As far as emotional and attitudinal issues in Multiple Sclerosis are concerned, early research suggested that some people were emotionally labile (meaning their emotions fluctuated rapidly), and that other variable emotional symptoms or states arose that appeared to be specific to people with the disease. However, it proved difficult to tell whether the problems were a personal – indeed an emotional – reaction to the onset of MS, or were caused by the Multiple Sclerosis itself. Current research is indicating that there are problems of an emotional kind that might be linked to the disease itself, as well as personal reactions to it.
Mood swings may be caused by the effects of demyelination in particular parts of the central nervous system that control moods and emotions, or by everyday frustrations and issues that arise in managing and think- ing about the effects of MS. Either way, recognizing that mood swings exist is the first step in being able to manage them more effectively.
In more extreme cases, mood swings are refer red to medically as a ‘bipolar disorder’, with relatively rapid and severe swings between depression and elation. Medical assistance should be sought in such cases.

Euphoria

One of the first symptoms that doctors described over 150 years ago was an ‘elevation of mood’ in some people with MS. This was also called ‘an unusual cheerfulness’ that seemed not quite appropriate in someone with a long-term medical condition. In fact, some of these attributions of
‘elevated mood’ were not linked to the Multiple Sclerosis itself, but to the circumstances in which it was diagnosed. However, since that time, the idea that some people with MS may occasionally have what is often described as ‘euphoria’ has become more accepted. This can be linked with mood swings that may take people with MS through a range of emotions from depression, perhaps to anger and indeed to ‘euphoria’ over a period of time.
The previous clinical concern with euphoria has led to far less attention being paid to the much more serious problem of depression, which we have just discussed. It is possible that, in some people with MS, a euphoric presentation has cloaked an underlying depression. Euphoria is viewed as a widespread phenomenon because of the very positive reactions – the relief almost – that some people with MS feel once diagnosed. Because the process, and the communication more so, of the diagnosis may take some time, some people felt that their symptoms may have been due to even more serious conditions – a brain tumour, for example, or that they were ‘going mad’. Some doctors have treated the, often profound, relief of some of their patients on hearing that they
‘only’ have Multiple Sclerosis, as indicating a euphoric state caused by the MS, rather than an understandable relief that they have a condition far less threatening than others they had feared.
Although inappropriate laughter may occasionally be embarrassing, it seems to be a result of damage to a particular part of the nervous system, and may require professional help to manage – this particular phenomenon of ‘euphoria’ seems to be overemphasized and, in terms of everyday symptom management, other emotional problems, particularly those centred around depression, are more harmful and significant.

Effects of drugs

Any drug that has powerful effects on symptoms is likely to have a wider range of effects – what we usually call ‘side effects’ – that we don’t usually want. In particular, drugs that act in various ways on symptoms related to the central nervous system may well have effects on your moods and feelings.
Steroid drugs in particular – still quite widely used in relation to managing attacks or exacerbations of MS – may have mood-changing properties. These properties are not always predictable, and people can sometimes have quite strong reactions to steroid drugs. Perversely, some people may feel more depressed, while others may feel more cheerful on them. There is something which has become known as a steroid ‘high’, where people can become more active (indeed ‘hyperactive’) on the drugs, and then feel a ‘low’ when they come off them; others may experience quite bad mood changes from such drugs. Try monitoring yourself and get a family member to discuss any changes that they see in you, and then report such changes to your neurologist or other doctor treating you.
Some other drugs may have mood-changing effects, especially if you suddenly increase or decrease the dose that you are taking. For example, baclofen (Lioresal), a drug very widely used to control spasticity, has been known to produce major effects on mood; for example, if a high dose is withdrawn suddenly, people may feel very agitated, experience substantial mood changes, or even hallucinate. So is sensible to report any untoward reactions that you may have with your drugs to your GP or neurologist before gradually reducing the dosage. Other drugs, such as diazepam (Valium), used for relaxing muscles, may make you feel very relaxed! Sometimes low doses of antidepressants, used to treat urinary problems or some sensory symptoms, may also change your mood.
Although we don’t want to exaggerate the number of mood or emotional reactions that you might have to the drugs being taken for symptoms, these additional side effects, which can occur relatively soon after you have decreased or increased doses, may be caused by them. If you are in doubt, report your symptoms to your GP or neurologist, and seek their advice as to how best to manage them.

Management of mood swings

Family and friends are often the first people to recognize that mood swings are occurring. For all of us, relationships with other people are bound up with knowing what they will do in a relatively predictable way. If this expectation breaks down, as it may do if mood swings (technically described as ‘emotional lability’) are serious, then family relationships may suffer substantially. For some families these problems can be very difficult to handle, and thus external advice and help can be sought.

Counselling and/or drugs and cognitive behaviour therapy
After a consultation with your GP or neurologist, you may be able to get counselling or have a systematic discussion of your family and personal problems arising from the mood swings; if counselling fails, a tricyclic antidepressant (such as amitriptyline) might be prescribed. There is also increasing but still unsystematic evidence that fluoxetine (Prozac) may offer some help in this situation. As we noted earlier, previous administrations of steroids – usually to treat exacerbations of the MS – may have prompted some increase in mood swings (see above), in which case a drug such as lithium or carbamazepine might reduce these swings. Cognitive behaviour therapy has been found useful also in people with mood swings in Multiple Sclerosis.

Self-help
Often your emotional response to a situation may be just rather ‘too
strong’ for the particular situation concerned. You could try breathing deeply, pausing before the tears or laughter come, particularly in stressful situations. If you find yourself laughing or crying without any apparent cause – indeed your mood may be totally at variance with this expression of emotion – and it is difficult to stop, almost certainly this is a result of damage caused by MS itself, probably to areas of the brain controlling the release of emotional expression. This problem has to be managed socially, which is not an easy task, but you could be prescribed medications which have some dampening effect on the release of emotions. It would be best to consult your GP or neurologist about these matters.