What is the link between multiple sclerosis and stress?
A number of published papers have shown that stress affects MS. 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 summarized 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.
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