Patient and Provider Insights into the Impact of Multiple Sclerosis on Mental Health: A Narrative Review

Abstract

Graphical Plain Language Summary Multiple sclerosis (MS) is a chronic disease in which the immune system attacks the central nervous system, causing inflammation and neurodegeneration. People living with MS may experience a variety of symptoms as a consequence of this process, including many “invisible” symptoms that are internally manifested and not seen by others. Of the invisible symptoms of MS, which we have reviewed in a companion article, mood and mental health disorders are of particular concern due to their high prevalence and significant impact on patient quality of life. In this review, we showcase the experiences of patient authors alongside perspectives from healthcare provider authors as we promote awareness of the common mental health conditions faced by those living with MS, such as depression, anxiety, adjustment disorder, bipolar disorder, psychosis, and suicidal ideation. Many of these conditions stem in part from the increased stress levels and the many uncertainties that come with managing life with MS, which have been exacerbated by the environment created by the coronavirus disease 2019 (COVID-19) pandemic. 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. 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. 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.

Uncovering patterns of real-world psychological support seeking and the patient experience in multiple sclerosis

“…This is commonly exhibited in the form of anxiety, depression, negative affect and sometimes with symptoms of trauma (Counsell et al, 2013). It is therefore important that people with MS receive the appropriate psychological support to deal with these psychological difficulties (Davis et al, 2021). Psychological support has been divided into different components: emotional support (such as comforting, listening and being available for them; Koopman et al, 2006), information provision (Topcu et al, 2020;While et al, 2009) and concrete support (making practical care arrangements; Harrison and Stuifbergen, 2002).…”

Telemedicine as a strategic intervention for cognitive rehabilitation in MS patients during COVID-19

“…This system could collect patients’ data and help with the therapy process through sensors [ 53 ]. Some digital mental health modalities are introduced to promote resilience in these patients [ 54 ]. The Wellbeing Neuro Course (an Internet-based psychological program) could reduce depression and anxiety [ 55 ], along with many other programs [ 56 ].…”

Researching COVID-19 in progressive MS requires a globally coordinated, multi-disciplinary and multi-stakeholder approach—perspectives from the International Progressive MS Alliance

“…32,33 Finally, one of the important, positive offshoots of the pandemic has been the effectiveness of e-health and telemedicine in assessing and managing anxiety and disorders of mood and cognition across the lifespan. 34,35 While these approaches are being used in PwMS, 36,37 findings as to their benefits are awaited. This presents the community with an opportunity to continue using these media to monitor PwMS more frequently, offer potentially effective pharmacological and rehabilitation treatments, and incorporate these platforms as an early warning system for clinical progression.…”