These and other physical symptoms can be severe and limiting. However, emotional changes and mental health challenges can be just as (if not more) disabling.

How to address three common mood and mental health concerns for people with MS:

1. Depression

It is easy to assume that people with a chronic illness like MS will inevitably become depressed. This assumption relies on the idea that depression is a reaction to MS. While this is possible, recent research has discovered that depression may also be a symptom.

For persons with relapsing-remitting MS, early in the disease, depression appears to be linked to inflammatory processes. Later, in the secondary-progressive phase, unhelpful thoughts, such as feelings of guilt, worthlessness or hopelessness are more frequent. So the depression in this case is thought to be more reactive — linked to frustrations with lifestyle changes or loss of function.

Depression, together with anxiety, may worsen thoughts of suicide and shouldn’t be left untreated. In most cases, it can be effectively managed with a combination of antidepressants and cognitive behavioral therapy. This type of therapy focuses on identifying and shifting thoughts, beliefs and behaviors that may contribute to emotional distress.

2. Anxiety

Approximately half of people who have MS and depression also experience anxiety. But anxiety can also occur independently without depression. Anxiety disorders are three times more common in MS than in the general population. Anxiety has been linked to decreased social interaction and increased levels of pain and may even impact cognitive skills such as how fast your brain processes information.

When it comes to living with multiple sclerosis, anxiety often stems from the uncertainty over what the next day will bring. In relapsing-remitting MS, the flare-ups can occur unexpectedly. You never know if there is going to be an exacerbation, how severe the symptoms will be if an exacerbation occurs or if MS symptoms will progress over time. It can be difficult not to worry, especially if you have many responsibilities around caring for your health, family or children and work.

If you’ve ever experienced anxiety, you know it can make daily life difficult. One way some people deal with anxiety is by avoiding its source. These avoidance behaviors could make you skip a doctor’s appointment, reduce your time with friends or stop you from doing what you enjoy.

The treatment for anxiety includes behavioral therapy and exposure exercises to help build confidence and tolerance.

3. Pseudobulbar Affect

Pseudobulbar affect is a condition rooted in a disconnect between how you feel and express emotions. If you have this condition, you may start crying suddenly, although you don’t feel sad or upset. Or you may start laughing uncontrollably over something that you don’t even find that funny.

This happens due to the breakdown in communication between the front and the back of the brain. In people with MS, brain lesions that disrupt the functioning of neurotransmitters may cause this breakdown. It may also result from the overall atrophy of the brain in later stages of MS. Steroid use can increase the risk of developing pseudobulbar affect, and reducing or stopping steroids may make it go away.

Pseudobulbar affect can sometimes be confused with conditions such as depression, mood swings and bipolar disorder. The inappropriate outbursts of emotion can also be a source of embarrassment and anxiety.

If you are a support partner of someone with MS, watch for signs of depression and anxiety both in your loved one and in yourself. They may not always be obvious and can often look like irritability, anger or a growing detachment from social life.