Increased exposure to sunlight may help alleviate the depression and fatigue associated with multiple sclerosis (MS), and may even reduce the overall level of disability caused by the disease, research suggests.

Prior research has linked both vitamin D deficiency and lower levels of unprotected sun exposure to a higher risk of developing MS. Likewise, other studies have linked lower vitamin D levels to higher rates of depression. Because depression, along with anxiety, fatigue and cognitive impairment, are common and potentially disabling symptoms of MS, researchers from Maastricht University Medical Center in the Netherlands recently conducted a study to examine the relationship between these separate factors. The study was recently published in the journal Acta Neurologica Scandinavica.

The researchers followed 198 MS patients for an average of 2.3 years. Twice per year, participants reported on their levels of sun exposure, and researchers measured participants' vitamin D blood levels and evaluated the participants for depression, anxiety and fatigue. Once a year, participants were evaluated for cognitive impairment.

The researchers found that higher levels of sun exposure were significantly associated with lower levels of depression and fatigue. Notably, while they also found an association between higher vitamin D levels and lower depression and fatigue levels, this association disappeared after adjusting for the influence of sunlight. Thus the researchers concluded that it is exposure to sunlight and not vitamin D levels that lead to improvement in symptoms of depression and fatigue among MS patients.

Because the vitamin D levels found in the study were all relatively low, however, the researchers did not rule out the fact that higher levels might lead to further improvements in depression and fatigue.

No association was found between sun exposure or vitamin D levels and levels of anxiety or cognitive impairment.

Sunlight improves more than mood

Another recent study suggests that for some MS patients, exposure to sunlight may also reduce their risk of disability. The study was based on a survey given to 1,372 people registered with the Flemish MS Society in Belgium. Participants reported their sun exposure, skin type and disability-related MS symptoms. Researchers assigned each participant a score on the Expanded Disability Status Scale, with a score of 6.0 or higher indicating disability. A score of 6.0 indicates an inability to walk without at least some assistance.

The researchers found that among people with relapsing-remitting MS (RRMS), those who "always" wore sunscreen were 1.8 times more likely to suffer from disability then those who "sometimes" or "never" wore sunscreen. Similarly, RRMS patients whose sun exposure was equal to or greater than that of the non-MS population were 30 percent less likely to suffer from disability.

The researchers also found that among respondents with primary progressive MS (PPMS), those who reported "sun sensitivity" from birth were 1.8 times more likely to suffer from disability than those who had not had lifelong sensitivity. Sun sensitivity was defined as being able to spend only 30 minutes or less in the sun without burning.

Of course, such research does not prove that exposure to sunlight is a direct cause of less MS-related disability, or that such exposure would equally benefit all MS patients. However, given the widespread prevalence of vitamin D deficiency and insufficiency, increasing numbers of doctors are now recommending that people try to increase the amount of time that they spend exposing their unprotected skin to sunlight. For light skinned people, a minimum of 15 to 30 minutes per day of sun on the face and hands are recommended, while people with darker skin may need significantly more exposure.

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