MS Mood Swings: Understanding Emotional Lability and How to Manage It

🧠 Why Does MS Affect Mood?

Multiple sclerosis doesn’t just affect the body—it impacts the brain. Since MS is a neurological condition that causes inflammation and damage to the central nervous system, it often disrupts the very circuits responsible for mood regulation.

Key ways MS may affect mood include:

Demyelination: Damage to the protective sheath (myelin) surrounding nerves affects how the brain processes emotional responses.
Lesions in emotional centers: If MS lesions form in the frontal lobe or limbic system, emotional control can be disrupted.
Fatigue and pain: Ongoing physical strain can wear down emotional resilience.
Medication side effects: Some MS drugs can trigger mood changes.
Life disruption: The stress of living with a chronic illness can take a psychological toll.

🌀 What Is Emotional Lability?

Emotional lability refers to rapid, intense, and often unpredictable changes in mood that may seem disproportionate to the situation. One moment you’re laughing, the next you might be crying—without a clear reason.

Common signs include:

Crying spells that come suddenly
Laughing uncontrollably at inappropriate times
Feeling emotionally “out of sync” with what’s happening
Difficulty controlling reactions once they start

This isn’t about being overly sensitive or dramatic—it’s a neurological symptom of MS.

Looking for online therapy? Click here.

😢 What Is Pseudobulbar Affect (PBA)?

Pseudobulbar Affect (PBA) is a condition linked to brain damage from MS, stroke, ALS, or traumatic brain injury. It’s characterized by episodes of sudden, involuntary crying or laughing that don’t match how you feel inside.

You may feel:

Emotionally neutral but start sobbing
Embarrassed by sudden laughter in a serious moment
Frustrated by your inability to “hold it together”

PBA can be mistaken for depression or anxiety, but it has distinct neurological roots.

How to tell the difference:

Symptom	Depression	Pseudobulbar Affect
Duration	Persistent sadness	Brief episodes
Trigger	Emotional life events	Minimal or no trigger
Internal emotion	Matches outward reaction	Doesn’t match (disconnected)
Frequency	Ongoing	Sudden, episodic

🔬 The Science Behind It

MS damages communication between the cortex (emotional regulation) and brainstem (reflex reactions). When the pathway is interrupted, emotional responses may “bypass” your control.

This is why someone with MS might:

Laugh hysterically at a minor joke
Cry during a happy conversation
Shift from calm to rage without warning

It’s not weakness—it’s wiring.

🙈 Emotional Triggers You Might Not Realize

Some people with MS find that their mood swings have subtle or unexpected triggers, such as:

Changes in temperature
Sensory overload
Hormonal shifts (especially for women)
Medication withdrawal or dosage changes
Chronic sleep issues
Gut dysfunction (linked to the gut-brain axis)

Tracking your mood alongside symptoms, diet, and environment can reveal patterns.

🩺 When to Talk to a Doctor

Mood swings related to MS should never be brushed off. Speak to your neurologist or primary care doctor if:

You feel embarrassed, scared, or out of control
Your relationships are suffering
You’re avoiding social situations due to emotional unpredictability
You suspect PBA but haven’t been formally diagnosed
You’ve considered self-harm or feel persistently hopeless

There are treatment options—including medications like Nuedexta for PBA or mood stabilizers for emotional lability.

🧘How to Manage MS Mood Swings

Managing emotional lability requires a mix of physical, emotional, and social strategies.

1. 💊 Explore Medical Options

You’re not alone—and you don’t need to suffer in silence. Medication may help.

Options include:

Nuedexta: FDA-approved for PBA
Antidepressants: SSRIs, SNRIs, or tricyclics can help stabilize mood
Mood stabilizers: Such as gabapentin or valproate (off-label)
Low-dose naltrexone (LDN): Some MS patients report mood benefits

Always work with your neurologist to personalize your plan.

2. 🌬️ Practice Breathwork and Grounding Techniques

Simple tools can create space between emotion and reaction:

Box Breathing: Inhale 4 seconds, hold 4, exhale 4, hold 4
5-4-3-2-1 Grounding: Name 5 things you see, 4 you can touch, 3 you hear, 2 you smell, 1 you taste
Progressive muscle relaxation: Tighten and release muscles from head to toe

These can be used discreetly, even in public.

Click here to try breathwork.

3. 🧠 Try Cognitive Behavioral Therapy (CBT)

CBT helps reframe thought patterns that intensify emotional reactions.

You’ll learn:

To separate facts from assumptions
To recognize “thinking traps” (like catastrophizing)
To pause before reacting
To replace judgment with compassion

It’s highly effective for people managing neurological conditions.

Looking for online therapy? Click here.

4. 🧍Get Moving (Gently)

Exercise can boost endorphins and regulate nervous system responses.

Try:

Stretching/yoga
Walking (with assistive devices if needed)
Swimming
Chair workouts
Dancing to music at home

Listen to your body—consistency over intensity.

5. 🍽️ Support Mood with Nutrition and Supplements

A few nutrients linked to emotional regulation:

Omega-3s: Reduce inflammation and support brain health
Magnesium: Calms the nervous system
Vitamin D3: Linked to mood and MS progression
B-vitamins: Crucial for neurotransmitter balance
L-theanine and ashwagandha: Gentle calming herbs

Also, reduce:

Excess caffeine
Alcohol
Ultra-processed foods

Ask your care team before adding supplements. Looking for supplements for people with MS? Click here.

6. 🧘 Practice Self-Compassion

One of the most healing things you can do: talk to yourself like you would a loved one.

Instead of:

“I’m so embarrassing—what’s wrong with me?”

Try:

“This isn’t my fault. My brain is having a hard time, and I deserve kindness.”

Self-compassion has been shown to reduce emotional distress, especially in chronic illness.

7. 🤝 Educate Loved Ones

People may misread mood swings as being “too emotional” or “overreacting.”

Help them understand:

What emotional lability or PBA is
What you need during or after an episode
That you’re not in control of every emotional outburst

Use real examples. Send them articles. Invite them into your world.

8. 📓 Track Your Episodes

Use a journal or mood tracker to log:

What triggered the episode
What it felt like
How long it lasted
How you responded
What helped

Over time, this becomes a roadmap to emotional mastery.

🛑 What Not to Do When Dealing with Mood Swings

Avoid:

Suppressing all emotion: It’s okay to feel
Isolating yourself: Connection can regulate the nervous system
Blaming yourself: These symptoms are neurological, not personal
Over-apologizing: Take accountability when needed—but don’t shame yourself for having MS

👂 What Real People Say

“I thought I was going crazy—crying at the drop of a hat. When I learned it was PBA, I cried again… but this time from relief.”
— Sarah, 44

“I carry a card that explains PBA. I’ve handed it to teachers, coworkers, even my Uber driver once. People have been surprisingly understanding.”
— Malik, 39

“I used to think I had no control. Now I have a whole toolbox of things that help. I still have episodes—but they don’t rule my life anymore.”
— Jess, 29

📋 Action Plan: Managing MS Mood Swings

✅ Ask your doctor about emotional lability and PBA
✅ Explore medications if symptoms are severe
✅ Try one grounding exercise today
✅ Begin a mood and trigger journal
✅ Pick one supplement to discuss with your care team
✅ Share an educational resource with someone close to you
✅ Celebrate one moment of emotional awareness this week