Managing the Mind: The Role of Stress in Multiple Sclerosis

Multiple sclerosis (MS) is the most common autoimmune inflammatory neurological disease. Around 2.2 million people are affected by this condition globally, and it presents with a wide variety of symptoms. When you have MS, your body’s own defence system, also known as the immune system, mistakenly attacks healthy parts of the nervous system. This causes damage to the protective covering around nerve fibres, or myelin, through a process called demyelination. As a result, the transmission of messages along the nerves becomes disrupted, leading to a slowing down or even a complete blockage of communication between the brain and the rest of the body.

The Role of Stress in Multiple Sclerosis

Everyone at some point in their life experiences stress. Stress has been increasingly recognised as a factor that can influence the course and symptom burden of MS ever since this connection was first identified in 1868 by Jean-Martin Charcot. For example, Zapanti and colleagues, in their study, mention that under stress, the body releases hormones and neuropeptides, which can disturb the immune system through a process known as immune dysregulation. This, in turn, can lead to changes in the production of chemical messengers known as cytokines that help immune cells communicate. Stress can also cause alterations in lymphocytes (white blood cells), which play a key role in the immune response and could eventually contribute to the worsening of MS.

It has also been shown that in individuals with MS, the main parts of the body’s stress system are often disrupted. These include the hypothalamic–pituitary–adrenal (HPA) axis (which regulates stress hormones like cortisol), the sympathetic nervous system (which controls “fight or flight” responses), and the dopaminergic system (which uses the chemical messenger dopamine to influence mood).

There are several studies that have looked at the ways in which stress affects the course of disease and the quality of life of MS patients. For example, according to some studies, MS patients are more prone to recall stressful life events prior to the onset of symptoms, and other studies show that patients who went through distressing experiences were more likely to relapse than those who did not.

Notably, a study conducted by researchers at Karolinska University Hospital collected data from 2,930 newly diagnosed MS patients. The findings revealed that stressful life events can increase the risk of developing MS by 17–30%. Moreover, the study also revealed that women are more likely than men to develop MS in response to certain stressful situations, such as disputes at work or in families, marriages, or family members’ illnesses or accidents. In addition, stressful events occurring within five years prior to the onset of MS symptoms were found to have a particularly significant impact on disease manifestation.

Most recently, a meta-analysis carried out by Drathen and colleagues studied a large population of 25,000 individuals with MS. Their findings revealed that stress may noticeably influence the worsening of MS. Individuals living with diagnosed stress-related disorders experienced double the risk of developing MS, whereas even more stressful experiences, such as war, were linked to a threefold higher chance of relapse.

Research indicates that stress that lasts a long time or occurs repeatedly can trigger MS relapses much more than short-term stress. Early life experiences, such as parental divorce, may slightly increase the risk of developing MS. Personal factors, such as higher anxiety or stronger heart reactions to stress, can also make relapses last longer.

Stress Management and Coping Strategies

Even though numerous studies have correlated stress with the worsening of MS, there are others that report no such association. For instance, a study conducted in 2011 found that severe stress at home, childhood or adolescent abuse, and repeated sexual abuse were not significantly associated with the risk of developing MS, indicating that stress may not play a major role in the onset of the disease. Therefore, no firm conclusions can be drawn. However, managing stress in general may offer potential benefits for quality of life.

For example, a study by a team of researchers at Wroclaw Medical University in Poland evaluated the role of managing stress and using effective coping strategies in improving the quality of life of patients with MS. The study indicated that higher levels of stress were linked to lower quality of life across all domains. Using coping strategies based on acceptance, active coping, humour, active problem-solving, planning, and seeking emotional and social support was associated with a higher quality of life. In contrast, coping mechanisms such as self-blame, denial, and substance use were linked to a lower quality of life in patients.

Moreover, personal and social factors also influenced the quality of life. For example, females, older adults, rural residents, divorced or widowed individuals, and those who were not working reported higher stress and lower quality of life. Overall, the findings indicated that using positive, active coping strategies can help patients with multiple sclerosis manage stress more effectively.

Another study conducted in Northern Ireland found that MS patients with poorer physical health were more likely to experience fatigue, depression, or anxiety, with anxiety being the most powerful predictor. This suggests that addressing these symptoms through psychological interventions may help improve both the physical and mental quality of life for people with MS.

The role of strategies like mindfulness in lowering stress in MS patients was explored by researchers in another study published in 2014. This study, conducted on 119 people with MS, found that higher levels of trait mindfulness could lower psychological stress, improve coping skills, increase resilience, and enhance quality of life. This indicates that mindfulness may help reduce stress and potentially lessen the burden of MS. Overall, even though the precise impact of stress in multiple sclerosis remains uncertain, stress management is a practical strategy to improve patient well-being and quality of life.

Sources

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