Can Stress Trigger Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic central nervous system disease in which the immune system attacks the brain and spinal cord. It can cause symptoms such as fatigue, sensory changes, pain, muscular weakness, cognitive dysfunction, and depression.

Studies conflict over whether stress can cause MS, but there is evidence to support that prolonged stress plays a role in MS flare-ups and the development of lesions. MS can also cause stress for the people who live with it.

Read on to learn more about how stress and MS are linked.

Can Stress Cause MS?

Studies have shown mixed results on whether stress causes MS. Earlier studies have suggested that MS lesions occur more often after a stressful life event, but this finding has not been proven.

Two areas of the stress response system—the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system—may also be associated with MS. An earlier study suggests that people with MS may experience interruptions in communication between the immune system and these two areas.

People with MS often describe a link between stress and their experiences with MS. Some people with MS feel their MS was triggered by going through an exceptionally stressful period of time. Studies that involve more self-evaluation and subjective measures may help give insight into the link between stress and MS.

There is stronger evidence to support that prolonged stress plays a role in exacerbating MS in those who already have it. Some studies even suggest that stress management may be able to slow down the development of new MS lesions and help the person have fewer flare-ups.

Can MS Cause Stress?

Evidence suggests stress is more common in people with MS than in the general population. People with MS may have a reduced ability to handle stress when facing a chronic illness.

In addition to the typical day-to-day stress common to everyone, stressors for people with MS include:

• Being newly diagnosed
• The unpredictability of the condition
• Living with and managing symptoms
• Side effects of treatment
• Navigating mobility limitations and disability
• Effects on the ability to perform tasks, including work, parenting, and daily activities like housework
• Effects on personal relationships
  

Managing Stress

Stress management can be beneficial for people with MS. There are several different ways to manage stress.

Be Realistic

• Recognize what is within your control and what isn't.
• Keep a journal to better understand what triggers your stress.
• Set realistic goals.
• Plan ahead for expected or unexpected situations.
• Prioritize activities and tasks.
• Simplify where you can.
• Relax standards you place on yourself, such as keeping the house spotless or the lawn perfectly cut.
• Learn to say no.

Get Moving

• Engage in physical activity that you enjoy, which can help release stress, increase endorphins, gain energy, help with physical health, and improve sleep.
• Activities such as yoga and tai chi can help get you moving.

Practice Relaxation and Mindfulness

Try mindfulness techniques such as:

• Mindful meditation
• Mindfulness exercises such as progressive muscle relaxation
• Guided imagery
• Breathing exercises
• Yoga
  

Sleep and Rest

• Get at least seven or eight hours of sleep per night.
• Evaluate the quality of your sleep and address any sleep issues, such as insomnia or sleep apnea.
• Put rest periods into your schedule.
• Set an alarm to remind you to stop what you are doing and rest.

Talk to Others

• Communicate with friends, family, and other important people in your life.
• Join a support group.
• Seek professional help from a counselor, therapist, or another mental health professional.
• Ask for help and be specific with requests.

Use Daily Coping Strategies

• Get necessary but unpleasant tasks out of the way by doing them earlier in the day.
• Use the "three-fourths rule" (fill up and restock things like medication, gas, and groceries when they are three-fourths gone), so you don't run out of items or scramble to get them last minute.

Get Practical

• Keep a supply of needed items on hand.
• Make notes.
• Use gadgets or devices that you find helpful.
• Leave earlier when going places if you tend to feel rushed.
• Keep prepared foods in the house for days you aren't up to cooking.
  

Avoiding MS Flare-Ups

An MS flare-up, also called a relapse or attack, is when new MS symptoms occur or old symptoms worsen. To classify as a relapse, it must:

• Be separated from the previous flare-up by at least 30 days
• Last at least 24 hours
• Not be explained by something else such as fever, acute infection, or acute stress (this would be called a pseudo-relapse)

In some studies, long-term, prolonged, or continuous emotional stress (such as from divorce or a death in the family, or even a new baby or planning a wedding) has been shown to have the potential to trigger a relapse, though not all studies on the subject have found this result.

Personality type and how the person responds to stress may be more influential than the stress itself, with those who perceive stress positively having better health outcomes than those who view stress negatively (even if they have less stress).

MS flare-ups can't always be prevented, but keeping stress levels lowered through stress management may help.

Treating MS Flare-Ups

If the flare-up is mild and doesn't cause significant distress or disruption, it may not need to be treated.

More severe flare-ups may be treated with a short course of high-dose corticosteroids. This may include Solu-Medrol (methylprednisolone) given intravenously, or Deltasone (prednisone) given orally.

Other options include:

• H.P. acthar gel: A highly purified preparation of adrenocorticotropic hormone (ACTH) in a gel administered through injection
  
• Plasmapheresis: Plasma exchange
• Rehabilitation: Program used to help restore or maintain essential functions, administered by specialists such as physical or occupational therapists, speech/language pathologists, or cognitive remediation specialists
  

Other Flare-Up Triggers

It isn't always possible to avoid MS triggers. Studies suggest that MS flare-ups may be influenced by factors such as:

• Age
• Sex
• Pregnancy
• Vitamin D serum levels
• Interactions between genetic and environmental factors
• Infectious diseases/serious infections

While they aren't relapses, MS symptoms can fluctuate day-to-day and be temporarily influenced by factors such as:

• Temperature (like a hot, stuffy room)
• Short-term stress (prolonged stress may trigger a full flare-up)
• Minor infections (such as a urinary tract infection, cold, or stomach virus)

Summary

MS can cause stress due to the nature of the condition, its symptoms, and its impact on daily life. Evidence is mixed on whether stress can cause MS. There is more evidence to support prolonged stress triggering flare-ups in people who already have MS than there is for MS triggering the onset of MS.

Stress management techniques, such as daily coping skills, planning ahead, healthy lifestyle habits, mindfulness, and seeking support, may help prevent MS flare-ups.

A Word From Verywell 

Having MS is stressful, and, unfortunately, prolonged stress may exacerbate MS. It may feel like a vicious cycle, but there are ways to break it. If you have MS and are struggling with stress, talk to a healthcare provider or mental health professional. They can offer resources to help.