Addressing Mental Health and Invisible Symptoms in MS Care: Constance V. Katsafanas, DO

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"MS affects a lot of women. It affects men too, certainly, and men have their own challenges but women do as well. There are unique issues in women's mental health, in depression, and in high-functioning neurodivergence. Masking is something a lot of women are very practiced at, and it's not good for mental health."

Mental health disorders are common comorbidities in patients with multiple sclerosis (MS), with higher rates of depression, anxiety, and stress compared with the general population. These common comorbidities can contribute to reduced quality of life and increased disease burden. Evidence suggests that psychological factors may interact with disease activity and functional outcomes, underscoring the importance of routine screening and integrated management of mental health in MS care.¹ Additionally, stigma surrounding mental health remains a significant barrier to diagnosis and treatment, further emphasizing the need for proactive, multidisciplinary approaches to support patient well-being.

In addition to psychiatric comorbidities, MS is characterized by a range of “invisible symptoms,” including fatigue, cognitive impairment, and mood disturbances, which may not be readily apparent on physical examination but substantially impact daily functioning. Fatigue alone has previously affected approximately 59% of patients globally and is associated with diminished quality of life and work capacity, whereas cognitive impairment and depression frequently co-occur and contribute to overall disability.^2,3 Recognition and systematic assessment of these nonvisible manifestations could be critical, as they often precede or occur independently of overt neurologic deficits and require targeted management strategies.

In a recent interview, NeurologyLive^® spoke with MS expert Constance V. Katsafanas, DO, the director of the Neurology Residency Program at Marcus Neuroscience Institute, a part of Baptist Health South Florida, who emphasized the importance of integrating mental health care into routine MS management. She highlighted the clinical relevance of identifying and addressing invisible symptoms, which are frequently underrecognized yet substantially affect patient functioning and quality of life. Katsafanas also advocated for a proactive, multifaceted approach to care, including early intervention for radiographic disease activity alongside optimization of modifiable factors to support overall disease management and daily functioning.

REFERENCES
1. Kang W. Understanding the Effect of Multiple Sclerosis on General and Dimensions of Mental Health. J Clin Med. 2022;11(24):7483. Published 2022 Dec 16. doi:10.3390/jcm11247483
2. Yi X, Zhang Y, Du Q, et al. Global prevalence of fatigue in patients with multiple sclerosis: a systematic review and meta-analysis. Front Neurol. 2024;15:1457788. Published 2024 Oct 2. doi:10.3389/fneur.2024.1457788
3. Bogaardt H, Golan D, Barrera MA, et al. Cognitive impairment, fatigue and depression in multiple sclerosis: Is there a difference between benign and non-benign MS?. Mult Scler Relat Disord. 2023;73:104630. doi:10.1016/j.msard.2023.104630