Fatigue in Multiple Sclerosis is often linked to inflammation in certain areas of the brain rather being a consequence of lifestyle factors.

Now, a study concludes that anxiety and depression in MS may be driven mainly by uncontrolled neuro-inflammation rather than by the uncertainty of living with an unpredictable disorder or the feeling of loss that comes with disability.

Subclinical inflammation is defined as new or worsening MRI activity without recognized relapses or increased physical disability.

The main finding of the study was that new MRI lesions alone were associated with increased depression and anxiety. This concerned only “state” anxiety, often a temporary condition, and not “trait” anxiety, which is persistent and reflects one’s personality or temperament.

Steroids, used for relapses, often, though only temporarily, improve mood, perhaps because they reduce inflammation in the brain.

Atrophy of the hippocampus is linked to mood disorders in patients without MS. Similarly, inflammation is detectable in the cerebrospinal fluid and in measuring cytokines in about half of patients with affective and schizophrenic disorders.

Fatigue in Multiple Sclerosis often improves when patients switch to a more effective disease-modifying drug. This may also be true for mood disorders, although this has not been studied. Could anti-anxiety or anti-depressant drugs alone help the course of MS? In support of this idea, stress management therapy was found to reduce new active MRI lesions over the course of 24 months.

See Neurology, Volume 89, September 26, 2017, pages 1338-47.

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