Stress & Multiple Sclerosis – Can stress cause MS?

Stress is an inevitable part of modern life. It has been shown to contribute to a long list of health problems such as chest pain, headaches, insomnia, stomach problems and a lowered immune system with more frequent infections.

However, if you have MS, you have an additional incentive to make sure that you try to manage your stress – studies show that negatively experiencing stress can affect MS relapses and worsen MS symptoms. 

Can stress cause MS?

Stress does not directly cause multiple sclerosis (MS), but it may trigger symptoms or relapses in people who already have the condition.

Many people with MS report that their first symptoms appeared during or after a period of significant stress or trauma, which has led to ongoing discussion about a possible link. However, scientific studies have not found clear evidence that stress causes MS to develop. Research does show that long-term stress can worsen symptoms and increase the risk of MS relapses in those already diagnosed, and stress-management strategies have been associated with fewer new lesions seen on MRI scans.

The connection between long periods of stress and MS exacerbation within people who already have an MS diagnosis has been realised through scientific research and studies. Stress management has also been seen to slow down new areas of MS lesions on an MRI scan.

What is an MS relapse?

An MS relapse is a period when new neurological symptoms appear or existing MS symptoms worsen due to inflammation damaging the myelin in the central nervous system.

To be classed as a relapse, symptoms must last at least 24 hours, occur at least 30 days after a previous relapse, and have no other cause such as infection, fever, or acute stress – otherwise they are considered a pseudo-relapse. Relapse symptoms vary widely, ranging from mild sensory changes to more significant disability, and may involve one or multiple symptoms at the same time. Relapses can last days, weeks, or months, and in relapsing-remitting MS they are typically followed by a remission, although symptoms do not always fully resolve.

Stress and MS relapses

Studies have found that continuous emotional stress, rather than short-term stress, can trigger an MS relapse in people with RRMS. Long-term, continuous stress keeps the immune system on hyper-alert, is very pro-inflammatory and creates a lot of wear and tear in the body, otherwise known as allostatic load.  

There is so much evidence to back this up, just take a look at the list of studies below. One study at the University of Pittsburgh found that stressful events like a death in the family or divorce were often followed by an MS relapse within six weeks, while the study in the Netherlands found that stressful life events more than doubled the rate of relapse. 

However even stress caused by positive events like a new baby or organising a wedding can increase the chance of an MS relapse. 

But it is not stress itself that necessarily causes the problem, rather our response to it. In fact, people who perceive stress as a positive have better health outcomes than those with less stress, but who perceive it negatively.

Fortunately, there are lifestyle changes that you can make, that have been clearly shown to reduce stress, including mindfulness meditation, exercise and diet to help you manage stress and strengthen your mind-body connection.

What is the link between multiple sclerosis and stress?

Stress does not cause multiple sclerosis, but research shows it can worsen symptoms and increase relapse risk in people with relapsing-remitting MS (RRMS).

A number of published papers have shown that stress affects RRMS. Here are a few:

• At UCLA, studies showed stress can precipitate MS relapses and worsening disability through a variety of mechanisms – including excessive inflammatory response and worsening degeneration. The immune system balance of Th1 (exciting inflammation) versus Th2 (reducing inflammation) cytokines is intimately involved in the development of relapses in people with MS.
• In Switzerland, researchers studied 14 healthy medical students to see whether a psychologically stressful event (their final exam) could modify Th1 cytokine’s levels. The students showed a significant increase of an inflammatory cytokine (tumor necrosis factor alpha) starting the next day; this cytokine has been shown to be elevated in MS relapses.
• In Pittsburgh, a study by the Department of Psychiatry at the University of Pittsburgh followed 50 women with MS to see how major life events affected their MS disease activity. Nearly half of all major life events were followed within six weeks by a relapse.
• 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. This study also noted that those with coping mechanisms could reduce this risk. 
• In 2006, the same research group summarised the effects of stress on MS:

“A growing literature reports that stressful life events are associated with exacerbation and the subsequent development of brain lesions in patients with multiple sclerosis.”

• Acute short-term stressors generally caused no problems, but bigger stressors such as conflicts, loss, bereavement, poor social support, anxiety and depression were shown to be risk factors for MS exacerbations.
• In the Netherlands, researchers examined 73 patients with relapsing-remitting MS at an MS clinic. During the study, 70 had major stressful events. Stress more than doubled the exacerbation rate during the following four weeks. The researchers also noted a 3-fold increase in relapses following infections during the study, but this was independent of the stress associated with the infection.

Can stress cause more MS lesions?

Stress does not directly cause new MS lesions, but ongoing or prolonged stress may be linked to increased disease activity in people with MS.

MS lesions are areas of damage or scarring in the central nervous system and are closely associated with MS symptoms and relapses. While research has not shown that stress causes MS to begin, studies suggest that long periods of stress can worsen symptoms and may be associated with increased lesion activity in people with relapsing-remitting MS. The impact of stress can vary between individuals and MS types, but learning effective stress-management strategies may help reduce relapses and support overall disease control.

Can MS be triggered by stress?

Stress does not directly cause multiple sclerosis, but it may act as a trigger for symptom onset or disease activity in some people.

Many people with MS report that their first symptoms appeared during or after a period of significant stress, which has led to questions about whether stress can trigger the condition. However, research has not found clear evidence that stress alone causes MS to develop. What studies do show is that stress can influence immune activity and is associated with relapses and symptom worsening in people already living with MS, particularly those with relapsing-remitting MS.

How the program can help

Good news: although it’s simply not possible to avoid stressful life events, there are ways that you can learn to deal with stress so that you can prevent MS relapses. Scientists have discovered that stress management techniques can significantly reduce lesions and MS relapses. MS symptoms can also be stressful in themselves and symptoms can naturally feel worse if you are feeling stressed and anxious, so stress management will also help you day-to-day.

Some of the ways in which you can manage stress effectively include: 

• Meditation – strong scientific evidence shows that meditation affects areas in the brain that can help you to respond to stress more effectively.
• Exercise – exercise can directly reduce stress by increasing your endorphins, but it also improves your overall sense of wellbeing, especially if you are enjoying the physical activity and socialising with friends at the same time.
• Diet – chronic stress releases cortisol and studies have shown this increases the desire for calorie-laden, sweet, fatty, processed foods. A bad diet can lead to inflammation of the gut which leads to an MS relapse. So what’s the best diet to help reduce stress and improve MS symptoms? We have made it easy with an Overcoming MS diet which includes reducing saturated fats, increasing omega-3 intake and a wide range of colourful fruit and vegetables. Take a look at all our delicious recipes for inspiration.
• Sleep – Good quality sleep is vital to reduce stress as a good night’s sleep will help you to better manage any stress which comes your way. You need at least seven or eight hours of sleep per night.
• Identify what is making you anxious – counselling can be beneficial in helping you to identify your source of stress, make life changes and develop coping mechanisms.

The Overcoming MS program combines all of these factors with the added support of a community.