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Mood swings and MS

In a series of blogs, clinical neuropsychologist Dr Annie Hickox answers your questions about the emotional or psychological effects of MS, from anxiety to sleep problems. The first is about mood and MS.

The question

Why does my mood change from calm and easy going to stressed and lacking in patience within minutes? It can then switch back just as easily. Could my fatigue be contributing? How can I track the triggers and help control my emotions?

Annie's answer

Mood swings are very common in MS. They may arise as part of an emotional reaction to the illness, or may arise from depression and anxiety. Occasionally, the illness can affect the emotional control centres of the brain. Mood swings can seem to come 'out of the blue' and it can be difficult to identify specific triggers that set them off. Fatigue is a very common cause of daytime moodiness and, as you suggest, may play a role in your mood.

Mood changes usually do have triggers. The most common trigger is a negative automatic thought (NAT) that happens so quickly we are not even aware of it. Cognitive therapy helps patients identify their thoughts, and the way that thoughts influence feelings and behavior. For example, a negative thought, e.g. "I can't cope with one more thing going wrong today" is more likely to leave us feeling stressed and anxious. A more helpful thought, e.g. "I am going to talk to my partner about how I can share some of my day to day responsibilities so that I don’t feel exhausted" is likely to make us feel a sense of relief and hope.

Keeping a mood diary can be a valuable way of identifying triggers. Note the time of day, and what thoughts went through your mind (such as, "I don’t have the energy to do everything the way I did before, I am letting everyone down"). Then note how that thought made you feel. You may find that the same negative thoughts go through your mind day in and day out. Once you have kept a diary for a few days, try to find a more helpful way of thinking about the situation, e.g. "I'll have a 20 minute nap after lunch every day, then I will have more energy for cooking". If you are saying the word should to yourself, drop it, and say something like, "I would like…or I can…". Self-criticism is a major factor in low mood.

Ups and downs are a normal part of life, but the strategies above can help you catching them early and turn them around. Communicate to others how you feel, and make sure that you have a balance of pleasurable and fulfilling activities. Seeking support from your MS nurse or a clinical psychologist can help you tackle the stresses that may be maintaining your poor sleep and anxiety.

Annie has been working as a clinical neuropsychologist for 25 years, in both the NHS and private practice. She has a Ph.D. in Clinical Neurosciences from the University of Edinburgh.