When people talk about common symptoms of multiple sclerosis (MS) they usually mention issues like vision problems, tingling and numbness, and fatigue. Mental health disorders such as depression and anxiety rarely make it on to that list, but they should.

Depression is one of the most common MS symptoms, according to the National Multiple Sclerosis Society (NMSS). Clinical depression — the most severe form of the disorder — is more frequent among people who have MS than it is in the general population.

Severe depression can be life-threatening, because it may include suicidal feelings and ideation. According to a research article published in Multiple Sclerosis Journal in March 2017, the rates of both suicide and suicidal intent are higher in people with MS compared to the general population.

The unpredictability of MS and the life changes it can cause can understandably lead to depression. However, depression is just as common in other immune-mediated, neuroinflammatory diseases, suggesting that inflammation may play a role in the condition, per the NMSS.

Researchers don’t yet fully understand why depression is so common in MS, but many factors seem to play a role, according to the NMSS. These include:

The reaction to difficult life situations or stresses, such as MS diagnosis
Major transitions, such as diagnosis, exacerbations, or when a significant change in function or abilities occurs
The disease itself, such as when MS damages parts of the brain that are involved in emotional expression and control, causing behavioral changes
MS-related changes that occur in the immune or neuroendocrine systems, which can be accompanied by mood changes
Side effects of medications, such as corticosteroids and possibly interferon medications

Anxiety is also common among people with MS, notes the NMSS. Anxiety can be caused by the uncertainty and unpredictability of living with MS, loss of function, and changes to life circumstances. Among people who are newly diagnosed, lack of knowledge about MS can also contribute to anxiety.

The Normal Grief and Anxiety of a Chronic Illness

Being diagnosed with any serious chronic illness qualifies as a life crisis, and feeling grief, or having anxious, worried feelings, are natural human reactions to such a crisis.

It’s entirely natural and common to grieve when you first learn that you have MS, or when you experience losses or changes caused by MS, such as the loss of your job or certain abilities. While mourning these losses may seem like depression, grief is typically time limited, as opposed to depression, which typically doesn’t improve without treatment, per the NMSS.

Although grief usually gets better on its own without treatment, counseling, self-help groups, and other support systems can be helpful. Support groups may also help you deal with normal anxiety and distress that may be caused by MS.

Symptoms of Depression and Anxiety

Clinical depression is persistent and continuous, with symptoms lasting at least two weeks and sometimes up to several months or longer, according to the NMSS.

Per the NMSS, depression symptoms include:

Sadness or irritability
Loss of interest or joy in daily activities
Changes in appetite
Sleep disturbances
Agitation or slowing in behavior
Fatigue
Feelings of worthlessness or guilt
Problems with thinking or concentration
Persistent thoughts of death or suicide

People with an anxiety disorder often have intense, excessive, and persistent worry and fear about everyday situations, according to Mayo Clinic. These feelings affect daily activities, are difficult to control, are out of proportion to the actual danger, and can last for a long period of time.

Common anxiety signs and symptoms include:

Feeling nervous, restless or tense
A sense of impending danger, panic, or doom
Increased heart rate
Breathing rapidly
Sweating
Trembling
Feeling weak or tired
Trouble concentrating or thinking about anything else other than what you are presently worried about
Difficulty sleeping
Gastrointestinal (GI) problems
Difficulty controlling worry
The urge to avoid things that trigger anxiety
Panic attacks

Do You Have Depression or Anxiety?

Per the NMSS, your answers to these two questions can help you figure out if you are experiencing normal grief that commonly occurs with MS, or clinical depression:

During the past two weeks, have you often felt down, depressed or hopeless?
During the past two weeks, have you had little interest or pleasure in doing things?

If you answered yes to either or both of these questions, you may be depressed. To learn for sure whether you have depression, you can get a free, confidential screening through Mental Health America.

You can also contact an MS Navigator online or at 800-344-4867 during standard business hours for help finding a mental health professional near you.

If you are thinking about harming yourself or experiencing a mental health emergency, call the 988 Suicide and Crisis Lifeline at 988.

If you answered no to these questions, but your mood is low, you may be experiencing grief or other emotional changes, per the NMSS.

To screen for anxiety, a self-administered test called the GAD-7 (GAD stands for “generalized anxiety disorder”) can help you assess whether you’re experiencing minimal, mild, moderate, or severe anxiety.

Treatment for Depression and Anxiety

Depression requires treatment from a mental health professional, who may prescribe an antidepressant medication or other types of medication to stabilize your mood, explains the NMSS.

Certain forms of therapy may also be helpful. Cathy Chester, a New Jersey–based freelance writer who was diagnosed with MS at age 28, experienced a bout of depression following a health crisis and, luckily, got help for her symptoms.

One summer, she had kidney stones and gallstones at the same time. “After that was taken care of,” Chester says, “my hormones plummeted. I understood what that dark cloud felt like, the most awful feeling. I knew then what depression was.”

She sought help for her depression from both a therapist and a psychiatrist.

“With the help of medication and CBT, that took care of it,” she says. CBT, or cognitive behavioral therapy, is a form of psychotherapy based on the premise that a person’s thoughts — not external events — largely determine how he feels. In therapy, the therapist helps the individual learn to challenge negative thoughts and replace them with more realistic ones.

Along with medication, CBT is used to treat both depression and anxiety in MS, per the NMSS.

In addition to benefiting your physical health, aerobic exercise has also been found to boost mood in people among MS patients, notes the NMSS.

People with severe anxiety should also seek the help of a mental health professional, who may prescribe medication.