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MS research update – Emotional changes in people with MS – 16 November 2015

Summary

This study looked at emotional changes in people with relapsing remitting MS and primary progressive MS and their relationship with different symptoms.

The study found that more participants with MS had other emotional changes, which were more subtle and difficult to detect than depression or anxiety. Some participants had other mood symptoms such as emotional blunting (a lack of emotional reaction) or decreased emotional control.

As even subtle emotional changes can also have an impact on quality of life the researchers conclude that a health professional’s ability to recognise these smaller changes, not just major depression and anxiety which can be more obvious, could help people with MS access the support they need to manage any emotional changes they are experiencing.

Background

About half of people with MS experience depression at some time and many others can experience periods of low mood, depressive symptoms and other emotional changes. This can be the result of living with MS but can also be a symptom caused directly by MS if there is a lesion in an area of the brain involved in mood.

Many of the symptoms associated with depression such as fatigue, constipation and sleep problems are also symptoms of MS and some MS symptoms such as cognitive (thinking) symptoms can make emotional assessment more complicated.

This study looked at emotional changes in people with relapsing remitting MS and primary progressive MS and their relationship with different symptoms.

How this study was carried out

60 people with relapsing remitting MS (RRMS) and 41 with primary progressive MS (PPMS) in France took part in the study. Each person with MS in the study was matched to control participants (who did not have MS), for age, gender and level of education.

The participants were assessed in various ways:

  • Levels of disability were measured using the EDSS scale.
  • Quality of life was measured using the short form 36 (SF-36) questionnaire. 
  • Cognition was assessed using several different tests, which looked at aspects of cognition such as attention, memory, information processing speed and executive function (like planning and judgement).

The participants completed several questionnaires that explored their emotions and mood.

  • The Echelle d’Humeur Depressive (EHD, translates as the Depressive Mood Scale) which helps to identify other emotional issues in people who do not have major depression or anxiety.
  • Beck Depression Inventory - II (BDI-II) and the Beck Depression Inventory - Fast screen (BDI-FS) to examine depressive symptoms.
  • State-Trait Anxiety Inventory (STAI) to examine levels of anxiety.

What was found

The participants with MS had more anxiety, depressive and emotional symptoms and fatigue than the participants in the control group. There were no significant differences in the proportion of people (around 20%) with RRMS and PPMS who had with moderate-to-severe depression or anxiety.

The study found that more participants with MS had other emotional changes, that were more subtle and difficult to detect than depression or anxiety. Around a quarter (25%) to a third (33%) of participants had other mood symptoms such as emotional blunting (a lack of emotional reaction) or decreased emotional control.

Levels of depression, anxiety and other emotional changes (as determined by scores on the mood questionnaires) were not related to levels of disability, fatigue, cognitive symptoms or length of time someone had lived with MS. In people with RRMS a lack of emotional control was related to a decrease in quality of life.

What does it mean?

The study found that emotional changes are common in both people with RRMS and PPMS and can be found in people who do not meet the criteria for a diagnosis of depression or anxiety. As even subtle emotional changes can also have an impact on quality of life the researchers conclude that a health professional’s ability to recognise these smaller changes, not just major depression and anxiety which can be more obvious, could help people with MS access the support they need to manage any emotional changes they are experiencing.

Lamargue Hamel D, Deloire M, Ruet A, et al.
Deciphering depressive mood in relapsing-remitting and progressive multiple sclerosis and its consequence on quality of life.
PLoS One. 2015 Nov 10;10(11):e0142152. doi: 10.1371/journal.pone.0142152. eCollection 2015.
abstract
Read the full text of this paper

More about mood in MS

Living with MS can be challenging and long lasting changes in mood could be due to managing these challenges or directly as a result of MS and its effect on the central nervous system. People with MS can experience depression, anxiety, stress and other emotional changes, such as an inappropriate or excessive emotional response to an event (pseudobulbar affect).

However many people can find it difficult to talk about mood changes and to seek appropriate support. If you are concerned about changes in your mood, it is important that you speak to your MS specialist team or GP. They should be able to refer you to specialist support or may be able to prescribe treatment directly.

Treatment usually works well and there are various options available, you can try different approaches to find the best one or combination that works for you. You could try medication, talking therapies such as Cognitive behavioural therapy (CBT) or self-management techniques such as exercise, relaxation and mindfulness.

You can read more about anxiety, stress and depression in the A to Z of MS including information on the different therapies available and what you can do to help yourself.  

If you have been recently diagnosed with MS, the MS and your feelings information sheet explores how your feelings may be affected and how you can adjust after diagnosis. You can read it online or you can download or order a printed copy.

Research by topic areas...

