Emotional and Psychological Symptoms in Multiple Sclerosis

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Managing the plethora of physical symptoms in multiple sclerosis (MS) is no small feat. So, it's no wonder that emotional and psychological symptoms, like depression, grief, and anger, often take a back seat.

The problem with this is that emotional changes in MS are often intertwined with how a person is feeling physically. Therefore, by ignoring or not acknowledging the emotional symptoms you or a loved one is experiencing, your physical symptoms may actually worsen — a double whammy.

Here are some of the most common psychological states or emotions seen in people living with MS. With the guidance of your healthcare provider, please try to address and tackle each one — you can and deserve to feel well.

Symptoms of MS
Verywell / JR Bee 


Depression is common in MS and may stem from the disease itself, and/or from the consequences of living with a disabling, unpredictable neurological illness.


While everyone feels "blue," sad, or down at times (this is normal), the symptoms of depression occur nearly every day. In other words, depression symptoms are more or less constant and are severe enough to disrupt your daily functioning and/or interfere with your relationships, either at work or at home.

The two most classic symptoms of depression are feeling sad or irritable nearly all the time and losing interest in activities that you once enjoyed.

Other symptoms include:

  • A change in appetite
  • Sleeping difficulties
  • Unusual agitation/restlessness or sluggishness (often noticed by others)
  • Lack of energy
  • Feeling overwhelmingly guilty, hopeless, or worthless
  • Memory or thinking problems
  • Suicidal ideation


If you think you may be suffering from symptoms of depression, be sure to see your healthcare provider. The good news is that depression is a very treatable condition.

In addition to medication, depression is often treated with the following therapies:

  • Talk therapy, such as psychotherapy or cognitive-behavioral therapy
  • Healthy lifestyle habits (e.g. regular exercise, good sleep patterns, and eating balanced, nutritious meals)
  • Complementary therapies, such as relaxation therapy, acupuncture, and light therapy

In the end, a multifaceted approach to treating depression is your best bet — and may even help ease some of your other MS symptoms, like fatigue and pain.

If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911. You can also call the National Crisis Hotline at 1-800-273-TALK or text "ANSWER" to 839863.


While most people associate grief with losing a loved one, it's perfectly normal to grieve a diagnosis of MS, as well as the "losses" brought on by having MS. These losses may be physical (e.g., loss of mobility or energy) or cognitive (e.g., loss of mental prowess), as well as mental or emotional (e.g., a diminishing sense of well-being and identity).


Besides a feeling of loss, other symptoms or signs of grief in MS may include:

  • Denial
  • Isolation
  • Anger
  • Depression
  • Anxiety and frustration
  • Fear or worry
  • Irritability


Grief is a normal reaction — so coping with or managing your grief is probably a more appropriate term than treatment. When coping with your grief, it's important to consider the severity of your symptoms.

For instance, if you are feeling so anxious or sad that you are having a hard time going to work or taking care of household chores, then it's time to see your healthcare provider. You may need treatment — medication and talk therapy — for clinical depression or generalized anxiety disorder.

On the flip side, if you are feeling irritable or anxious here and there (meaning it's not extreme or persistent), engaging in healthy coping strategies may be useful — journaling, exercising, joining a support or self-help group, or trying out a mind-body therapy, like mindfulness meditation.


Regardless of whether or not you have MS, anger is a normal feeling. However, anger may be intensified in people with MS.

Some experts believe there may be a biological explanation for your rage — that MS-related damage to certain areas of the brain results in anger.

Others believe that anger occurs as a result of living with such an unpredictable disease — one that robs people of their ability to do things (e.g., vision or mobility problems) and presents daily challenges and burdens (e.g., trouble writing a check or caring for your children).


It's important to keep in mind that not everyone who is angry, is in a "rage" and flying off the handle. Some people are silently angry — they tend to isolate themselves and fume in silence or act passive-aggressively towards others. In other instances, anger is actually a symptom of depression.

Anger may also manifest as physical symptoms and signs, such as:

  • Headaches
  • Heart palpitations or a tightening sensation in the chest
  • Increased blood pressure
  • Tingling
  • Unusual tiredness


Similar to managing many other emotional changes in MS, easing your anger often requires multiple strategies — perhaps, joining an MS support group, taking anger management classes, engaging in family counseling, and performing relaxation techniques like yoga or tai chi, among others.

Keeping busy and distracted is another way to combat your anger. If you are bored or isolated during the day, angry feelings can fester and boil over. Consider finding a hobby, letting yourself escape in a book or movie, or scheduling regular outings with a loved one or friend.

To diffuse an acute situation — when you are feeling angry at the very moment — try releasing your energy by going for a walk, punching a pillow, or letting out a scream.

Once you have calmed down, you may try writing down your feelings and frustrations and working through them on paper — journaling can be a powerful tool for releasing negative emotions and managing stress.

Pseudobulbar Affect

Pseudobulbar affect (PBA), also known as emotional lability or emotional incontinence, is a term that refers to uncontrollable outbursts of laughter and/or crying. These outbursts are really impossible for a person to control and can be extremely distressing for the person affected, as well as for that person's loved ones.


It's important to note that with PBA, a person's outward laughing or weeping does not necessarily correlate with their underlying mood or with something in their environment. In other words, a person with PBA may be laughing hysterically, but that does not mean they are feeling happy inside or that something funny triggered this outburst.


PBA can be a challenging symptom to treat and often requires medication, such as one of the following:

  • A drug called Nuedexta, which is a combination oral (by mouth) drug that contains both dextromethorphan and quinidine
  • A tricyclic antidepressant, such as Elavil (amitriptyline)
  • A selective serotonin reuptake inhibitor (SSRI), such as Luvox (fluvoxamine)

Behavioral Changes

A person with MS may exhibit behavioral changes, sometimes even inappropriate behavior, such as impulsivity and social and/or sexual disinhibition.

While this may be alarming, it's important to keep in mind that this disinhibition is a reflection of a person's disease. It is believed to occur as a result of MS-related damage to the part of the brain that controls impulses.


Besides impulsivity, poor judgment, and/or disinhibition, other behavioral changes may include:

  • Aggression
  • Impatience
  • Apathy

It's interesting to note, as well, that research suggests that behavioral changes can predict cognitive and functional impairment in people with MS. This makes sense — you can imagine that acting on impulses or expressing apathy may result in unemployment, relationship difficulties, and executive functioning problems.


Treatment of impulsivity and disinhibition often entails a comprehensive approach — one that may include medication, psychotherapy, and family counseling.

A Word From Verywell

No doubt, living with MS is an emotional rollercoaster — from the lows of coping with sometimes unbearable symptoms to the highs of finding a medication or strategy that helps you feel and function well again.

For right now, do your best to take one day at a time, seek out support from your MS doctor and loved ones, and remain strong and steadfast in your coping abilities. In the end, having MS likely gives you a deeper sense of what is important in life.

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