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Emotional Changes
In addition to its physical symptoms, multiple sclerosis (MS) may have profound emotional consequences. At first, it may be difficult to adjust to the diagnosis of a disorder that is unpredictable, has a fluctuating course, and carries a risk of progressing over time to some level of physical disability. Lack of knowledge about the disease adds to the anxieties commonly experienced by people who are newly diagnosed.

In addition to these emotional reactions to the disease, demyelination and damage to nerve fibers in the brain can also result in emotional changes. Some of the medications used in MS can also have significant effects on the emotions.

Emotional changes are very common in MS, they are a reaction to the stresses of living with a chronic, unpredictable illness and because of neurologic and immune changes caused by the disease. Bouts of depression (which is different from the healthy grieving that needs to occur in the face of losses and changes caused by MS), mood swings, irritability, and episodes of uncontrollable laughing and crying (pseudobulbar affect) pose significant challenges for people with MS and their family members.

Pseudobulbar affect (PBA) is a condition in which the person suddenly starts to laugh or cry. The reaction isn’t triggered by anything—like a funny joke or sad movie. The person just burst into laughter or tears without any real cause and they can't stop. About 10% of people with MS have PBA, according to the National MS Society.

Researchers have begun to define specific categories for mood swings, emotionalism, and affective disorders that people with MS may experience. Even so, you may experience changes that don't neatly fit into these categories. Instead, you may recognize characteristics from one or more category, with certain aspects of some being stronger than others.

Emotional Changes Observed in MS:
• Major depressive episodes as well as less severe depressive symptoms.
• Grieving for losses related to the disease.
• Stress and reactions to stressful situations.
• Generalized distress and anxiety.
• Emotional lability or mood swings.
• Pseudobulbar affect (PBA) - uncontrollable laughing and/or crying.
• Inappropriate behavior such as sexual aggressiveness.

Emotional lability, often referred to as "moodiness" or "mood swings", may affect persons with MS and is manifest as rapid and generally unpredictable changes in emotions. Family members may complain about frequent bouts of anger or irritability. It's unclear if the emotional lability observed in MS stems from the distress related to the disease or if it's caused by some nerve damage in the brain. Whatever the cause, emotional lability can be one of the most challenging aspects of MS from the standpoint of family life.

Emotional lability describes a state where emotions and the way they are expressed can't be controlled as they once were. Instead, people experience rapid ups and downs in their feelings. People may find their emotions are easily aroused, freely expressed and tend to change quickly and spontaneously. For example, you may easily burst into tears or suddenly get very angry over something, in a way that seems exaggerated or out of proportion. Whether these outbursts involve crying, anger, laughter or anything else, they are usually brought on by a specific event.

The most common emotional changes in MS include:
• Grief and Sadness: Natural reactions to the changes and/or losses that MS can cause. These feelings will likely ebb and flow over the course of the disease.
• Worry, Fear, Moodiness, Irritability and Anxiety: Normal reactions in the face of unpredictability; anyone can become irritable and anxious when faced with difficult challenges.
• Depression: One of the most common symptoms of MS.

Depression, persistent anxiety and extreme irritability are not natural or inevitable, even in people with MS. However, they are very common. These changes require treatment just like any of the physical symptoms of the disease; mood changes can be a significant source of pain and distress in and of themselves.

Moodiness and Irritability

Moodiness and irritability may manifest as rapid and generally unpredictable changes in emotions. Family members may complain about frequent bouts of anger or irritability.

The increase in irritability and moodiness can have multiple causes:
• Many people who are depressed become irritable or moody.
• Changes in the brain may be responsible.
• The challenges of life with MS can make many people feel irritable.

Whatever the cause, emotional lability can be one of the most challenging aspects of MS from the standpoint of family life. Family counseling may be very important in dealing with emotional lability since mood swings are likely to affect everyone in the family.

A correct diagnosis of the problem is essential in order identify the right treatment. While an antidepressant may be the optimal treatment if the depression is the cause, a mood stabilizing medication may help with severe mood shifts and emotional outbursts.

Euphoria

Euphoria is characterised by persistently cheerful mood, particularly at times of difficulty. People may seem strangely unconcerned about their ongoing physical deterioration, and may have a sense of optimism that appears out of place, given their situation.

In some people, both their mood and the way they express their feelings is euphoric. In others, their outward expression of optimism fails to give the true impression of their inner feelings of despair.

MS and Inappropriate Behavior

A very small proportion of people with MS exhibit inappropriate behavior such as sexual disinhibition. Disinhibition is one of the rarest behavioral symptoms of MS and only a very small percentage of people are affected. This type of behavior is thought to result in part from MS-related damage to the normal inhibitory functions of the brain.

These behaviors may also reflect very poor judgment related to cognitive dysfunction caused by MS. Such behavior is generally beyond the control of the individual and is not a sign of moral weakness or sociopathic tendencies.

The treatment of these problems is complex. The person with MS may require some form of psychiatric medication, perhaps along with psychotherapy. Family members will probably need supportive counseling since these behaviors are often shocking and disruptive. In some cases, the affected individual may require supervision to prevent the manifestation of the behaviors in question.

For 24/7 suicide prevention in the U.S. call 1-800-273-8255
National Suicide Prevention Lifeline or online at www.suicidepreventionlifeline.org
The Lifeline provides 24/7, free and confidential support for people in distress