Ms and anxiety

[Deanna143]

Hi! My name is DeAnna and I just turned 24. I was diagnosed with ms may of 2012 due to optic neuritis and spots on my brain. I started copaxon in August after I got diagnosed and although it was very scary and all new to me, I was completely fine and remained positive continuing on with life as normal. In November of 2012 I got my first panic attack which was followed by another panic attack and generalized anxiety. I would say the anxiety was horrible up until march of this year. It started with physical an anxiety (tingling in my leg, fear I couldn't swallow, ringing in my ears) - these would occur multiple times throughout the course of one day. After that it was more generalized - fear of going in large crowds, loud places, even going out to dinner was an issue. In the mix of my life being turned upside down from the anxiety and not being able to feel normal for even one day- I became a hypochondriac. As soon as I hear about someone getting diagnosed with a disease or I feel an abnormal pain in my body my mind immediately takes off and I seriously fear I am dying from cancer or about to have a brain aneurism.

I am a relatively happy fun person. Since the anxiety started I feel unhealthy and unhappy. Although I have come a very long way with it and it has improved tremendously without medication, I still have days and times where I have to talk myself out of situations where I feel anxiety. I guess I'm posting this because I just don't understand where it all came from. I've never had anxiety, panic attacks, or been a hypochondriac. The average person would tell me it's from the diagnosis of ms and not knowing what was to come, but I was perfectly fine for several months after the diagnosis. So could it be from the copaxon? Or just developed out of nowhere? Any input would be wonderful ! Thanks a bunch !

[Anonymoose]

Hi Deanna,
Sorry to hear you've joined our ranks. You've come to a good place though. Apparently you aren't the only one experiencing anxiety on Copaxone. See google search https://www.google.com/search?q=copaxon ... ent=safari

It seems you are getting a good handle on the anxiety already. Attitude is half the battle. I think magnesium might help with anxiety and evening primrose too. Our resident nutritional guru will be able to better explain.

It's important to find a good balance between not letting anxiety take over and not pushing yourself through it too hard. Stress is very toxic/dangerous to msers.

Take care...

[Annesse]

Hi Deanna~

Anxiety can be associated with MS. For instance, in the following study the researchers stated that anxiety disorders are quite common in patients with MS.


Semin Clin Neuropsychiatry. 1999 Apr;4(2):103-13.
Anxiety in patients with multiple sclerosis.
Riether AM.

“Anxiety disorders are quite common, and frequently overlooked, in patients with multiple sclerosis (MS)…”

One major cause of this would be that MS patients have low levels of GABA.

In the following study published in Archives of Neurology the researchers found significant reductions of GABA in the cerebrospinal fluid of patients with MS.

Levels of γ-aminobutyric acid in cerebrospinal fluid in various neurologic disorders.
N. V. Bala Manyam, MD; Leonard Katz, MD; Theodore A. Hare, PhD; Joseph C. Gerber, PhD; Mark H. Grossman, PhD
Arch Neurol. 1980;37(6):352-355. doi:10.1001/archneur.1980.00500550054006.

“significant reductions of the GABA level in CSF were seen in patients with Huntington's disease, dementias, cerebellar cortical atrophy, multiple sclerosis, epilepsy, and Parkinson's disease.”

Researchers in the following study, published in Multiple Sclerosis, concluded MS patients had “diffuse GABAergic alteration in neurons.”

Mult Scler. 2012 Nov;18(11):1633-5. doi: 10.1177/1352458512440207. Epub 2012 Mar 14.
Inflammation inhibits GABA transmission in multiple sclerosis.
Rossi S, Studer V, Motta C, De Chiara V, Barbieri F, Bernardi G, Centonze D.

“…Our results provide evidence that focal inflammation in MS perturbs the cytokine milieu within the circulating CSF, resulting in diffuse GABAergic alteration in neurons.”


GABA (gamma-aminobutyric acid) is the major inhibitory neurotransmitter in the brain. Excitation in the brain must be balanced with inhibition. Too much excitation can lead to anxiety, insomnia, impulsivity, inability to focus attention, and even seizures. Anti-anxiety medications, such as benzodiazepines and barbiturates work by binding to GABA receptors to increase its inhibitory effect and relieve anxiety. The significantly lower levels of GABA found in MS patients would explain the association with anxiety.

So, I think your instincts may be right, your anxiety might be associated with the disease process occurring in MS.

[THX1138]

That is interesting about the GABA.

I had a lot of anxiety before and after my diagnosis. The diagnosing physician prescribed me Xanax, a benzodiazepine.
That worked great for a while, but in a month or two on it, my body got used to having it (as people do) and I would feel much worse than before if I missed a dose. Since then I have read that after a few months of taking benzodiazepines, people are up taking them just ot prevent the withdrawal effects. I fully agree with this idea. After several years taking various benzodiazepines, I tapered off very slowly (close to year) using the Valium Taper protocol.

In the past year or so I have discovered that Magnesium is the answer, giving relief from anxiety without sleepiness or other side effects. Magnesium is an essential nutrient that few people get enough of, and one of the many symptoms of not getting enough Magnesium is anxiety.

Some of us here would be more than willing to make suggestions about what kinds to use and how to go about it.

I with you the best,
THX1138

[Annesse]

Right THX1138~

Low GABA is related to many of the symptoms occuring in MS, but medications oftentimes just create more of an imbalance in the long term. Best to address the underlying cause of the low GABA if possible I think.

Deanna143~There is also a connection to low GABA and premenstrual exacerbations. You don't happen to experience this by any chance do you?

Low GABA would also be connected to spasticity. GABA is needed for the muscles to relax.

Baclofen and Gabapentin (Neurontin) are two of the medications used to treat spasticity in patients with MS. Baclofen is a derivative of GABA and Gabapentin increases GABA concentration in the brain, as the following study confirms.

Neuropsychopharmacology. 2012 Dec;37(13):2764-71. doi: 10.1038/npp.2012.142. Epub 2012 Aug 8.
The impact of gabapentin administration on brain GABA and glutamate concentrations: a 7T ¹H-MRS study.
Cai K, Nanga RP, Lamprou L, Schinstine C, Elliott M, Hariharan H, Reddy R, Epperson CN.

“…Gabapentin, marketed for the treatment of seizures and neuropathic pain, has been shown to increase in vivo GABA concentration in the brain…”

[jimmylegs]

zinc and magnesium are two of the essential nutrients known to be depleted in ms patients. medications can sometimes, by various mechanisms, exacerbate this problem. careful informed dietary change - and, if necessary, supplementation - has the potential to help

two related studies:

Release of glutamate and GABA in the hippocampus under zinc deficiency (2003)
http://www.ncbi.nlm.nih.gov/pubmed/12704815
"Zinc homeostasis in the brain is affected by dietary zinc deficiency, and its alteration may cause brain dysfunctions. On the basis of the previous evidence that hippocampal zinc was responsive to 12-week zinc deprivation, responsiveness of hippocampal zinc to dietary zinc deficiency was examined in rats fed a zinc-deficient diet for 4 weeks. ... In the brain of the zinc-deficient rats, ... zinc concentration in the hippocampal extracellular fluid was approximately 30% of that of control rats. These results demonstrate that vesicular zinc is responsive to dietary zinc and may decrease easily under zinc deficiency. ... Gamma aminobutyric acid (GABA) concentration in the hippocampal extracellular fluid during stimulation with high K+ was increased in the control rats, but not in the zinc-deficient rats. The present study suggests that the excitability of hippocampal glutamatergic neurons is enhanced by dietary zinc deficiency"

Anxiety and stress among science students. Study of calcium and magnesium alterations (2006)
http://www.jle.com/e-docs/00/04/1D/1B/article.phtml
"...The present results showed that the evaluated students did not experiment a stress increase during exams but suffered a significant anxiety increase. It is interesting to observe that the psychological findings agree with urinary biomarkers studied. It is known that anxiety is related to partial magnesium decrease associated with an increase in urinary magnesium excretion [12-17]. This might be partially attributed to the plasmatic glucose decrease caused by anxiety that leads to catecholamine secretion in order to restore glucose levels. These hormones are implicated in hypomagnesemia [9-11]. Also, an increase in aldosterone secretion might be able to explain the findings of this paper, as aldosterone leads to an increased renal excretion of magnesium [27-29]. The noticeable increase in muscular tension linked to anxiety consumes an important amount of energy that is partially due to the ATP-ADP transformation. A high increase in urinary phosphate excretion [30-32] also contributes to the magnesium reduction. Indeed, magnesium has been proposed for treatment in different anxiety disorders [33-38]. Stress correlates with a urinary calcium increase resulting from cortisol liberation [39, 40]. Cortisol blocks the calcium tubular reabsorption mediated by aldosterone, and as a consequence increases calcium urinary excretion [5-8]. Moreover, aldosterone causes an increase in renal magnesium excretion. In the present paper, we did not observe changes in stress and no correlatively significant increases were detected in urinary calcium concentration or excretion.
It must be pointed out that no differences were observed in urinary concentrations and excretion of magnesium and phosphate (phosphorus) when the first urine of the morning was studied (2h urine). This can be linked to the relaxation induced by sleep that must be accompanied by a decrease in anxiety.
Conclusion
The present results showed that the evaluated university science students did not experience stress increase as a consequence of exams but suffered a significant increase in anxiety. This was associated to a urinary magnesium excretion increase responsible for partial magnesium depletion."

