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12832842 tn?1448732401

Ms and mental illness

Hi all,
I'm wondering if there are any connections with ms and mental illness. It seems a " Tabu" subject as it seems under reported. People are embarrassed most likely , or don't want to talk about it.
Well.. I have had 3 separate episodes of irrational thoughts along with lightheartedness, usually a slight headache or  a slight numbness that feels "internal " within my head. Having these internal dialogues with myself. Trying to calm myself down from becoming too panicky while feeling these strange emotions.
Ie: I was having lunch with a friend. It was a bit hot, and I was just coming off of a relapse. ( bladder). Then it started. I left to go home , I'm driving, and thoughts such as.. Oh.. Just drive off the road. " and then myself saying.. Stop . This is ridiculous. This is just a corky symptom. Don' let it get to you. If say this lasted approx an hour or so.
One other time was more recent. I was really tired. Went to lie down. I feel like I was hallucinating, feeling like I was on the floor. When I wasn't. Hearing noises and feeling like my husband was rocking the bed. But wasn't. Eventually drifted to sleep. Scary, I have an appt to talk to my doc about this but wanted any insights that may be out there.  I know one of the larger lesions is within my frontal lobe. Not sure what can be done with this type of symptom. Unless this is just overall anxiety?? I also wasn't exersising at all. I was re doing our house. Wondering if there's a connection there. Anyway. I just want people to feel comfortable talking about this type of thing. It's scary acing a disease we don't understand. These support groups are essential. Thank you all. As always.
Andi
26 Responses
667078 tn?1316004535
I believe MS can cause mental illness. The reason I believe this is MS effects the brain. Like causing a variety of problems with the body it makes sense it would cause problems in the brain. Years ago MS specialist did not think MS effected memory or caused pain. I am not saying all people with MS have mental illnesses just that they can. I was suspected of mental illness for years until I went to a psychiatrist who looked at my MRI. He said you are not Bipolar you have a neurological condition. I did not know it was MS at the time. Another psychiatrist told me that the MS made my brain not shut off in the same way it tells my muscles to spasm all the time. I was herded into the mental illness column because they had no other diagnosis to give me. I know people with MS with all kinds of mental illnesses.

Alex
11079760 tn?1483389730
Hi Andi,

I found this on the National MS Society website. You might find the information helpful:

http://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Clinical-Bulletin-Emotional-Disorders-5-5-14.pdf

Good luck with your appointment. Let us know how it goes.

Cheryl
4943237 tn?1428994695
There's a really good book called "Faulty Wiring - Living with Invisible MS" by Suzanne Robins.  This book gives a pretty good insight into just how badly MS induced mental illness can affect someone.  It also answers a lot of the more general questions people have about MS.

Poppy
987762 tn?1331031553
COMMUNITY LEADER
Some Mental Health conditions are now well recognised as potentially being a direct result of neuron damage, but keep in mind that M/H issues can be hard to pin down because they can also be the indirect result of DMD's, symptom treatment medications and living with the chronic MS issues too eg cognitive impairment, fatigue, sleep issues, chronic pain, limited mobility, etc etc etc

Research information:
"The mood and affective disorders can be divided into four broad categories including major depression, bipolar affective disorder, euphoria, and pseudobulbar affect. Behavioural changes such as confabulations, paranoid ideas, irritability, pathologically increased libido, and alcohol and substance abuse have been reported sporadically in MS patients with extensive brain lesions, requiring specialized psychiatric management [McDonald and Compston, 2006]."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002616/

Morphological correlates of psychiatric MS symptoms.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002616/table/table1-1756285608100325/

Prevalence of psychiatric disorders in MS and general population.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002616/table/table2-1756285608100325/

Correlation of psychiatric symptoms with MS features.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002616/table/table3-1756285608100325/

Personally i don't understand why different countries have differing levels of tabu that often surrounds M/H issues, it doesn't really make sense to connect any negative connotations towards someone, who has a medical condition that no one, no matter your life story, ever gets a choice.......

Hugs.........JJ  
Avatar universal
JJ, these citations are interesting. I've never researched this issue, but have long known that depression can be primary in MS, resulting from lesion activity in the part or parts of the brain that control mood.

This past summer, while I was having IV steroid infusions for TN, my neuro by chance came into the room, and we had a wide-ranging chat about many things MS. Although fortunately I don't have depression, I asked about this occurrence, and specifically about mood disorders other than depression, since depression is all I'd read of. He agreed that MS can also cause primary anxiety, which makes sense. I then asked about bi-polar illness, and he said no, that's not MS. Hmm. He usually is one to offer very specific research data to back up his statements, and what he said contradicts what is above.

