MOGAD, MS & NMOSD: Psychiatric Risks & Timing Patterns

The landscape of neuroinflammatory disease management is becoming increasingly nuanced, as new research highlights the distinct psychiatric profiles associated with MOGAD, RRMS, and NMOSD. A recent cross-sectional study, presented at the 2026 ACTRIMS Forum, reveals not only a high prevalence of psychiatric comorbidities across these conditions, but also critical differences in *when* these symptoms emerge relative to neurological onset – a distinction with significant implications for early diagnosis and intervention. This isn’t simply about acknowledging mental health alongside neurological illness; it’s about recognizing that the timing of psychiatric symptoms may be a diagnostic clue, and potentially even a precursor, to neurological disease in some patients.

For years, the connection between multiple sclerosis and psychiatric disorders has been recognized. Research has shown that depression and anxiety can precede the clinical manifestation of MS, suggesting a potential role for neuroinflammation in mood regulation. However, MOGAD, a more recently defined entity, has remained comparatively understudied in this regard. This new study, led by Moritz Niederschweiberer, MD, at the Mayo Clinic, begins to fill that gap, revealing a potentially different trajectory for psychiatric symptoms in MOGAD patients. The finding that psychiatric symptoms are more likely to emerge *after* neurological onset in MOGAD suggests a reactive, rather than proactive, relationship – potentially linked to the psychological impact of a new, often debilitating, neurological diagnosis.

The study’s findings, based on a review of electronic medical records from 257 MOGAD patients, 257 RRMS patients, and 58 NMOSD patients, underscore the importance of comprehensive psychiatric screening for individuals presenting with demyelinating diseases. The relatively small sample size of the NMOSD cohort warrants further investigation, particularly given the observed higher incidence of insomnia in this group. The consistent finding of anxiety across all three conditions reinforces the need for routine anxiety screening and support services for these patients.

The Forward Look

This research is likely to spur a shift in clinical practice, prompting neurologists to incorporate more proactive psychiatric assessments into the diagnostic workup for demyelinating diseases. The temporal distinction between RRMS and MOGAD – psychiatric symptoms *before* vs. *after* neurological onset – could become a valuable diagnostic marker, aiding in more accurate and timely diagnoses. Furthermore, the findings highlight the need for tailored mental health interventions. For RRMS patients, early intervention targeting pre-existing psychiatric symptoms may potentially mitigate disease progression or improve quality of life. For MOGAD patients, interventions may need to focus on coping with the psychological impact of a new neurological diagnosis and managing symptoms as they arise. Expect to see increased research focused on the underlying neurobiological mechanisms linking neuroinflammation and psychiatric comorbidities, potentially leading to novel therapeutic targets. The next phase will likely involve longitudinal studies to confirm these findings and explore the potential for predictive biomarkers.

REFERENCES
1. Niederschweiberer M, Bakir C, Vorasoot N, et al. Depression and Anxiety Precede Neurological Onset in RRMS but Follow Onset in MOGAD – a cross-sectional comparison study. Presented at ACTRIMS Forum 2026; February 5-7; San Diego, California. P346.
2. Chertcoff AS, Yusuf FLA, Zhu F, et al. Psychiatric Comorbidity During the Prodromal Period in Patients With Multiple Sclerosis. Neurology. 2023;101(20):e2026-e2034. doi:10.1212/WNL.0000000000207843
3. Sechi E, Cacciaguerra L, Chen JJ, et al. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A Review of Clinical and MRI Features, Diagnosis, and Management. Front Neurol. 2022;13:885218. Published 2022 Jun 17. doi:10.3389/fneur.2022.885218
4. Tan YY, Saffari SE, Tye JSN, et al. The burden of psychiatric morbidity in Multiple Sclerosis, AQP4-antibody NMOSD and MOGAD before and after neurological diagnosis. Mult Scler Relat Disord. 2024;89:105775. doi:10.1016/j.msard.2024.105775