I was diagnosed with anxiety just over a year after I was diagnosed with multiple sclerosis. Moments of panic and worry had punctuated my life and overwhelmed my brain for years, long before I learned about the degenerative disease preying on my central nervous system. But the official MS diagnosis, and everything that changed because of it, acted like a megaphone for my existing anxiety.
Now I juggle treatment for two chronic illnesses that are sometimes at cross purposes. When one of them flares up, the other one will almost certainly react, but not always in the same way. Living with dueling conditions is like playing a board game with the wrong pieces: It’s definitely not the game you’re used to, and you aren’t sure if there’s even a way to win. That’s not to say that managing anxiety on top of another chronic illness is impossible — just that it’s a frustrating, often time-consuming challenge to master.
It’s not uncommon to wrestle with mental and physiological health issues at the same time, says psychotherapist and counselor Olivia Djouadi. “The balance of them can be quite difficult, as they do affect each other,” she said. “When people first start seeing me, their anxiety or depression can be quite strong, which makes everything else much harder, and their medical conditions can feel like they are unmanageable.”
Management is exactly the skill patients need to master, or at least tackle. “Seeing a counselor or therapist can lessen both conditions, but not cure them,” Djouadi said. “Sometimes people can see doctors or therapists almost as magicians. They’re not, but both will work to do the best for people so they are functioning better in their own lives.”
Figuring out that balance can be as much of a challenge as reaching an initial diagnosis. Beth, 44, was also diagnosed with anxiety following her diagnosis with relapsing remitting multiple sclerosis, around six years ago. “I realize now that I probably had anxiety for a long time before I was diagnosed with MS,” she said, “but being diagnosed with a chronic illness just ramped up the level of anxiety I felt.” Her MS diagnosis “took away all sense of control I had in my life.”
Because MS, like many chronic illnesses, is negatively affected by stress, Beth found that her anxiety had a major impact on her body: “The constant high level of vigilance about the smallest things meant I was really unkind to myself. I used energy I didn’t have worrying about what others thought about me, and whether I was going to wake up blind, or unable to walk, each morning.”
The two conditions are inextricably linked, and Beth can’t untie them. “I get particularly anxious about any worsening I perceive in my MS symptoms,” she said. “If I don’t look after myself, in terms of getting enough sleep, eating right and exercising, my anxiety levels spike.” Beth’s treatment course for anxiety includes cognitive behavioral therapy and mindfulness, alongside medication. She also relies on a disease-modifying treatment to manage her multiple sclerosis. Beth has the same resolute attitude toward both conditions: “Like MS, anxiety is a war I’m determined to win.”
By some estimates, up to one-third of the population has more than one chronic illness, a term for any long-term diagnosed condition, mental or physical, that requires ongoing treatment. Typically, chronic illnesses are incurable but manageable. Symptoms can be present consistently or flare up periodically. While some chronic illnesses have outward symptoms, many are invisible — anxiety among them.
Lucy, 19, was recently diagnosed with anxiety, but says she’s lived with it for about five years. “I have had chronic recurrent multifocal osteomyelitis since age 8, which causes lesions and inflammation of my bones in my lower back, tailbone, hips, and now my thighs,” she said. Lucy often feels uncomfortable in public settings, which is common among those with chronic illnesses. “My anxiety spirals from so many places,” she said, “but I definitely feels that my CRMO has a major impact due to the way I walk. And it’s a hidden illness, so if I’m sat down on a subway due to pain, I feel a lot of judgement from those standing, as no one can really see what’s wrong.”
Lucy says she’s often overwhelmed in her daily life, sometimes due to anxiety, other times due to the people around her. “Because anxiety and CRMO are hidden illnesses, no one seems to care,” she said. “As soon as someone sees you smile once, they think you’re fixed.”
Living with chronic illness can trigger all kinds of anxious or depressive spirals. Sometimes treating anxiety can even interfere with treating chronic illness. Writer and editor Amy Roberts, 32, has asthma (“but thankfully not what I’d consider to be a chronic case of it”), and as a result, doesn’t currently take any medication for her anxiety. “Doctors have told me the available options could worsen my migraines or affect my asthma medication,” she said. Living with both conditions is a complicated balancing act — you’re constantly deciding which illness to medicate, and when.
She also feels that the two conditions are inextricably linked and that their symptoms play off one another. “Anxiety is definitely linked in some way to my asthma, as shortness of breath can trigger anxiety, and vice versa,” she said. Some factors worsen her anxiety, such as alcohol, which Roberts calls “a major trigger.” She also feels her menstrual cycle is tied to her mental health: “I get bad anxiety in the week leading up to my period, and apocalyptic anxiety during my period.”
Treatments for the two conditions aren’t always at odds, though. Beth, for instance, takes medication for neuropathic pain, a common MS symptom in which damaged nerves cause bodily tingling, itching and stabbing pains. She takes two different types of prescription medication for the issue, Amitriptyline and Lyrica. Both drugs are thought to have anxiety-reducing effects.
Not every strategy for juggling treatment needs is chemical; some accommodations are actually social. All it takes is a patient-first outlook from the medical provider. The fixes don’t have to be complicated either. “To make things a bit easier, I do see clients online, because I know anxiety, MS and other conditions can make traveling harder,” said Djouadi. “I see people from the comfort of their own home.”
My anxiety almost certainly predates my MS diagnosis. But it didn’t become necessary to medicate my mental health condition until MS changed my body, and my life, drastically. Medication isn’t the answer for everyone — clinicians have an assortment of tools for anxiety, from medication to talk therapy to meditation and lifestyle modifications. What’s important is that patients dealing with anxiety on top of another chronic illness feel heard, even if neither condition can be seen.