Emotional Challenges

Last updated Jan. 13, 2022, by Marisa Wexler, MS

Fact-checked by Inês Martins, PhD

Multiple sclerosis (MS) is caused by the immune system erroneously attacking and damaging the brain and other parts of the nervous system.

Since the brain is responsible for regulating and experiencing emotions, the nervous system damage that occurs in MS can result in mental health challenges or emotional changes for patients who may already be experiencing the stress of navigating the world with a chronic illness.

Mental health issues can be managed through a variety of medications, such as antidepressants or anxiolytics (anti-anxiety medicines), specialist care such as talk therapy, as well as lifestyle modifications (e.g., a proper diet and physical activity).

Depression and anxiety

Depression is a mental illness characterized by a profound lack of energy accompanied by feelings of sadness and hopelessness. Compared to the general population, depression is about three times more common in people with MS. In fact, more than half of MS patients are estimated to have clinically relevant depression.

Anxiety is defined by feelings of fear, dread, and uneasiness. Anxiety is about three times more common in MS than in the general public, with more than 40% of patients reporting clinically relevant anxiety.

Depression and anxiety can influence each other and often co-occur. By some estimates, half of MS patients with clinical depression also experience substantial anxiety. Because mental health problems are often difficult to discuss, it’s likely that the prevalence of these problems is under-estimated.

Pseudobulbar affect

Some people with MS may experience a condition known as pseudobulbar affect, a sudden burst of uncontrollable laughter or crying that is not connected to the person’s emotional state. Patients may suddenly laugh although nothing is funny, or cry when they are not sad. This laughing or crying is not under voluntary control, and patients cannot easily stop the outburst, even if they would like to, which can be very distressing.

An estimated one in 10 people with MS experiences pseudobulbar affect, though this rate is likely higher because the symptom tends to be under-reported.

A medication called Nuedexta (dextromethorphan hydrobromide and quinidine sulfate), by Avanir Pharmaceuticals, was approved in the U.S. in 2010 for pseudobulbar affect. It is the only approved medication specifically for this indication. Other antidepressants may also help manage this symptom.


Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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