effective. The right medication can help a person feel better able to engage in the work of talk therapy.
Seeing a therapist or mental health professional is where the diagnosis and problem-solving work get done. It’s a safe place to explore feelings and challenges while learning strategies to help you cope and adapt.
Finding the right therapist is key. Whether it’s a psychologist, psychiatrist, social worker, or counselor, it’s essential that you feel comfortable and connected with that person and aligned in your goals for treatment.
Exercise has been shown to improve mood!
But if you’re feeling down, depressed, and/or anxious, your motivation to exercise may be non-existent. Take our word for it, physical movement – even little bits of it – can help your mood improve.
So, if you need help getting started, here are a couple things to try:
Support groups can be a valuable addition to your mood management strategies, but they can’t replace your three-legged stool. When looking for a support group, it’s helpful to keep these tips in mind.
Your mood matters – to you and those around you. Take your emotional pulse periodically and reach out to your healthcare team for guidance if and when changes occur.
If you have questions about moods in MS, please contact the Can Do Team and we’ll be happy to answer them.
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