I didn't pursue this or even think to look it up later, because it was just a hypothetical question as I don't have a mood disorder, but this area certainly gets a lot of posts on the forum. Often they seem to come from posters without MS but with severe health OCD, which as we well know can cause many very real symptoms.

ess
987762 tn?1331031553
COMMUNITY LEADER
Depression and anxiety are more widely recognised but there are other psychiatric issues connected with MS, definitely not as common but there is a bit of concern that it's more to do with under reporting and or not getting relevant psychiatric assessments. The first 2 articles are specifically mentioning Bipolar disorder in MS and the 3rd is just more 2015 research on bipolar....

2008:
"Neuropsychiatric symptoms are also commonplace and are occasionally the first presentation of MS.7,8 As many of the characteristic signs and symptoms are nonspecific and pseudoneurologic in nature, patients are often suspected of suffering from a primarily psychiatric condition,9 and diagnosis may be delayed."

"Bipolar disorder is also twice as common in MS patients as in the general population13,21 and often presents later in the course of MS, as in the case of Mr. A, who presented with his first episode of mania at age 41 years. While treatment with high doses of corticosteroids may precipitate mania, the increased prevalence of bipolar disorder does not appear related to this treatment alone.14

Though rare, there have been case reports of patients diagnosed with MS only after presenting with acute, lateonset mania in the absence of neurologic signs.8 Mr. A's late onset of manic symptoms would be highly atypical for primary bipolar disorder and suggests that MS lesions in critical brain regions may be a substantial contributing factor to his presentation.21

For example, lesions along the orbitofrontal prefrontal cortex circuit lead to impulsivity, mood lability, and personality changes, symptoms frequently seen in acute mania.8 On the other hand, a history of manic or hypomanic symptoms in Mr. A may have been long overlooked given the complexity of his neurologic and cognitive presentation, leading to a delay in diagnosis of bipolar disorder."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528238/

2014:
"Compared to controls, MS patients had a higher lifetime prevalence of DSM-IV Major Depressive Disorders (MDD; P<0.0001), BD I (P=0.05), BD II (P<0.0001) and Cyclothymia (P=0.0001). As people with MS had a higher risk of depressive and bipolar spectrum disorders, ratio MDD/bipolar spectrum disorders was lower among cases (P<0.005) indicating a higher association with Bipolar Spectrum Disorders and MS."

"This study was the first to show an association between BD and MS using standardized diagnostic tools and a case-control design. The results suggest a risk of under-diagnosis of BD (particularly type II) in MS and caution in prescribing ADs to people with depressive episodes in MS without prior excluding BD. The association between auto-immune degenerative diseases (like MS) and BD may be an interesting field for the study of the pathogenic hypothesis."

2015 on bipolar and the cerebellum:
"Sometimes, a new way of looking at something can bring to light an entirely new perspective.

Using a different type of MRI imaging, researchers at the University of Iowa have discovered previously unrecognized differences in the brains of patients with bipolar disorder. In particular, the study, published Jan. 6 in the journal Molecular Psychiatry, revealed differences in the white matter of patients' brains and in the cerebellum, an area of the brain not previously linked with the disorder. Interestingly, the cerebellar differences were not present in patients taking lithium, the most commonly used treatment for bipolar disorder."
http://www.sciencedaily.com/releases/2015/01/150106081217.htm

It's definitely early days in the identification of psychiatric disorders primarily caused by neurological conditions like MS, and with a pre-existing MS dx it might be difficult to determine the exact cause for various MS related reasons.......what came first the chicken or the egg, primary sx of MS vs secondary etc but maybe the question should be....does the causation truly matter apart from the relevance to the differing pharmaceuticals treatment options? hmmmmmm interesting thought.

I expect due to the nature of health anxiety, conversion-functional disorder patients etc it will still come down to the 'absence' of the abnormal neuro clinical signs and other typical MS diagnostics but some M/H patients may actually be less black and white and more grey than first thought, which might make a primary dx of M/H a tad harder to accept for some, and probably delay getting the medical help they need.....

Cheers..........JJ
12832842 tn?1448732401
Wow! Lots to digest. One thing I do know for certain. There have been 3 instances I know that have been scary. I don't think in a truly psychotic episode you can " talk yourself out of it". During the moments the changes in my thinking took place, I was calming myself down. Once I got home I seemed to settle. Nobody around me would know these thoughts were passing through. I guess I just can't figure out which category this falls under. In looking above.  I know I'm subject to anxiety but have always handled it well. Depression I had briefly with a new diagnosis. That was more situational.  I'm not sure what my Neurologist will say. But I need to tell him. The next mri will be interesting. More lesions? And more importantly.. Where.
More than anything I want people to talk about it.
Avatar universal
Mood disorders are a bit easier for me to understand. It's a vast over-simplification, but moods are largely chemical releases and re-uptakes or lack thereof. Not the right amount or the right timing and moods, or feelings, come adrift. That's why medications can be helpful, as they re-regulate chemical releases. I imagine this is much like the way the pancreas secretes insulin, or doesn't, but insulin can be added to help this process.