[Ash3]

I know how you feel. I never had anxiety until I was diagnosed as well. I was on avonex but since May 15 I have been on Tecfidera. I take low dose of klonopin as needed and does seem to help however I feel it is related to the disease. I am a worrier but I have always been that way. So overtime and raising teenagers and every day with this disease is an adventure it can be hard. Hope this makes you feel a little better. Ash3

[Deanna143]

I really appreciate all your inputs and after reading everything I am definitely going to the doctors ASAP and having my GABA and magnesium levels checked ( I'm due for yearly bloodwork anyway). I am planning on taking those results to a hematologist or possibly a phyciatrist to get their input on what may possibly help with the anxiety without the use of drugs. I do have klonapon but rarely take it because I feel like I'm on slow mode. Once I have more information I will definetely post and share the findings. Thanks again everyone ❤

[jimmylegs]

serum magnesium test would be wise. a serum zinc test would be more valuable than a gaba test IMHO - zinc is low in ms patients on average, and it affects all kinds of important things not just gaba.
serum zinc and serum magnesium are a good start. beware of a 'normal' result - lab ranges and reference ranges are next to useless.. you want your zinc level up over 18 umol/L (top of the reference range is 18.5) and you want your magnesium level as high as 1.4 mmol/L (top of the reference range is 1.1). mainstream doctors are extremely unlikely to have that information - it's all in the academic research but definitely has not made it into mainstream practice yet.

[THX1138]

I really appreciate all your inputs and after reading everything I am definitely going to the doctors ASAP and having my GABA and magnesium levels checked ( I'm due for yearly bloodwork anyway). I am planning on taking those results to a hematologist or possibly a phyciatrist to get their input on what may possibly help with the anxiety without the use of drugs. I do have klonapon but rarely take it because I feel like I'm on slow mode. Once I have more information I will definetely post and share the findings. Thanks again everyone ❤

Obviously you are taking this issue seriously. That's great!

Unfortunately, lab tests often are not all they should be.
They can even be misleading, and in my personal experience, I have found the serum Mg test to be disturbingly misleading. I had all sorts of Mg deficiency symptoms, especially muscle symptoms. I told my doctor I was deficient in Mg and she gave me a serum Mg test and it came back "Normal." After that, she refused to believe that I was in need of more Mg.

At the time I was unaware that different labs have different "Normal" ranges.

Here is a link from a respected U.S. government website that contains published medical studies. This article discusses the problem with a result of "Normal" from a serum Mg test:
http://www.ncbi.nlm.nih.gov/pubmed/20170394

Jimmylegs is quite knowledgeable regarding what are desirable serum Mg scores.

We'll get you feeling better
THX1138

[RyanYum]

It's tied to the disease, i didn't have anxiety until after my first major attack. Try taking a high cbd tincture of marijuana, it helps a ton.

[jimmylegs]

any stressor including an attack can increase magnesium demand, driving down levels that may already be suboptimal. it's a downward spiral because the worse your status is, the easier it is to become negatively affected by difficult situations.

[THX1138]

Here is pretty good video on magnesium:

http://www.youtube.com/watch?v=GUWL1o2hSrs

I will add that the Dr. says, "... plus B6 and D and Selenium to get the job done...."
One thing about the Vitamin D: Magnesium is used up when Vitamin D is converted from its inactive form to its active form in the body. People have been reporting Mg deficiency symptoms from taking large amounts of Vitamin D (such as is popular today).

THX1138

[Landress]

any stressor including an attack can increase magnesium demand, driving down levels that may already be suboptimal. it's a downward spiral because the worse your status is, the easier it is to become negatively affected by difficult situations.

I have just been through the wringer at the hosp. (I posted on the main forum thread). What is the best magnesium currently suggested? I am using citrate.

Lynne

[jimmylegs]

citrate is decent but if you want to take more and be able to absorb it rather than getting the runs, then go for magnesium glycinate.

also try to increase your dietary magnesium intake to as close to 400mg per day as poss. then another couple hundred from the capsules. this link shows how many mgs of magnesium per serving for various foods, so you can tally up: http://www.whfoods.com/genpage.php?tnam ... #foodchart

also, think about whether you might need to cut back on gluten grains. gluten can interfere with magnesium absorption. (and other nutrients too for that matter)

eating animal protein is supposed to be somewhat protective against the nutrient binding properties of gluten.