Overview of Multiple Sclerosis (MS)

Definition and general symptoms (physical and emotional)

Multiple sclerosis (MS) is a degenerative disease that affects the brain and the spinal cord. It currently has no cure, and the symptoms vary greatly from patient to patient, rarely manifesting all at once. The most common symptoms are:^1,2

• Fatigue
• Clumsiness
• Dizziness
• Muscle stiffness and muscle spasms (tremors)
• Problems with balance and coordination
• Mood changes
• Cognitive function issues (memory, concentration, learning, judgment, and thinking)
• Difficulty controlling the bladder

Emotional challenges associated with MS (e.g., depression, anxiety)

People are greatly affected when they discover they have this illness, and frequently, ignorance can exacerbate symptoms. After being diagnosed, people may experience grief, worry, fear, mood swings, irritability, anxiety and depression.³

Cannabis as a therapeutic option

Brief history and growing interest in cannabis for symptom relief

The properties of cannabis have been known since 2800 BC when the Chinese Emperor Shen Nung included it in his pharmacopoeia. Its use spread from Central Asia and western China to the rest of the world and has been mentioned numerous times in texts from Indian Hindus, Assyrians, Greeks, and Romans. These texts demonstrated the usefulness of cannabis in treating various ailments such as arthritis, depression, amenorrhea, inflammation, pain, lack of appetite, and asthma.⁴

Emotional well-being in MS

Common emotional symptoms

Anxiety and depression

Anxiety occurs in 36% of individuals with MS. Anxiety also increases the likelihood of substance abuse, greater social stress, and reduced societal support, which further contributes to social isolation. 

Depression has a prevalence of 30-40% in MS patients. Although its severity is higher in individuals with brain lesions than in those with spinal cord lesions, the link between depression and MS is more likely due to the unpredictability and uncertain prognosis of the disease. Depression has been observed to be more prevalent in the early stages of multiple sclerosis, most likely as a result of the uncertainty surrounding the diagnosis. A decline in quality of life, worsening of MS symptoms, poor disease management, higher use of medical services, decreased employment, decreased effectiveness of therapies, and an increase in suicidal thoughts and attempts are all implications of depression in MS.⁵

Mood swings and emotional instability

It's possible to experience emotional changes. These frequently show up as abrupt bursts of strong emotions that are greatly exaggerated compared to the stimulus. It's normal to cry when you're joyful, to become upset or even laugh uncontrollably when you hear unpleasant news.⁶

Fatigue and its emotional toll

Fatigue, being a subjective factor, is often difficult to assess and is frequently not given enough importance. Yet it is one of the main contributors to the deterioration of quality of life among people affected by MS. It occurs in approximately 75% of those affected. In many cases, this fatigue prevents individuals from accumulating work hours, impacting their finances and employment opportunities. Additionally, apart from causing tiredness, it can also affect sleep, leading to drowsiness.⁷

Quality of life issues

Social isolation

Social isolation encompasses feelings such as loneliness, helplessness, and social despair, which together lead to reduced social tolerance. The vast majority of people with MS are young adults with much of their lives ahead of them, making the impact of receiving the diagnosis a significant factor in their decision to isolate themselves.⁸

Impact on relationships and mental health

The lack of knowledge, uncertainty, and sometimes fear about how the disease will progress can greatly affect romantic relationships. Added to this are the psychosocial issues mentioned earlier, which reduce the person's quality of life and, consequently, impact their relationships.⁹

Cannabis and its potential effects on MS symptoms

Cannabis components and their effects

THC and CBD: A brief explanation of their roles

THC and CBD have differences in their potential medical applications. THC is often effective in managing pain, alleviating nausea and vomiting, stimulating appetite, and addressing certain mental health conditions. CBD has shown better results in reducing anxiety, depression, and epilepsy, and has shown promise in alleviating inflammation.¹⁰

Cannabis’s role in symptom management

Pain relief and muscle spasticity

Medical marijuana has proven to be highly useful in alleviating muscle spasticity and pain relief. Marijuana interacts with the endocannabinoid system (ECS), which is involved in regulating muscle function and pain perception. Molecules like THC react with the ECS, relaxing muscles and reducing spasticity. On the other hand, CBD reacts in an analgesic manner, relieving pain.¹⁰

Impact on sleep and overall mood

As we mentioned earlier, MS can lead to drowsiness. One of the benefits of cannabis is that CBD promotes improved sleep, which in turn can help improve other MS-related patterns, such as fatigue and overall mood.¹⁰

