Multiple Sclerosis & Anxiety: What’s the Link?

Many people with multiple sclerosis (MS) experience mental health symptoms, including anxiety. The uncertain nature of the condition—in which relapses and new symptoms seemingly can strike at any time—is thought to be a major reason why. But the immune system's attack on the brain and the resulting neuroinflammation and neurological changes also seem to play a role.

Read on to learn about how MS can lead to anxiety and how to cope.

MS and Anxiety

It's common for people with MS to experience symptoms of anxiety or have anxiety disorders.

The exact prevalence of people with MS experiencing anxiety symptoms varies among studies, but it is believed to be between 34% and 43%. This is much higher than the estimated prevalence of about 18% in the U.S. population overall.

Despite the high occurrence, anxiety in people with MS remains understudied.

There is some evidence that anxiety may be related to neuroinflammation and deficits in frontal lobe functioning (including attention, problem-solving, and memory retrieval) that occur with MS. Research also suggests that it may be due to living with the unpredictability of MS rather than the physical disease process.

MS symptoms and progression can vary. Concern about the potential seriousness of symptoms and outcome of future episodes may contribute to severe and/or prolonged anxiety in people with MS. Research suggests that anxiety tends to be higher at the onset of the condition.

Increased anxiety in people with MS is also associated with:

• Gender (both MS itself and anxiety in MS are more common in women)
• The presence of moderate to severe depression
• Substance use, including smoking and alcohol
• Pain and fatigue
• Lower disability levels
• Younger age of onset
• Greater social stress
• Limited social support

Demyelination (damage to the protective covering surrounding nerve cells), damage to nerve fibers, and some of the medications used to treat MS (such as corticosteroids) may also contribute to emotional changes and anxiety in people with MS.

Left untreated, anxiety in people with MS can lead to:

• Impaired social functioning and decreased social interaction
• Impaired cognitive functioning
• Lowered treatment compliance
• Lower quality of life
• Physical symptoms or worsening MS symptoms
• Increased thoughts or actions of self-harm or suicide (particularly if depression is also present)
  

Symptoms of Anxiety

Anxiety can have both physiological and psychological symptoms.

Physiological symptoms may include:

• Shortness of breath
• Trembling
• Increased heart rate or heart palpitations
• Hot or cold sensations
• Dry mouth
• Fatigue
• Nausea
  
• Tense muscles
• Restlessness
• Sleep difficulties, especially trouble falling asleep
• Frequent urination
  

Psychological symptoms include:

• Frequently feeling worried, guilty, or out of control
• Racing thoughts
• Difficulty making decisions
• Chronic feelings of unhappiness
• Feeling inadequate, criticized, or easily embarrassed
• Inflexibility and being less willing to make changes
• Hostility or anger toward others
• Repeating certain behaviors or thoughts
• Over-anticipating things
• Excessive concern with physical health
• Thinking negatively about the future

Strategies for Coping With MS Anxiety

Anxiety with MS can be managed with professional treatment and coping strategies.

Medication

For some, medication may be beneficial. Options include:

• Antidepressants: Including Celexa (citalopram), Lexapro (escitalopram), Effexor (venlafaxine), and Cymbalta (duloxetine hydrochloride)
• Antianxiety medications (or benzodiazepines): Including Valium (diazepam), for short-term use
  

Therapy

Working with a mental health professional can help a person with MS learn to manage their anxiety symptoms.

Some strategies include:

• Cognitive behavioral therapy (CBT): Learning to identify problematic thoughts and behaviors and changing them into productive ones
• Biofeedback: Learning to control body responses
  
• Acceptance and commitment therapy (ACT): Identifying what is most valuable to the person and finding a way to pursue it
• Support groups: Interacting with others who are also living with anxiety and MS

Mindfulness

Practicing mindfulness techniques and exercises, whether led by a professional or on your own, may help with anxiety.

Examples include:

• Guided imagery
• Body scan exercise
• Meditation
• Mindfulness-based stress reduction (MBSR)
  

Other Measures

Physical exercise and being mobile to the best of your ability may help improve anxiety symptoms. Practicing yoga is a great way to combine physical activity with mindfulness.

Increased social support—including emotional, technical, and informational support—from people such as family members, friends, coworkers, healthcare professionals, and other people with MS has been shown to help mitigate the impact of anxiety and depression.

How to Get Help

Finding the help that works best for you is important. You can start by talking to your healthcare provider. They can help you find resources and make a referral to a specialist or mental health professional if necessary.

The format with which you receive help is also important. In-person sessions are an option, but remote therapy is also a promising choice, especially if access is an issue.

When looking for a therapist or other professional to help with your anxiety, it can help to have some questions prepared ahead of time. For example:

• What is your experience working with people who have MS and anxiety?
  
• Which therapies and relaxation techniques do you use?
• Are your services covered by my insurance?
• Do you involve care partners and family members in the treatment?
• What are your feelings on using medication for anxiety?

The National Multiple Sclerosis Society provides a search tool that can help you find different types of resources available to you.

Summary

It is common for people with MS to experience symptoms of anxiety or anxiety disorders. This may be due to neuroinflammation as a result of MS, or the psychological stress that comes with being diagnosed with a chronic condition. Left untreated, this anxiety can affect functioning and quality of life.

Treatments like medication, therapy, and mindfulness exercises can help with anxiety management. Physical activity, such as yoga, and increased social support can also provide benefits.

A Word From Verywell 

While looking after your physical health with MS, it's just as important to care for your mental health. If you are experiencing symptoms of anxiety, talk to your healthcare provider or a mental health professional about what you're feeling. Anxiety can be treated and managed alongside MS.