Last week I wrote a post - Mood Swings, Medication, and Multiple Sclerosis - in which I shared a slice of my mental health reality. For me, the experience of mood swings being more prevalent during certain times of the month has become much more common since finally being diagnosed with MS and prescribed Copaxone. Whether the cause of the mood swings is MS itself, a side-effect to medication, or simply hormonal changes, the experience remains as unpleasant.
The passionate response to the post was humbling for me. What was intended to be light-hearted, spoke the truth for several individuals who saw themselves in the description of my personal experience. Thanks so much for sharing part of your own story with me. Let’s extend our conversation and discuss the ways in which mood can be affected by multiple sclerosis.
In the comments last week, hmking4 mentioned Involuntary Emotional Expression Disorder (IEED) which is increasingly being recognized by MS experts as being the result of neurological damage caused by MS, however only one of many causes in the non-MS population. This is an extreme example of mood changes, or emotional lability, experienced by a small percentage of patients with MS; it is also known as Pseudobulbar Affect (PBA) in which the person may have an inappropriate emotional response to a situation. For instance, laughing uncontrollably at a funeral, or crying out of the blue for no particular reason at all. The uncontrollable and inappropriate nature of PBA is what sets it apart from general mood swings or mood disorders. Merely Me wrote a post explaining a bit about this disorder last month, see Laughing or crying for no reason? It may be your MS.
I briefly touched on the topic of PBA earlier in the year in Multiple Sclerosis: Psychosomatic, Neurologic, Mood Disorder, or Personality?, a post in which I also discuss a bit about depression and the difficulty in finding a diagnosis for one patient. Another post regarding mental health and MS can be found here - Depression, Inflammation, and Multiple Sclerosis - in which I quote my neurological infusion nurse as saying, “In some patients, depression is the earliest symptom of MS.”
Last year, Dr. Gross wrote about the relationship between multiple sclerosis, neuropsychiatry and MRI findings in A Window into the Neuropsychiatry of MS. Below is an excerpt from Dr. Gross’s post:
"In 1999, Diaz-Olaverrieta et al. out of Mexico City published a study on Neuropsychiatric Manifestations of Multiple Sclerosis (MS). This research was highly instructive because it was one of the first to catalogue the range of Neuropsychiatric problems in MS patients including those with only mild complaints or difficulties. It also showed that most of these features did not have an MRI explanation- that is, there was no obvious reason for the Neuropsychiatric conditions based upon where MS lesions were found on MRI.
The authors noted that Neuropsychiatric symptoms were present in 95% of MS patients and 16% of control subjects (those without MS who were evaluated). Changes present were depression symptoms (79%), agitation (40%), anxiety (37%), irritability (35%), apathy (20%), euphoria (13%), disinhibition (inappropriate or outlandish "acting out") (13%), hallucinations (10%), aberrant motor behavior (abnormal movements) (9%), and delusions (7%). The only relationships with MRI were between euphoria and hallucinations and moderately severe MRI abnormalities. The authors concluded that diverse types of Neuropsychiatric symptoms are common in MS; symptoms are present between exacerbations; and there are variable correlations with MRI abnormalities.
Translation? When a patient with MS has a problem in their mood or behavior, it is not often understandable the way a right-sided weakness or a balance problem is."
As you can probably guess, I find this topic to be highly fascinating and increasingly more relevant to my MS experience. I must admit that I experience clinical depression and have for many years. Within that experience, I also have major depressive episodes and have been fighting not to sink into one in recent weeks.
So I’m selfishly interested in examining this topic for the benefit of our community at MS Central and for myself. For the next few weeks, I will discuss depression, mental health, stress, medications (including side-effects), and multiple sclerosis. We will also explore ways to manage each of these influences and maintain our quality of life.
Let’s get started. What do you think of Pseudobulbar Affect? Did you know that up to 10% of MS patients experience this disorder?
What topics are of most interest to you in discussing Mental Health and Quality of Life? I have my ideas of where to go with this, but it’d be nice for you to also guide the conversation.
More Posts in this Series: