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Could depression and anxiety be early warning signs of multiple sclerosis? Liliya Rodnikova/Stocksy
  • Psychiatric issues may be early indicators of multiple sclerosis, according to a new study from the University of British Columbia.
  • They are a new addition to a growing list of symptoms, including sleep disorders, fatigue, anemia, and pain, that may precede multiple sclerosis by years.
  • Although such symptoms do not directly predict the disease, their frequent appearance in the years preceding the illness adds to experts’ understanding of the life-changing condition.

Researchers from the University of British Columbia suggest in a new study that they have identified what may be an unreported early indicator of multiple sclerosis (MS) years before its symptoms appear: psychiatric issues, including depression, anxiety, bipolar disorder, and schizophrenia.

The study is published in Neurology, the medical journal of the American Academy of Neurology.

For the current study, the authors analyzed administrative and clinical data from British Columbia in Canada. The researchers looked at a quartet of populations starting five years before diagnosis of MS. In their “administrative cohort” — based on claims of demyelination — were 6,863 cases of MS and 31,865 controls. In the “clinical cohort” — the onset of MS symptoms — there were 966 cases of MS and 4,534 controls.

The study finds that people who eventually develop MS in the administrative cohort have twice the number of psychiatric issues before an MS diagnosis than members of an MS-free control group:

28% compared to 14.9%. Similar findings were observed in the clinical cohort (22% compared to 14.1%).

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The study’s authors also observed that healthcare usage, including psychiatric sessions, prescriptions, and hospitalizations, was higher among people in the administrative cohort who eventually developed MS. Their frequency, compared to controls, increased each year until MS symptoms appeared. These findings weren’t observed in the clinical cohort.

The study follows previous research from the study’s lead author, Dr. Helen Tremlett, that first proposed a “prodromal period” for MS, preceding significant MS symptoms in which indicators of eventual disease may appear. This research suggested that sleep disorders, fatigue, anemia, and pain may be prodromal symptoms.

Prodromal periods have been identified for other diseases, including Parkinson’s disease, with which constipation often precedes Parkinson’s symptoms by years.

Multiple sclerosis is a chronic disease that affects elements of the central nervous system, including the brain, spinal cord, and optic nerves. Experts believe it is some immune system malfunction that leads to damage to the protective layer, myelin, that protects axons, the cable-like structures through which electrical signals travel between neurons.

The disease also damages neuron bodies located in the brain’s gray matter. As MS progresses, the cerebral cortex, the outermost layer of the brain, shrinks. This is referred to as cortical atrophy.

While cases are highly individualized — each person with MS may experience their own progression of symptoms, which may be permanent or temporary.

Dr. Naila Makhani, who collaborated with Dr. Tremlett on the previous study, said:

“MS is diagnosed when a person has both typical neurological symptoms, lasting at least 24 hours, and typical findings on imaging. Typical symptoms of MS include vision loss, double vision, weakness, numbness or tingling, and balance problems. Other symptoms may also occur.”

“The prognosis for MS is a much more favorable one nowadays compared to the early 90s,” said Dr. Mary Ann Picone, Medical Director of the MS Center at Holy Name Medical Center in Teaneck, NJ.

Dr. Picone was not involved in the study.

“Worldwide databases,” Dr. Picone added, demonstrate that fewer patients are transitioning to progressive forms of MS. The first five years from diagnosis tend to be the most predictive of how a patient will do.”

MS is rarely fatal, although it can be the driver of complications, such as swallowing difficulties or chest or bladder infections. Although this gap is decreasing, the current average lifespan for a person with MS is 5 to 10 years shorter than it is for people without the disease.

“For a long time, it was thought that MS only really began clinically when a person experienced their first demyelinating event, such as in the form of vision problems,” Dr. Tremlett tells UBC News. Dr. Tremlett is a professor of neurology at the University of British Columbia and a member of the school’s Djavad Mowafaghian Centre for Brain Health.

Dr. Tremlett explained to Medical News Today:

“A better understanding of the extent and burden of early psychiatric morbidity in MS is needed, especially as it can negatively affect quality of life, impact disability progression, and possibly increase mortality risk.

Additionally, expanding our knowledge of the MS prodrome may allow for earlier disease recognition and treatment.”

The study does not assert that the presence of the proposed MS prodromal symptoms necessarily signifies imminent MS in any of themselves.

“Studies show that persons with MS who are treated earlier have a better overall prognosis,” said neurologist and MS specialist Dr. Barbara Giesser, who was not involved in the study.

“Prompt diagnosis and treatment is important,” Dr. Giesser said, “because there are almost two dozen FDA-approved treatments, called disease modifying therapies, that can limit future damage and slow disease progression.”

Dr. Tremlett agreed. “There are more than 20 FDA/Health Canada approved disease-modifying drugs to treat MS,” she added.

“Additionally, [a] person with MS can initiate healthy lifestyle choices that are also important in disease management,” said Dr. Giesser.

According to the National Multiple Sclerosis Society, such lifestyle choices include being as physically active as possible, eating well, not smoking, and getting out of one’s house more often. They also recommend not giving up, if possible, on things that are challenging to do.

The assortment of suggested prodrome symptoms would not seem to have much to do with the eventual symptoms of MS, and for now, the connection is unclear.

However, said Dr. Tremlett, “I hypothesize that many of the mechanisms that drive mental health-related issues after MS onset also drive those issues before MS onset. It would not be unreasonable to suspect that myelin loss could be one of likely several mechanisms.”

Dr. Picone agreed, adding such symptoms “can be related to the subclinical demyelination which is occurring for years before a clinical diagnosis. The more effective we are at decreasing inflammation early on, the better chance there is to decrease disability progression years later.”