The Emotional and Psychological Symptoms of MS

Reviewed by Miriam Franco, MSW, PsyD, MSCS and Jack Burks, MD
Edited by Susan Wells Courtney


This article is the third in a three-part series on the management of MS symptoms. The earlier articles in this series addressed the “hidden” symptoms of MS, such as pain and fatigue, as well as the physical symptoms of MS, which include mobility, spasticity, and several other well-recognized symptoms. These two articles appeared in the Winter/ Spring 2013 and the Summer/Fall 2013 issues of The Motivator, respectively.

This latest article addresses the emotional and psychological symptoms of MS, describing depression, anxiety, and pseudobulbar affect (PBA), along with treatment strategies for these symptoms. This writing also examines other important issues affected by emotional factors, such as changing roles and relationships, sexual dysfunction, and self image.

Readers should keep in mind that everyone experiences changes in emotions at one time or another, as well as the typical “ups and downs” of everyday life. A tragic event may cause someone to feel sadness for an extended period of time, and stressful events can cause great anxiety until the problems are resolved. These are normal reactions from which most people recover and eventually return to their usual, healthy outlook on life. However, when someone experiences severe and/or prolonged depression or anxiety, possibly not related to any specific event or issue, professional help may be needed.

According to MSAA’s publication, Understanding and Treating Depression in Multiple Sclerosis, nearly one in 10 American adults suffers from a depressive illness during any given one-year time period. Over the course of a lifetime, estimates increase to one in five for women, and one in eight for men. These rates are for the general population; individuals with MS are at an even greater risk.

Photo of a woman thinking

Does this mean that everyone with MS will experience emotional issues? Absolutely not! But knowing the symptoms and recognizing a problem if one should arise is vital to maintaining a happy and productive life. The important thing to remember is that effective treatments and support are available, and no one needs to suffer from these debilitating emotions.

With MS, the rate of depression is three-times higher than the general population and it is also higher than with other chronic illnesses. Anxiety, too, is estimated to affect 43 percent of individuals living with MS and is typically undetected and untreated – more so than depression. The combination of heightened levels of depression and anxiety, if untreated, can even pose a risk of suicide in MS. Pseudobulbar affect (PBA) occurs in 10 percent of people with MS, although some research suggests that a much larger number may be affected. It is characterized by sudden, uncontrollable expressions of laughter or crying without an apparent trigger. It occurs in other chronic, neurological conditions and is an extremely distressing symptom.

Depression can result from the physical effects of MS within the nerves of the brain, or as with anxiety, it can be a natural byproduct of living with the disease. PBA is always caused by physical changes in the brain. It is crucial to understand that individuals are not able to control such emotions and they should never feel ashamed or judged for experiencing them. The good news is that these symptoms are treated no differently in MS than in those without MS, and are all highly treatable.

Emotional disturbances can cause significant pain and suffering, and lead to disruptions in family, work, and social life. As noted later in this article, emotional disturbances can also impact roles and relationships, sexual function, and one’s self image. Physicians, nurses, psychologists, and social workers who can identify, diagnose, treat, and manage these disturbances effectively are vitally important. These professionals can help their patients and family members talk about the emotional symptoms of MS – not just the physical ones. They encourage patients and family members to seek psychiatric and psychological treatment, which can have a dramatic, positive impact on the quality of their patients’ lives.

The sections in this article have been written and reviewed by top MS experts, some of whom are members of MSAA’s Healthcare Advisory Council, and reviewed by MSAA’s Chief Medical Officer Jack Burks, MD. Please note that while specific treatment strategies and medications are listed, this information may not be considered as specific medical recommen-dations or advice. The details provided in this article are for informational purposes only, and readers are strongly urged to see their physician before making any changes to their treatment regimen, exercise routine, or any other aspect of their healthcare or lifestyle.

For more information or to access previous copies of The Motivator or MSAA’s booklet on depression, please visit MSAA’s website at While on our website, visitors may view a number of online educational videos and webinars, including those on the symptoms of MS and their treatment options. Readers may also call MSAA at (800) 532-7667 to order copies of publications, learn about MSAA’s programs and services, and speak with a trained Helpline consultant for information, support, and resources.