Depression and anxiety are common among people living with multiple sclerosis (MS). Approximately half of the people who have both MS and depression also experience anxiety. However, anxiety can occur independently without depression. Anxiety with MS may occur due to the unknowns of life with MS. For example, in those with relapsing-remitting MS, flare-ups can occur unexpectedly.

Anxiety disorders in people with MS range from panic attacks, phobias, obsessive-compulsive disorder, and generalized anxiety disorder. Anxiety can cause avoidance behaviors such as skipping appointments with your health care provider, avoiding your friends, and not leaving the house. Symptoms of anxiety include:

• Experiencing sleep disturbances
• Having a pounding or racing heart
• Having trouble controlling feelings of worry
• Experiencing feelings of being out of control
• Having headaches, muscle aches, and stomach aches
• Being irritable
• Feeling restless, wound-up, or on edge

Various medications may help improve your MS-related anxiety symptoms. Be sure to talk with a health care professional if you feel that anxiety is affecting your daily quality of life. Your neurologist or primary care provider can refer you to a mental health professional to help you.

What Prescription Medications Can You Take for Anxiety With MS?

The systems in our brain that control our emotions can be greatly affected by stress. Disruptions in the serotonin pathways in particular can lead to anxiety disorders. Serotonin is a chemical messenger (neurotransmitter) that affects many functions, including mood regulation.

Medications have been designed to target serotonin pathways to reduce the symptoms of anxiety and depression. Remember that it can take up to eight weeks for prescription medications to reach their full effects. The different types of anti-anxiety prescription medications commonly used for MS are described below.

Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are generally the first treatment option for people with MS who also experience depression or anxiety. These medications are also commonly prescribed in the general population. The side effects of these medications are usually mild and decrease over time. Here are the SSRIs that may be prescribed for anxiety:

• Fluoxetine (Prozac) — Also treats MS-related fatigue
• Sertraline (Zoloft) — Also treats MS-related fatigue
• Citalopram (Celexa)
• Paroxetine (Paxil)
• Escitalopram (Lexapro)

Selective Serotonin and Norepinephrine Reuptake Inhibitors

Selective serotonin and norepinephrine reuptake inhibitors (SSNRIs) may be more effective in treating severe depression (and anxiety) or mood disorders that are not sufficiently helped by SSRIs. The two main SSNRIs that are prescribed for people with MS-related anxiety are:

• Venlafaxine (Effexor) — Also treats hot flashes in postmenopausal women
• Duloxetine (Cymbalta) — Also treats neuropathic pain

Tricyclic Antidepressants

Although tricyclic antidepressants can also treat anxiety, they are not commonly prescribed to people with MS. This is because these drugs have side effects (that can make other MS symptoms feel worse) such as:

• Dry mouth
• Constipation
• Bladder problems
• Sexual dysfunction
• Blurred vision
• Dizziness
• Drowsiness
• Increased heart rate

In cases of treatment-resistant depression or anxiety, the following tricyclic antidepressants may be used alone or in combination with other medications:

• Amitriptyline (Elavil)
• Imipramine (Tofranil)
• Nortriptyline (Pamelor)

Benzodiazepine Drugs

Benzodiazepines are only prescribed for short-term use because they can be habit-forming and can decrease cognition:

• Diazepam (Valium)
• Lorazepam (Ativan)
• Alprazolam (Xanax)

What Supplements Can You Take for Anxiety With MS?

Many people living with MS may want to add herbs or nutritional compounds to their diet to manage their MS-related anxiety. Be sure to talk to your neurologist and other doctors before starting new supplements. The U.S. Food and Drug Administration does not regulate supplements, and claims by companies or individuals selling supplements may not be evidence-based. Some supplements may interact with a medication you take for MS or another health condition or can be detrimental to your health.

St. John’s Wort

St. John’s wort is available in many forms, including capsules, tea, or liquid extracts. It is thought to reduce depression and anxiety by affecting the levels of chemical messengers in the body that affect mood. Although studies have found that St. John’s wort can help reduce anxiety symptoms, it may increase symptoms in some people.

If you take St. John’s wort with other medications that affect neurotransmitter levels (SSRIs or SSNRIs), you may experience serotonin syndrome. This causes symptoms such as agitation, tremors, sweating, and diarrhea. St. John’s wort is known to have negative interactions with many medications, including birth control and some over-the-counter heartburn medications.

Kava Kava

Kava (also called kava kava) is an extract from the roots of the Piper methysticum plant. It has been shown to have a mild anxiety-reducing effect. Kava is considered an anxiolytic because it has a relaxing and euphoric effect. However, it is potentially damaging to the liver, so it should be used with caution. Kava should not be combined with alcohol — the two compounds interact and increase the risk of liver damage.

Cannabis

Your doctor may recommend cannabis (marijuana) to treat certain conditions and symptoms associated with MS or other diseases. It may relieve pain, help with bladder problems, and also reduce MS-associated anxiety. Consuming cannabis to control MS symptoms is not right for everyone with MS, and there may be side effects. In addition, smoking cannabis is not recommended, as smoking can damage your lungs.

Can Anxiety Medication Worsen MS Symptoms or Make Treatments Less Effective?

People living with MS and anxiety should talk with their doctor before starting any new medication or supplement. Some medications or supplements may make MS symptoms worse or interact with current medications.

Additionally, approximately 40 percent of individuals living with MS consume excessive alcohol as a method of coping with their anxiety and MS symptoms. One of the dangers of consuming alcohol with MS is that it is known to interact with many medications, which may lead to unpleasant side effects. Be sure to talk with your doctor or pharmacist to ensure that alcohol does not interact with your medication.

Impact on MS Symptoms

Although anxiety can increase MS symptoms, the more commonly prescribed SSRIs or SSNRIs for anxiety are less likely to make common MS symptoms worse. Tricyclic antidepressants are usually not prescribed to people with MS (unless absolutely necessary) because they are known to increase common MS symptoms.

Impact on Disease-Modifying Treatments

Disease-modifying treatments (DMTs) are highly effective medications that can help slow the progression of MS and reduce disability. There are several injectable, oral, and infused medications that your doctor may prescribe to treat your MS.

Fortunately, the use of prescription anti-anxiety medications such as SSRIs and SSNRIs does not generally make your DMT medication less effective. Therefore, treatment teams commonly prescribe antidepressant medications to people with MS because they are effective and can be combined with most DMTs.

However, more care should be taken if you are considering treating your MS-related anxiety with herbal supplements. People who take herbal drugs may not think that they can cause drug interactions or toxicity because they are derived from a natural source. Several herbal supplements contain compounds that are often metabolized by the same pathways as DMT medications. These interactions may make your DMT less effective or may increase the risk of side effects.

Tell your health care provider or pharmacist about any natural supplements that you are taking.

Impact on Symptom Management Medication

Because DMTs are not used to treat daily MS symptoms, those living with MS may use a variety of prescription and over-the-counter (OTC) medications to manage MS symptoms. For example, fatigue, bladder dysfunction, pain, and walking problems may be treated with different symptom-targeted medications.

Common symptom management medications include:

• Anti-inflammatory steroids to manage flares
• Muscle relaxants to manage muscle pains and tremors
• Stimulants to manage fatigue
• Bladder relaxants to manage overactive bladder symptoms
• Antibiotics to manage infections
• Vasodilators to manage sexual problems

If you have MS and are currently on several medications, it is important to remind your health care providers about any prescription or herbal anti-anxiety medications you are taking.

Talk With Others Who Understand

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