Disregulation of thought, however, is much more complex. I really don't know how much of the brain is involved in this and in what ways, or what causes our perception of reality to go off the rails. There are, of course, anti-psychotic drugs, so obviously there is chemistry involved, but what these do I have no idea. I do know of people whose mood disorders become so severe that the patient became psychotic and dangerous, so there obviously can be a connection.

If anyone knows of a Cliff Notes explanation, please let us know. There's probably a Mental Illness for Dummies book out there, because there's a Dummies book for everything else, it seems. But it's my guess that brief and transient misperceptions of reality in MS come largely from fatigue, pain, sleep disturbance, worries and similar factors secondary in MS,

ess
987762 tn?1331031553
COMMUNITY LEADER
I believe the first 2 incidents you mention could still fit a mild anxiety attack, your internal dialogue was 'challenging' the negative thoughts that were popping into your mind, and basically talking your self down from a full panic attack. Being brief enough to be your self again not long afterwards and your wording, suggests to me that your fatigue, self esteem, stress, frustration levels etc were likely exacerbating your anxiety and wouldn't in general be outside of anxiety...

The 3rd whilst you were also fatigued, is the type of situation that doesn't typically fit with anxiety because it involved audio and physical hallucinations, any situation that makes you unable to comprehend reality should definitely be cause for concern!

BUT before becoming really anxious that this type of isolated incident, could only be caused by a more serious type of mental health issue or symptomatic of more MS lesion damage, you need to keep in mind that psychotic issues are 'rare' (1-3%) in MS and theoretically it's more likely this situation was to do with your level of sleep deprivation, migraine, medication, dehydration, state of your mental health at the time etc and or the combination of....    

Hugs........JJ


  
987762 tn?1331031553
COMMUNITY LEADER
I have long disagreed with the theory of mental health disorders being caused by a chemical imbalance, and steadfastly held on to the theory behind brain plasticity, today the evidence is mounting that mental health is caused by the brains neural development and or neural deterioration.......  

"While the neuroscience discoveries are coming fast and furious, one thing we can say already is that earlier notions of mental disorders as chemical imbalances or as social constructs are beginning to look antiquated. Much of what we are learning about the neural basis of mental illness is not yet ready for the clinic, but there can be little doubt that clinical neuroscience will soon be helping people with mental disorders to recover."
http://www.nimh.nih.gov/about/director/2011/mental-illness-defined-as-disruption-in-neural-circuits.shtml

ADHD, ASD, OCD, Dyslexia, Bipolar, Anorexia, PSTD, anxiety, major depressive disorders etc are generally understood to have varying complex combinations of cognitive and psychiatric components, and whilst the historical focus has been on rebalancing the chemicals within specific parts of the brain that are improperly balanced......research is actually proving that these conditions demonstrate abnormal neural circuitry.

Basically the brains neural wiring is faulty either developmentally or degeneratively, which will go a long way towards understanding why cognitive behavioural therapy (uses brain plasticity principals) makes a significant difference with many conditions that never were thought to be neurological...

Food for thought..........JJ

btw if anyone's interested, recent HFA/Asperger research is finding repetitive cognitive training may actually be detrimental to those with higher functioning ASD, due to the repetition inadvertently compounding their inability to neurologically adapt to repetitively trained visual expectations.
  

  
    
Avatar universal
Hi, Andipw3! I'm glad that you're going to be able to talk with your doctor about these episodes. I hope you'll be able to speak with a psychiatrist and/or psychotherapist, as they may have ideas on how to manage these episodes or even address their root causes before they happen. Have you told any loved ones or friends about your episodes? Would you feel comfortable letting someone know so that you can reach out to them or they can check in on you occasionally?

One note I'd also like to make is that sometimes psychiatric disorders are misdiagnosed as multiple sclerosis. Perhaps this is something you can speak with your neurologist about. Here is an example of a study supporting this point that you may want to show to your doctor: http://www.ncbi.nlm.nih.gov/pubmed/17351525
987762 tn?1331031553
COMMUNITY LEADER
I had a look at that article but it was way short on providing any details, I did find another partial copy though unfortunately it too was lacking.....

http://www.researchgate.net/publication/6454622_The_Differential_Diagnosis_of_Multiple_Sclerosis

What i did notice from the part i did get to read, they seem to be drawing this conclusion, at least in part from data collected from the REFERRAL's to 3 MS clinics, this wouldn't typically be misdiagnosis stats but the totality of those 'referred' to the MS clinics who they did not diagnose with MS. One of which dated from 1979-1983 and pre MRI's, interestingly they also reported the lowest referred rate who had a psychiatric condition Dalhousie 14 ((27%) , Colorado 63 (45%), Marshfeild 53 (76%)

I've tried to find others but so far not finding anything that would support the conclusion that that particular study did.....

Still looking..........JJ
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