Learning to live with multiple sclerosis (MS) can trigger feelings of fear, grief, anxiety, and depression, especially in children and adolescents.
Although some children and teens with MS experience these feelings in an ebb-and-flow cycle, many others can develop a mood disorder.
In many cases, mood changes may start after receiving a diagnosis. A child’s mood can also change as the disease progresses, because MS affects parts of the brain that control these feelings.
This article will explain what we know about these mood disorders, particularly in children ages 10 to 17, plus describe symptoms and give tips about counseling for children — all with a special focus on the unique needs of children with MS.
Children and teens with MS face a variety of physical symptoms.
In addition, it’s estimated that nearly 30 percent of children and teens diagnosed with MS experience:
- memory problems
- issues with complex attention and processing speed
They’re also at an increased risk of developing a mood disorder.
Some of the more common mental health conditions for those with MS include:
- anxiety disorders
- panic disorder
- bipolar disorder
Parents and caregivers should keep in mind that just because a child is feeling sad or anxious, it doesn’t necessarily mean they have a mood disorder.
If you have concerns about your child’s moods or behavior, it’s important to talk with their doctor. The doctor may use a specific set of diagnostic tools to help determine whether your child has a mood disorder.
Clinical depression is one of the most common symptoms among adults with MS. Although there hasn’t been as much research into its impact on children and teens living with MS, it appears to also be extremely common for them. In a
The most common depression symptoms include:
- sadness and irritability
- a loss of interest in things around them
- appetite and sleep changes
- difficulty concentrating
- feelings of worthlessness or helplessness
- thoughts of suicide
A child has to adjust to a great deal of uncertainty when living with this condition, which impacts their quality of life.
If your child is showing symptoms of depression — especially if the symptoms are getting worse or interfering with daily activities — consider contacting a healthcare professional.
While not as common as depression, anxiety disorders are estimated to be three times greater in people with MS than in the general population, according to a
Generalized anxiety disorder is the most common anxiety disorder in MS patients, followed by panic disorder.
Since MS is an uncertain, unpredictable disease, there’s a higher prevalence of clinically significant levels of anxiety in people living with the condition.
Symptoms of an anxiety disorder in children or teens with MS include:
- persistent worry
- a preoccupation with physical sensations
Similar to depression, if the symptoms worsen or begin to interfere with daily activities, you should contact a doctor.
Bipolar disorders in children and teens involve extreme changes in mood and behavior — for example, feeling very happy or energetic (manic episode) followed by feeling very sad or down (depressive episode).
According to a 2016 cross-sectional study of adults, the prevalence of bipolar disorder is higher in people with MS than in the general population.
Symptoms of a manic episode include:
- intense happiness
- being extremely irritable
- talking fast
- having trouble sleeping or staying focused
- racing thoughts
- being overly interested in pleasurable or potentially harmful activities
- doing things that show poor judgement
Symptoms of a depressive episode include:
- unprovoked sadness
- anger and hostility
- increased complaints about pain, especially stomachaches and headaches
- a noticeable increase in time spent sleeping
- feeling helpless and hopeless
- difficulty communicating or maintaining relationships
- little interest in activities the person usually enjoys
If your child is showing signs of bipolar disorder or a worsening of manic and depressive episodes, consider reaching out to a healthcare professional.
Treating mood disorders usually involves a combination of psychotherapy (talk therapy) and pharmacological treatment (medication).
Often, a therapist will use a form of psychotherapy called cognitive-behavioral therapy (CBT) to treat depression, anxiety, and bipolar disorder.
However, one of the challenges in identifying and treating mood disorders in children with MS is that it relies on the child or teen to self-report. According to a 2016 review, mood disturbances are more frequently reported by parents than the child or teen.
Sometimes, even if a child doesn’t meet the criteria for a mood disorder diagnosis, they may still benefit from counseling. If you have concerns about your child’s moods or behavior but aren’t sure how to proceed, it’s always a good idea to talk with the child’s doctor.
When looking for a mental health specialist for your child or teen, it’s best to start with a psychologist, psychiatrist, or counselor trained to work with this age group. They have training focused on psychiatric disorders and treatment specific to this population.
That said, a qualified mental health expert who works with adults can also be a good option for children and teens, particularly if that expert has experience dealing with people with chronic conditions.
Your first step is to talk with your child’s primary care doctor or MS treatment team. They may have recommendations for therapists who have additional training with MS and children.
If your child or teen needs medication, a psychiatrist can provide therapy and prescribe medication.
The American Academy of Child and Adolescent Psychiatry has a tool on its website that allows you to locate psychiatrists who provide care for children and adolescents.
Additionally, the following online locators can help you find a mental health expert in your area.
Treating your child’s or teen’s mood disorders with medication is often a decision their treatment team will make.
Ideally, this conversation should involve:
- the mental health expert treating your child
- their primary care doctor
- a neurologist
This is important to help avoid any potential interactions with medications your child or teen is already taking for their MS.
With that in mind, according to the American Academy of Child and Adolescent Psychiatry, some of the more common medications for treating mood disorders in children and adolescents include:
- antianxiety medications
- antidepressant medications such as SSRIs, serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs)
- mood stabilizers such as lithium, valproic acid, lamotrigine, carbamazepine, and oxcarbazepine for the treatment of bipolar disorder
Side effects from mental health medications can range from mild to severe.
Because children and teens with MS may react differently to these drugs than children or teens who don’t have MS — and because they may also be taking MS-specific medications that could interact with some mental health medications — it’s critical to have approval from the doctor treating your child’s MS before starting treatment.
It’s also important for parents and children to closely monitor their experience and note any unexpected changes in mood, behavior, or other side effects once they begin taking these mental health medications. If you notice any changes, report them to your child’s doctor or mental health specialist as soon as possible.
For many children and teens, the physical symptoms of MS are often more visible than the emotional symptoms.
Changes in mood are normal for all kids, especially children with MS.
But if the changes are persistent, increasing in severity, or interfering with daily activities, your child may have a mood disorder.