Symptoms of multiple sclerosis can vary widely, because it’s not clear how and where the disease will attack.
But mood swings are a common response. There are two ways they can be part of your MS.
They can be part of your reaction to your MS. Your diagnosis can affect your mood. The symptoms of the disease can change how you feel about it, as well.
It can be a symptom of your MS. The lesions that cause other symptoms of the disease, like weakness, shakiness, and vision problems, can also cause emotional changes. This can happen when those lesions attack some areas of your central nervous system.
Mood Swings as a Reaction to MS
This is the most common way that MS affects your mood. An intense emotional reaction makes sense, because you have to process a lot of information that can be difficult to accept, especially at first. Later on, as your disease changes your day-to-day life, your emotions could come to the forefront again.
You could feel:
Anxiety: The worry and fear of what’s possible with MS can make you anxious about what may lie ahead for you and your loved ones. You may feel cranky and edgy. Some worry is normal. But talk to your doctor if it starts to get in the way of your everyday life.
Grief: When you find out you have MS, it can be a lot to take in. It’s natural to be upset from time to time after you learn about how the disease progresses, or when you start to notice symptoms. Some grief is normal. But it can spill over into anxiety and depression if it goes on for too long.
Depression: It’s a common symptom of MS. Treatment with therapy or medication can help. Talk to your doctor right away if you can’t seem to snap out of a low mood or if you have thoughts about taking your own life. Untreated depression is the primary cause of suicide in people with MS.
Your brain's frontal lobe, which is just behind your forehead, helps control your mood and how you express your emotions. MS lesions can damage this part of your brain. That could make you behave in a way that seems different or abnormal to those who know you.
The most common form of damage is the pseudobulbar affect, or PBA. You might suddenly start laughing or crying uncontrollably and far out of proportion to the emotion that you’re feeling. For example, you might burst into tears from a sad commercial on TV or suddenly get angry for no obvious reason. About 1 in 10 people with MS get PBA.
Doctors can often treat PBA with antidepressants or a prescription drug called dextromethorphan-quinidine (Nuedexta). If those don't work, there may be other drugs that could help. Talk with your doctor about it.
In rare cases, lesions in your brain can cause euphoria. You may seem to be overly happy when circumstances seem serious. You might not feel worried, even about big problems. Sometimes, your outward expression of euphoria may not match what you feel inside.
Euphoria is more likely if your MS is advanced, with lots of lesions, and brain shrinkage from the disease. There is no treatment for euphoria.
Some of the drugs that treat MS can also affect your mood.
For example, steroids, which doctors sometimes use to treat a relapse, can make you hyper or depressed. Plus, in some cases, a steroid “high” comes before a “low” period after treatment.
Modafinil (Provigil), which helps with tiredness, can make you anxious and depressed.
MS is a complex disease, both physically and emotionally. That’s why it’s best not to assume you know the source of serious emotional changes.
Be sure to tell your medical team about your mental health issues as they arise with your MS. Talk about all your physical and emotional symptoms, as well as all your medications, and let them guide you to the right diagnosis and a plan to manage it. Whether or not you need medication and therapy, your team should be able to help you find ways to make you feel better.