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Stress and MS

The issue of MS and stress is an important one. Major life events like marriage breakdown, moving house, losing or changing jobs, losing close friends or loved ones, and so on, have a profound effect on general wellbeing. A number of published papers have looked at the subject from several angles. It appears clear that major life events, or more particularly our reaction to them, can often trigger MS attacks.
Scientists at UCLA have summarised basic molecular and animal experimental research, as well as human clinical and epidemiological studies, showing that stress can precipitate MS relapses and worsening disability through a variety of mechanisms including an ‘overshooting’ of the inflammatory response, and through worsening degeneration.1 The immune system balance of Th1 (exciting inflammation) versus Th2 (dampening down inflammation) cytokines is intimately involved in the development of relapses in people with MS. MS is a Th1-predominant disease. Swiss researchers conducted a prospective study in 14 healthy medical students, to see whether a psychologically stressful event, in this case the students’ final examination, could modify one of the known Th1 cytokines, tumor necrosis factor alpha (TNF-alpha) levels. They showed a significant increase of TNF-alpha starting the next day, suggesting that stress can precipitate MS relapses by its effect on the immune system.2

Another study on stress and multiple sclerosis was conducted by the Department of Psychiatry at the University of Pittsburgh. They studied 50 women with MS, following on a weekly basis the occurrence of major life events such as those listed above, and their MS disease activity.3 Nearly half of all major life events were followed within 6 weeks by a relapse. Relapses were more common in those people clearly affected by the events, as demonstrated by a higher resting heart rate and blood pressure. Meditation has been shown to reduce these and is likely to therefore have a very positive effect on minimising the risks of relapse after major life events.

US researchers have studied the development of new MRI lesions in 36 people with MS and correlated these with stressful life events. After major life stresses, people were roughly 1.6 times more likely to develop a new lesion in the next eight weeks.4 The p value in this study was 0.0008, indicating that the findings did not occur by chance. This study also noted that those with coping mechanisms could reduce this risk.5 Again this lends support to the potentially beneficial effects of meditation in MS. In 2006, the same research group summarized the effects of stress on MS, noting that ‘a growing literature reports that stressful life events are associated with exacerbation and the subsequent development of brain lesions in patients with multiple sclerosis’.6 Acute short-term stressors generally cause no problems. In contrast stressors such as interpersonal conflicts, loss and complicated bereavement, poor social support, anxiety and depression are risk factors for MS exacerbations.7

Another MS and stress study by Dutch researchers examined 73 patients with relapsing-remitting MS at an MS clinic.8 During the study period, 70 had major stressful events. Stress resulted in a more than doubling of the exacerbation rate (relative risk 2.2, p=0.014) during the following four weeks. The researchers also noted a three fold increase in relapses following infections during the study, but this was independent of the stress associated with the infection.
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Overview

Overall, the evidence is quite congruent and clear. Stress plays a major role in MS relapses and strategies need to be developed to minimise the effects of stressful life events. Meditation is particularly helpful, but many people also find exercise helps in minimizing the effects of stress. Counseling may also be useful.
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  1. Gold SM, Mohr DC, Huitinga I, et al. The role of stress-response systems for the pathogenesis and progression of MS. Trends Immunol 2005
  2. Lalive PH, Burkhard PR, Chofflon M. TNF-alpha and psychologically stressful events in healthy subjects: potential relevance for multiple sclerosis relapse. Behav Neurosci 2002; 116:1093-1097
  3. Ackerman KD, Stover A, Heyman R, et al. Relationship of cardiovascular reactivity, stressful life events, and multiple sclerosis disease activity. Brain Behav Immun 2003; 17:141-151.
  4. Mohr DC, Goodkin DE, Bacchetti P, et al. Psychological stress and the subsequent appearance of new brain MRI lesions in MS. Neurology 2000; 55:55-61
  5. Mohr DC, Goodkin DE, Nelson S, et al. Moderating effects of coping on the relationship between stress and the development of new brain lesions in multiple sclerosis. Psychosom Med 2002; 64:803-809
  6. Mohr DC, Pelletier D. A temporal framework for understanding the effects of stressful life events on inflammation in patients with multiple sclerosis. Brain Behav Immun 2006; 20:27-36
  7. Strenge H. [The relationship between psychological stress and the clinical course of multiple sclerosis. An update]. Psychother Psychosom Med Psychol 2001; 51:166-175
  8. Buljevac D, Hop WC, Reedeker W, et al. Self reported stressful life events and exacerbations in multiple sclerosis: prospective study. Bmj 2003; 327:646.