Mental health and provider considerations when treating multiple sclerosis

As mental health disorders can be one of the “invisible” symptoms of multiple sclerosis (MS), mental health care can be integrated into routine MS care through the regular use of screening tools and an integrated approach to treatment.

As mental health disorders can be one of the “invisible” symptoms of multiple sclerosis (MS), mental health care can be a part of routine MS care through the regular use of screening tools and an integrated approach to treatment, according to a recently published paper.

Mood and mental health disorders such as depression, anxiety, adjustment disorder, bipolar disorder, psychosis and suicidal ideation affect MS patients at a higher rate than the general population. This may be the result of lesions of the central nervous system, interplay of invisible symptoms and the stress of living with MS.

“A patient-centered interdisciplinary approach, routine screening for mental health changes, and referral to specialists when needed can normalize discussions of mental health and increase the likelihood that people living with MS will receive the support and care they need” the authors, led by Bryan Davis, Psy.D., behavioral medicine provider with the Norton Neuroscience Institute Hussung Family Multiple Sclerosis Center, wrote in “Patient and Provider Insights into the Impact of Multiple Sclerosis on Mental Health: A Narrative Review” in Neurology and Therapy.

“Management techniques such as robust social support, cognitive behavioral therapy, mindfulness-based interventions and/or pharmacotherapy may be implemented to build resilience and promote healthy coping strategies,” the authors wrote.

The paper’s authors included people living with MS as well as health care providers.

People living with MS can encounter some of the following common health changes:

  • Mood changes after MS diagnosis
  • Higher stress levels
  • Higher anxiety
  • Loss of interest in everyday activities
  • Persistent feelings of sadness
  • Periods of unusually intense emotion
  • Loss of self-esteem
  • Fear of disease progression
  • Suicidal thoughts
  • Suicide attempts

Considerations for health care providers

Health care providers can encourage people living with MS to share any mental health changes and can integrate clinical interviews and regular use of screening tools to monitor for changes.

Initial management may utilize non-pharmacotherapeutic approaches such as cognitive behavioral therapy, mindfulness-based interventions or other strategies that build resilience, the authors wrote.

“Increasingly, patients have access to telehealth options as well as digital apps for mental health management. Taken together, these approaches form an integrative care model in which people living with MS benefit from the care of medical professionals, a variety of support networks/resources and self-management techniques for optimal mental health care” the authors wrote.

Mindfulness-based activities can include:

  • Aerobic exercise
  • Gratitude journaling
  • Meditation
  • Music therapy
  • Yoga

Additionally, therapeutic services, such as the Lego program at Norton Neuroscience Institute Resource Center, can help MS patients with physical symptoms such as hand motions and provide a sense of community to combat feelings of isolation.

MS patients need comprehensive care that addresses the whole person. People with MS need multidisciplinary treatment from many health care specialties, including neurology, behavioral and mental health, rehabilitation, and social services.

The National Multiple Sclerosis Society has designated Norton Neuroscience Institute’s MS program as a Center for Comprehensive MS Care. That means Norton Neuroscience Institute is recognized for demonstrating knowledge and experience treating MS. It also offers and coordinates a full array of medical, nursing, mental health, rehabilitation and social services.


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