Feeling Depressed and Worried About Your MS? You're Not Alone

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Hannah Perryman wasonly 24 in 2009 when she began experiencing severe pain and blurriness in her left eye. Her first clue she had multiple sclerosis (MS) came when a neuro-ophthalmologist diagnosed her with optic neuritis, an inflammation of the optic nerve, which is often the initial sign of the autoimmune disorder. “I remember being overwhelmed. I thought: This illness could take away my ability to walk, swallow, and function.”

Affecting one million people in the U.S., MS causes the immune system to mistakenly, and repeatedly, attack the central nervous system (CNS), which consists of the brain, spinal cord, and optic nerves, stripping nerves of their protective coating, called myelin. Nerve damage causes inflammation and a wide range of neurological symptoms, including chronic fatigue, numbness and tingling, vision changes, cognitive issues, and problems walking. Periods of wellness, known as remission, can be open-ended, with no predictable beginning or finish in sight. Relapses—when symptoms flare up again—can also appear without warning, and they, too, can linger for days, weeks, or months.

There are four main types of MS, but 85% who are diagnosed with it have relapsing-remitting MS (RRMS), says Kathleen Costello, associate vice president, Healthcare Access for the National MS Society. Individuals with RRMS experience unique symptom timelines and are forced to reckon with the stress such uncertainty can bring.

Why MS Can Lead to Depression and Anxiety

最初，Perryman表示诊断的冲击加剧了一个现有的抑郁症，因为她的青少年她现在相信自己的青少年来争夺和关闭，这一切都是MS的症状。（佩里曼可能是对的：研究表明，髓鞘损失可能实际上可能导致抑郁症。）即便如此，标记她的感受和了解有治疗选择，最终抬起肩膀的重量。“我的诊断在我之前没有别的道路翻了一下，”她说。

她发誓要把她的抑郁和焦虑视为一种与疾病挣扎的方式。定期运动，治疗（她的会议包括练习谨慎），加上疾病修饰的药物都帮助她管理了低情，并且在下一次复发将罢工时不知道不知道。到目前为止，她已经使它成为10年没有经常发作的症状，这种方法有助于她获得控制感。“在我有这种疾病的时候，有一种理解，它没有我。MS不会运行我所做的一切。“

Half of all people with MS will experience depression in their lifetime, and 44% will experience anxiety, according to Costello. At least part of this is biologic, says Barry Hendin, M.D., chief medical officer of the Multiple Sclerosis Association of America. Inflammation from MS literally scars the brain, leaving visible lesions, which can impact mood.

What’s more, depression is more prevalent in MS than in any other type of neurologic disease, even those with more predictably dire consequences, like ALS (a.k.a Lou Gehrig’s disease, where damaged nerve cells in the brain and spinal cord cause extreme muscle loss, shutting down the body’s ability to function), says Meghan Beier, Ph.D., a clinical psychologist and assistant professor at Johns Hopkins University School of Medicine in Baltimore. A big reason for this, she says, is the uncertainty MS brings. There’s no way to know when the next flare will occur or how the disease will ultimately play out.

People with MS may fear that they have no control over their lives. They know they could end up in a wheelchair—or they could not. Planning for the future can feel impossible. In addition, Dr. Hendin points to a variety of negative impacts of the disease: Relationships may be more challenging, occupational hazards are more common, cognitive decline can occur, and it can be difficult for people with MS to connect to the world around them. Throw in chronic pain, difficulty walking, plus problems with their bladders and bowels, and it’s not hard to see why depression and anxiety are so prevalent, he says.

Do Depression and Anxiety Actually Worsen MS Symptoms?

最近发表的一项研究Neurologyfound an association between anxiety and depression and a significantly increased risk of relapse in people with RRMS. Even so, an association does not determine causality—being anxious or experiencing low mood was not proven to directly trigger MS symptoms, says study author Amber Salter, Ph.D., assistant professor of biostatistics at Washington University School of Medicine in St. Louis. “Future work is needed is needed to better understand this relationship,” she concludes.

仍然，直接与否，连接是真实的。“我们知道更加沮丧和焦虑肯定会导致一个人感觉更糟糕，更糟糕的功能，”华盛顿医学大学多发性硬化症中心的心理学主任凯文N. Alschuler，Ph.D.。因此，虽然目前虽然这些条件实际上可以导致MS复发，但他说，焦虑和抑郁症可能会引发免疫系统内的脆弱性，这反过来可能导致症状恶化。他的结论是解决这些问题很重要，因为更沮丧和焦急降低了生活质量，并且可以让MS的人感觉比他们所做的更糟糕。

生活方式的变化可以产生很大的不同，情感和身体

Empowering patients to take control over their disease is key, says Michael Levy, M.D., an associate neurologist with Massachusetts General Hospital in Boston. “Diet, lifestyle exercise—those things are known to improve function.” He recommends an anti-inflammatory approach to eating that reduces unhealthy fats, includes some lean meats, and ditches added sugars.

