In discussing aspects of mental health and multiple sclerosis, we have covered depression symptoms, depression causes, and depression treatments, mood swings and medication side-effects.  Much has been written about MS and depression, but very little about MS and anxiety disorders, specifically panic disorder, obsessive compulsive disorder, and generalized anxiety disorder.

I found a fascinating article in the journal Multiple Sclerosis, Anxiety disorders and their clinical correlates in multiple sclerosis patients by M Korostil and A Feinstein (Multiple Sclerosis 2007; 13: 67-72), which sought to determine how common anxiety disorders are in patients with multiple sclerosis.  The study was completed by collecting neurological and demographic data, as well as interviewing subjects and completing a battery of assessments, of 140 MS patients who attend a neurological outpatient clinic in Toronto, Canada.

Here is a summary the type of data collected:

• Neurological information was gathered including disease course and duration, the presence of exacerbations, the use of disease modifying treatments and a measure of physical disability using the Expanded Disability Status Scale (EDSS). 

• All subjects were interviewed in-depth (using SCID-IV) to determine current and lifetime diagnoses of mental illness.

• Lifetime suicidal intent and attempts were assessed using the self-harm question from the SCID-IV, and three self-report questions derived from the Beck Suicide Scale (BSS).

• The interviews were supplemented with a self-report questionnaire, the Hospital Anxiety and Depression Scale (HADS). This scale, developed specifically for use with medically ill patients, minimizes the somatic symptoms of anxiety and depression and consists of seven questions pertaining to depression and seven to anxiety. 

• Psychosocial stressors were assessed in the following areas: work, finances, housing, marriage/relationships, friendships, and family supports.

• Subjects were also screened for cognitive impairment using the Neuropsychological Screening Battery for MS, developed specifically for patients with multiple sclerosis.

How common are anxiety disorders in MS patients?

Within this sampling of patients, the lifetime prevalence of any anxiety disorder was 35.7% while lifetime prevalence is 23% in the general population.  The prevalence of panic disorder was 10% (vs. 3.5%), obsessive compulsive disorder was 8.6% (vs. 2.5%), and generalized anxiety disorder was 18.6% (vs. 5.1%).  Fourteen percent of the patients were experiencing an active anxiety disorder at the time of the study.  Interestingly, phobias were seen less commonly as compared to the general population.  The prevalence of social anxiety disorder was 7.8% (vs. 13.3%) and simple phobia type disorder was 10.8% (vs. 11.0%).

All these numbers can be dizzying but they show how much more common anxiety disorders are for patients living with multiple sclerosis than for members of the general population. Subjects in this study with an anxiety disorder were more likely to be female and have a history of depression, drink to excess, report higher social stress and less support, and have contemplated suicide.  A small correlation was found between reports of high levels of social stress and generalized anxiety disorder