Addressing Depression, Anxiety, and Fatigue in Multiple Sclerosis

Physical and mental comorbidities that affect treatment compliance and quality of life are common in patients with multiple sclerosis and are associated with adverse outcomes. The link between psychological disorders, such as depression and anxiety, and physical conditions, including chronic fatigue and chronic pain, is problematic because so many of the symptoms overlap.

“Fatigue is a leading cause of diminished quality of life among individuals with MS, and is often considered to be the single most debilitating symptom of the disease. Fatigue also imposes significant socioeconomic consequences, including loss of work hours and loss of employment,” said Tiffany Braley, MD, assistant professor of neurology at the University of Michigan Multiple Sclerosis Center and Sleep Disorders Center. “Similarly, depression is another complex comorbidity in MS that may have multiple causes, including brain changes from the disease process itself, difficulty in coping with the stress of having MS, medication effects, and contributions from other comorbid symptoms or conditions.”

A review published in Sleep Medicine estimated the prevalence of referral for fatigue among MS patients to be 64%, while sleep disorders ranged from 36%to 50%, and restless legs syndrome in ranged from 15.5% to nearly 28%.¹

Additionally, a small study of 137 people with relapsing remitting MS published in 2014 found that 45.3% were experiencing sleep problems, 21.9% had depressive symptoms, and 19.7%had symptoms of anxiety.²

Both studies point to the difficulties of determining the prevalence of this cluster of comorbidities with the lack of a standard method of investigating and assessing these conditions and the use of a variety of data sources.

Addressing the Source

Understanding the interrelation of pain, sleep disturbances, fatigue, depression, and anxiety in MS is essential to guiding treatment for this cluster of comorbidities. In a study of 1,245 MS patients, researchers found that as pain increases, anxiety, fatigue, and problems with sleep also increase. By contrast, the direct effects of anxiety and fatigue on depression were moderate and the direct effect for sleep disturbances on fatigue and depression were smaller. The direct effect of pain on depression was not statistically significant, but the indirect effect of pain on depression was.³

Overall, the researchers concluded that people with MS  who report pain should be assessed for the full range of depression, anxiety, sleep problems, and fatigue, and those conditions should be addressed with combination therapies when available.