Mechanisms of Action

Interaction with the endocannabinoid system in mood regulation

The cannabinoid receptors we mentioned earlier are located in a region of the brain known as the limbic system, also referred to as the "emotional brain." These receptors help modulate communication between neurons, facilitating the release of neurotransmitters such as serotonin and dopamine, which are crucial factors in mood regulation.^11,12

Research on cannabis and emotional well-being in MS

Studies showing positive effects

Reduction in anxiety and depressive symptoms

THC can become a highly addictive molecule that could affect the patient's cognitive ability in the long term. However, it has been discovered that CBD and its anxiolytic efficacy do not produce any withdrawal syndrome and are useful for calming anxiety and depression.¹³

Improvements in quality of life

Medical cannabis has been shown to reduce fatigue (Rudroff, 2020), one of the biggest limitations on the quality of life for individuals affected by multiple sclerosis (MS). Other research has also demonstrated that cannabis can be effective for various symptoms such as muscle pain or insomnia.^14,15

Limitations in current research

Despite the promising effects of cannabis in managing multiple sclerosis (MS), there is still some contradiction regarding the effectiveness of cannabinoids in treating the condition. Additionally, certain factors such as dosage, genetics, and the molecular effects of cannabinoids lead to different responses among patients.¹⁶

Potential risks and considerations

Short-term side effects

Cognitive impairment, altered mood states

Psychoactive effects can range from states of euphoria and well-being to feelings of confusion, anxiety, panic attacks, fear, or paranoia.

Physical effects often include: 

• Red eyes
• Increased heart rate
• Low blood pressure
• Dizziness
• There can also be changes in the perception of space and time, along with difficulty in coordination¹⁷

Long-term risks

Using cannabis for a long time can increase the risk of developing anxiety and depression or exacerbating them, as it can affect the system that regulates dopamine in the brain. While it may help alleviate depression as mentioned earlier, using too much for a long period of time can produce dependence and low emotional regulation. Dependence can also develop psychosis and schizophrenia.¹⁸

Interactions with MS Medications

Drug interactions are very complex and difficult to predict. Currently, there are over 100 possible drug interactions for people with multiple sclerosis (MS). However. It has also been found that the following specific drugs interact in this way with cannabis:^13,19

• Increased toxicity when combined with teriflunomide and siponimod
• Increased dysrhythmias when combined with S1P
• Increased toxicity and reduced effectiveness when combined with cladribine

Patient perspectives and case studies

Reported benefits by MS patients

With an efficacy rate of at least 30%, it is indisputable that cannabis has proven to be quite beneficial for neuropathic pain. Improvements have also been observed in muscle cramps, spasticity, and sleep quality.²⁰

Particularly relevant is the experiment conducted by Rice et al. (2020), where up to 85% of participants with MS found cannabis helpful for pain and 79% for spasticity.²¹

Challenges faced by patients

Differences in legal access across countries/states

Each country has its own laws, prohibitions, and penalties regarding cannabis use. Although the great majority of nations now forbid it, many are progressively loosening their laws to differentiate cannabis from other substances deemed more “dangerous”. Furthermore, there is an increasing trend of favourable societal perceptions on the near-term full legalisation of cannabis. However, in many nations, political and religious considerations continue to be significant obstacles to legalisation.²²

Access to cannabis, dosage control, stigma

While cannabis use is increasing, so are reports warning about its side effects and the vulnerability of younger populations to these effects. As a result, there is often a certain stigma, and many doctors or patients are reluctant to use it in their therapies. In a survey by the North American Research Committee on Multiple Sclerosis (NARCOMS) on medical cannabis use (MCU), it was found that 16% of respondents were regular users, 47% had used cannabis for medical purposes, and only 20% had previously discussed it with their doctor.¹⁸

Summary

MS is a degenerative disease that primarily affects the brain and the spinal cord and causes physical and emotional symptoms. Cannabis has gained attention for alleviating MS symptoms

Studies suggest that cannabis may reduce anxiety, depression, and fatigue in MS patients, improving the overall quality of life. This article does, however, also emphasise the need for additional research by pointing out possible hazards including cognitive damage or long-term consequences like dependence

Patient reports suggest some benefits, particularly in managing neuropathic pain, spasticity, and sleep, although individual responses to cannabis vary.