Anxiety often goes hand-in-hand with multiple sclerosis (MS). Shared disease processes combined with the challenges of living with MS are thought to underlie this connection.

Multiple sclerosis (MS) is an immune-mediated disease caused by dysfunction in the immune system. In MS, your immune cells mistakenly attack the central nervous system (CNS), targeting the protective covering of the brain and spinal cord known as the myelin sheath.

When you think of MS, symptoms like fatigue, spasticity, and mobility changes may come to mind. But MS can affect psychological well-being, too.

Processes of neurodegeneration combined with the challenges of living with MS make anxiety a common co-occurring, or comorbid, condition. In fact, a review from 2021 indicates the prevalence of anxiety in MS is estimated at 22.1%, compared to 13% in the general population.

Here’s what to know about anxiety if you have MS.

MS is a chronic illness, lifelong illness. Unpredictable symptoms may change over time or lead to lasting impairment. So MS can come with a lot of uncertainty.

The stress of navigating life with MS can have a major emotional effect. It’s natural to go through a period of grief related to any changes you’re experiencing along the way. Feelings of worry, irritability, fear, and sadness are often part of the process.

The emotional toll of MS can contribute to mood disorders like depression and anxiety. A 2015 review, still cited in current literature, found depression and anxiety were the two most common comorbidities in MS.

While depression slightly edged out anxiety by less than 2% in the review, research from 2021 discovered many people living with MS find anxiety to have a larger impact on their lives than depression.

However, stress is just one factor that likely plays a role in MS and anxiety. A review from 2023 indicates shared genetic pathways, neurodegenerative processes, and dysfunctional immune reactions may also contribute to anxiety in people with MS.

Specific genes associated with both MS and anxiety are an area of current study. But the potential for shared genetic pathways means the same genes that increase a risk for MS could also increase the risk for anxiety disorders, and vice versa.

Meanwhile, the role of neurodegeneration and inflammation is clearer. According to the review, immune dysfunction in MS is not limited to the myelin sheath. Inflammatory processes can cause damage throughout the CNS, which may alter function in areas of the brain responsible for emotional processing and regulation.

Not all anxiety is cause for concern. It’s a part of your body’s stress response, which comprises the physiological reactions that help you react to threats and challenges. In the short term, anxiety can help heighten your awareness and encourage you to act.

It’s natural to experience some anxiety after receiving an MS diagnosis or when you’re experiencing disease-related changes. As long as anxiety is temporary, it may not have a significant impact on your life.

Anxiety that becomes persistent and chronic can be more concerning. It lays the foundation for anxiety disorders and remains present with you constantly, even when there’s no direct cause.

Chronic anxiety symptoms that may be a cause of concern include:

  • constantly feeling edgy, jumpy, or hypervigilant
  • having a sense of deep worry or dread
  • excessive reassurance-seeking
  • irritability
  • sleep disturbances
  • fatigue
  • worst-case scenario thought rumination
  • physical aches and pains
  • sweating
  • shortness of breath
  • racing heart rate
  • dry mouth
  • poor concentration or memory
  • trouble speaking

Even though physiological processes in MS may contribute to anxiety, anxiety is treatable. Speaking with your doctor can help limit how anxiety impacts your life with MS.

Try to be proactive about your mental health when living with a chronic illness like MS. Focusing on ways to strengthen your psychological well-being can boost your quality of life and help you face challenges related to life with MS.

Start with these strategies.

Exercise regularly

Exercise is often noted as a way to support mental health. And according to research, this remains true when you have MS.

A review from 2023 looking at the benefits of exercise in MS found it to be a promising, safe approach to managing anxiety.

Eat a balanced diet

Providing your body with the ideal amount of vitamins and nutrients can optimize your physical health, which, in turn, supports your mental health. But eating habits may also impact symptoms of anxiety.

A 2021 scoping review found higher levels of anxiety associated with diets high in fat, low in protein, and with high levels of sugar and refined carbohydrates.

Practice gratitude

The challenges that come with MS can make it difficult to look on the bright side. But practicing gratitude, through journaling, prayer, or other expressions, can help.

A systematic review from 2021 found maintaining a gratitude list was associated with significant improvements in perceived stress and depressive symptoms.

Prioritize sleep

Anxiety can disrupt your sleep, but poor sleep can also cause or worsen symptoms of anxiety. You can improve your chances for a good night’s rest by practicing proper sleep hygiene. Start by:

  • avoiding screen time before bed
  • sticking to a routine sleep-wake schedule
  • keeping your bedroom cool, quiet, and dark
  • avoiding large or heavy meals before bed
  • skipping stimulants like caffeine at night

Stay socially connected

Many people isolate themselves when they live with a chronic illness, especially if symptoms may be noticeable to others. But staying connected to family and friends is important to maintain a sense of support, camaraderie, and belonging.

Work with a mental health professional

The same doctor who treats your MS can also prescribe medications for anxiety. But working with a mental health professional may be a better option.

These specialists help you focus on treating anxiety at its roots. A therapist also helps you learn to break free of unhelpful anxiety patterns and guides you to new coping strategies for everyday life.

MS and anxiety often go hand-in-hand.

Shared pathological processes, along with the stress of living with a chronic condition, likely connect MS and anxiety. But working with a mental health professional and prioritizing psychological well-being can help reduce the effect anxiety has in MS.