研究表明，运动缓解焦虑和抑郁症的效果。一项研究发现，锻炼在MS患者中对抗抑郁症效应。Beier建议锻炼所有女士患者。她说抑郁症的症状是不那么活跃，更撤销。练习使您更加活跃，同时产生“帮助的好内啡肽[you]感觉好多了。”它还可以降低能激活疾病的应力;贝尔指出一项研究，表明压力管理成功减少MS患者的新MRI脑病变。Alschuler博士补充说，那些锻炼的人也倾向于对照顾自己更感兴趣，这可能导致MS的更好管理。

At the suggestion of a woman she met through the MS Society support group, Perryman ran her first sprint triathlon in September 2012. She’s since run four sprint triathalons, eight half-marathons, and the New York City Marathon (three times!). These days she’s focused on cycling and strength training.
“健身和运动和有氧运动和出汗 - 这是我管理我的心理健康的巨大方式，”她说。

Cognitive-Behavioral Therapy Can Help With Anxiety, Too

博士博士说，认知行为疗法（CBT）侧重于改善人的思想，行为和/或行动，也可以对MS的人有益。它涉及帮助人们从事较少的无益的行为来思考和行动，以借助他们的方式。研究备份：4月2020年4月的研究发现，CBT可以改善MS的许多症状，包括抑郁和焦虑。

“The goal isn’t necessarily to eliminate worries or depressing thoughts, but to not have them be blown out of proportion and take over the thought process,” he explains. Dr. Alschuler works with patients to set goals that move them from more depressive behaviors to behaviorally active ones. This means spending less time “fighting against a problem we can’t solve,” to developing skills to stay in the present so as not to be consumed by negative thoughts.

Devon Conway, M.D., a staff neurologist at the Cleveland Clinic in Ohio, says that the vast majority of his patients who learn coping mechanisms to help them deal with the uncertainty surrounding MS are better able to manage their anxiety. And, once they experience a period of stability, he adds, this helps to further curb it, which can lead to a better quality of life long-term.

贝尔也与她的病人,防止磨破ry from consuming them. She suggests they set aside specific time each day to “think about things that are bothersome and that could potentially happen." Consider it your designated worry time. When the time it up, focus on all the positive steps you're taking, then set aside the rest. She also said that mindfulness, the practice of focusing on the present moment, can help patients stop worrying about what the future might bring. Think of this way: You can't control the future, but you can control what you do right now.

When you’re feeling particularly low, turning to things that bring you happiness or comfort like music, an amusing television show, or journaling can provide welcome distractions, she says. Perryman agrees, and says she’s binge-watched dozens of shows over past years precisely for this kind of escape, includingLost，，，，Twin Peaks，，，，and无处不在的火点。She suggests learning what helps you feel calm and relaxed so you can turn to those outlets when you feel in the depths of despair.

Seek Help When Worry and Low Mood Become Overwhelming

Consider seeking the services of a mental health care provider, especially if your emotions are getting in the way of relationships and your ability to enjoy life, Beier advises. Her websitefindempathie.comassists those with health issues in finding a coach who specializes in their condition.

For those who need additional help, anti-depressants and anti-anxiety medications can be effective for some patients if their MS is causing the depression or anxiety, says Dr. Alschuler. Dr. Levy clarifies further: “Medications for depression were developed for depression, not necessarily for depression due to MS. But depression due to MS can also be responsive to medications.” People with MS may feel sad, aggravated, and/or stressed about their condition. These are situational emotional reactions rather than depression, per se, and these feelings would not necessarily improve with anti-depressant treatment, he adds.

科斯特洛说,虽然不是“robu证据st” for these drugs significantly improving symptoms in MS patients, they are often prescribed.

If there’s one reassuring takeaway, it’s that enormous strides have been made in managing MS—and even preventing relapse. While there is no cure for this condition, there are now nearly two dozen FDA-approved drugs that suppress or modulate the immune system to prevent it from invading the CNS to stop attacks and flaring symptoms from progressing, explains Dr. Levy. He says that prior to 1993, there were no medications available that could help control the progression of MS. Now, disease-modifying meds can significantly reduce the likelihood of attacks and disability. Adds Dr. Hendin, “That can keep you on a high-functioning trajectory for a very long time, and maybe your lifetime.”

Perryman takes this message to heart. “When I think of my future, I don’t see myself in a wheelchair now. That was real for me.” She’s considering climbing Machu Picchu as her next physical challenge. “I’ve gotten to a place where I feel I can do that. That’s not something I would have been able to do before.”

Meet Our Writer

朱莉·哈珀特

朱莉·哈珀特is a freelance journalist with more than two decades of experience writing for many national publications, includingThe New York Times，，，，CNBC andThe Wall Street Journal。她在碎片,解决众多话题让依ng from retirement and personal finance to education, health, the environment and parenting. You can follow her on Twitter: @julhalps

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