Assessment tools

Smrtka J Arnp-C Mscn, Brown T Md, Bjorklund G Pa-C.
Loss of mobility and the patient burden of multiple sclerosis: expert opinion on relevance to daily clinical practice.
Postgrad Med. 2015 Nov 12. [Epub ahead of print]
abstract

Collins C, Ivry B, Bowen JD, et al.
A comparative analysis of Patient-Reported Expanded Disability Status Scale tools.
Mult Scler. 2015 Nov 12. [Epub ahead of print]
abstract
Read the full text of this paper

Disease modifying drugs

Bruce J, Bruce A, Lynch S, et al.
A pilot study to improve adherence among MS patients who discontinue treatment against medical advice.
J Behav Med. 2015 Nov 12. [Epub ahead of print]
abstract

Dwyer MG, Zivadinov R, Tao Y, et al.
Immunological and short-term brain volume changes in relapsing forms of multiple sclerosis treated with interferon beta-1a subcutaneously three times weekly: an open-label two-arm trial.
BMC Neurol. 2015 Nov 11;15:232.
abstract
Read the full text of this paper

Tsivgoulis G, Katsanos AH, Grigoriadis N, et al.
The effect of disease-modifying therapies on brain atrophy in patients with clinically isolated syndrome: a systematic review and meta-analysis.
Ther Adv Neurol Disord. 2015 Sep;8(5):193-202.
abstract
Read the full text of this paper

Longbrake EE, Naismith RT, Parks BJ, et al.
Dimethyl fumarate-associated lymphopenia: risk factors and clinical significance.
Mult Scler J Exp Transl Clin. 2015 Jan-Dec;1.
abstract
Read the full text of this paper

Kvistad SS, Myhr KM, Holmøy T, et al.
Body mass index influence interferon-beta treatment response in multiple sclerosis.
J Neuroimmunol. 2015 Nov 15;288:92-7.
abstract

Giovannoni G, Gold R, Fox RJ, et al.
Relapses requiring intravenous steroid use and multiple-sclerosis-related hospitalizations: integrated analysis of the delayed-release dimethyl fumarate phase III studies.
Clin Ther. 2015 Oct 30. [Epub ahead of print]
abstract

Other treatments

Rahimdel A, Zeinali A, Mellat A.
Evaluating the role of corticosteroid pulse therapy in patients with secondary progressive multiple sclerosis receiving mitoxantrone: a double blind randomized controlled clinical trial.
Iran Red Crescent Med J. 2015 Oct;17(10):e30618.
abstract
Read the full text of this paper

Effects of dalfampridine extended-release tablets on 6-minute walk distance in patients with multiple sclerosis: a post hoc analysis of a double-blind, placebo-controlled trial.
Clin Ther. 2015 Nov 9. [Epub ahead of print]
abstract
Read the full text of this paper

 

Yamasaki R, Matsushita T, Fukazawa T, et al.
Efficacy of intravenous methylprednisolone pulse therapy in patients with multiple sclerosis and neuromyelitis optica.
Mult Scler. 2015 Nov 12. [Epub ahead of print]
abstract

Physical activity

Ketelhut NB, Kindred JH, Manago MM, et al.
Core muscle characteristics during walking of patients with multiple sclerosis.
J Rehabil Res Dev. 2015;52(6):713-724.
abstract
Read the full text of this paper

Prognosis

Vollmer T, Huynh L, Kelley C, et al.
Relationship between brain volume loss and cognitive outcomes among patients with multiple sclerosis: a systematic literature review.
Neurol Sci. 2015 Nov 4. [Epub ahead of print]
abstract

Psychological aspects

das Nair R, Kontou E, Smale K, et al.
Comparing individual and group intervention for psychological adjustment in people with multiple sclerosis: a feasibility randomised controlled trial.
Clin Rehabil. 2015 Nov 9. [Epub ahead of print]
abstract

Parada-Fernandez P, Oliva-Macias M, Amayra I, et al.
Accuracy and reaction time in recognition of facial emotions in people with multiple sclerosis.
Rev Neurol. 2015 Nov 16;61(10):433-440. Spanish, English.
abstract

Gedik Z, Sorias O, Idiman E.
Do coping styles mediate the relationship between disability status and psychosocial loss in people with relapsing remitting multiple sclerosis?
J Health Psychol. 2015 Nov 3. [Epub ahead of print]
abstract

Kratz AL, Ehde DM, Hanley MA, et al.
A cross-sectional examination of the associations between symptoms, community integration, and mental health in multiple sclerosis.
Arch Phys Med Rehabil. 2015 Oct 31. [Epub ahead of print]
abstract

Quality of life

Buhse M.
The elderly person with multiple sclerosis: clinical implications for the increasing life-span.
J Neurosci Nurs. 2015 Dec;47(6):333-9.
abstract

Rehabilitation

Nedeljkovic U, Raspopovic ED, Ilic N, et al.
Effectiveness of rehabilitation in multiple sclerosis relapse on fatigue, self-efficacy and physical activity.
Acta Neurol Belg. 2015 Nov 12. [Epub ahead of print]
abstract

Relapses

Ramo-Tello C, Tintoré M, Rovira A, et al.
Baseline clinical status as a predictor of methylprednisolone response in multiple sclerosis relapses.
Mult Scler. 2015 Jun 25. [Epub ahead of print]
abstract
Read the full text of this paper

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