Mental Health Challenges in Multiple Sclerosis
Summary
Mental health difficulties are among the most disabling non‐motor manifestations of multiple sclerosis (MS). Major depression affects up to half of people with MS during their lifetime, while anxiety disorders and cognitive impairment are also highly prevalent. Such symptoms can emerge early in the disease course and tend to worsen with advancing disability, exerting a profound impact on quality of life, treatment adherence and social functioning. Underlying mechanisms include focal and diffuse white‐matter lesions, grey matter atrophy, microglial activation and disrupted connectivity within cortico‐limbic networks. Genetic predispositions interact with immunological factors to shape individual risk, and psychosocial stressors such as unemployment and fatigue further compound psychological burden. The bidirectional relationship between neuroinflammation and mood dysregulation suggests that optimal control of central nervous system inflammation may ameliorate affective comorbidity. Yet mental health disorders in MS often remain under-recognised in clinical practice, hindered by overlapping somatic symptoms, insufficient screening and limited evidence on tailored interventions. Advances in polygenic risk profiling, functional neuroimaging and psychosocial research are now informing stratified approaches to assessment and treatment, with the aim of improving both neurological and psychiatric outcomes in MS.
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Mental Health Challenges in Multiple Sclerosis publication trend
The graph below shows the total number of articles in mental health challenges in multiple sclerosis across all publications each year (not limited to Nature Index journals).
Technical terms
Expanded Disability Status Scale (EDSS): A standardised scale for quantifying neurological impairment and disability progression in MS.
Polygenic Score (PGS): A composite index of an individual’s inherited risk for a trait, calculated by summing the effects of multiple genetic variants associated with that trait.
Neuroinflammation: The activation of the immune response within the central nervous system, involving microglia, astrocytes and the release of pro-inflammatory cytokines.
Resting-State Functional MRI (rs-fMRI): An imaging technique that assesses patterns of spontaneous brain activity and functional connectivity when the subject is not engaged in any specific task.
References
- Depressive symptoms, anxiety and cognitive impairment: emerging evidence in multiple sclerosis. Translational Psychiatry (2023).
- Polygenicity of Comorbid Depression in Multiple Sclerosis. Neurology (2023).
- Hippocampal Neuroinflammation, Functional Connectivity, and Depressive Symptoms in Multiple Sclerosis. Biological Psychiatry (2015).
- Fatigue and Suicidal Ideation in People With Multiple Sclerosis: The Role of Social Support. Frontiers in Psychology (2020).
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