Depression in multiple sclerosis - ScienceDirect

General Hospital Psychiatry

Volume 9, Issue 6, November 1987, Pages 426-434

General Hospital Psychiatry

https://doi.org/10.1016/0163-8343(87)90052-1 Get rights and content

Abstract

Standardized interview techniques, diagnostic criteria, and rating scales were used to assess 50 moderately disabled multiple sclerosis (MS) patients. Fifty-four percent met lifetime Research Diagnostic Criteria for major depression, with a significant increase in the rate from before to after the onset of MS symptoms. The MS patients were significantly more depressed than other medical patients described in the literature. Major depressions were associated with steroid-treated exacerbations and a history of major depression. Symptoms of depression may be easily confused with those of MS, resulting in inadequate diagnosis and treatment.

References (53)

D.A. Lewis et al.
Steroid-induced psychiatric symptoms. A report of 14 cases and a review of the literature
J Affective Disor
(1983)
M.M. Weissman et al.
The chronic depressive in the community: Unrecognized and poorly treated
Compr Psychiatry
(1977)
J.M. Charcot
Lectures on the diseases of the nervous system delivered at la Salpêtrière
M.V. Baldwin
A clinico-experimental investigation into the psychologic aspects of multiple sclerosis
J Nerv Ment Dis
(1952)
N.C. Bourestom et al.
Personality characteristics of three disability groups
Arch Phys Med Rehabil
(Sept 1965)
C.S. Cleeland et al.
MMPI profiles in exacerbation and remission of multiple sclerosis
Psychol Rep
(1970)
F.A. Whitlock et al.
Depression as a major symptom of multiple sclerosis
J Neurol Neurosurg Psychiatry
(1980)
N.P. Dalos et al.
Disease activity and emotional state in multiple sclerosis
Ann Neurol
(1983)
R.B. Schiffer et al.
Depressive episodes in patients with multiple sclerosis
Am J Psychiatry
(1983)
D Surridge
An investigation into some psychiatric aspects of multiple sclerosis
Br J Psychiatry
(1969)

P.V. Rabins et al.

Structural brain correlates of emotional disorder in multiple sclerosis

Brain

(1986)

S.S. Cottrell et al.

The affective symptomatology of disseminated sclerosis

J Neurol Psychopathology

(1926)

A Sai-Halasz

Psychic alterations in disseminated sclerosis. A general, statistical and Rorschach-test study on 200 patients

Mschr Psychiatry Neurol

(1956)

K.L. Jambor

Cognitive functioning in multiple sclerosis

Br J Psychiatry

(1969)

G.P. McIvor et al.

Depression in multiple sclerosis as a function of length and severity of illness, age, remissions, and perceived social support

J. Clin Psychol

(1984)

J.M. Peyser et al.

Cognitive function in patients with multiple sclerosis

Arch Neurol

(1980)

S.M. Rao et al.

Memory disturbance in chronic progressive multiple sclerosis

Arch Neurol

(1984)

L.M. Vowels et al.

Neuropsychological findings

J Endicott et al.

A diagnostic interview: The schedule for affective disorders and schizophrenia

Arch Gen Psychiatry

(1978)

J Endicott et al.

N Andreasen et al.

Family history method using diagnostic criteria

Arch Gen Psychiatry

(1977)

R.L. Spitzer et al.

Research diagnostic criteria: Rationale and reliability

Arch Gen Psychiatry

(1978)

J Endicott et al.

Use of the research diagnostic criteria and the schedule for affective disorders and schizophrenia to study affective disorders

Am J Psychiatry

(1979)

J Endicott et al.

Hamilton depression rating scale extracted from regular and change versions of the schedule for affective disorders and schizophrenia

Arch Gen Psychiatry

(1981)

G Rodin et al.

Depression in the medically ill: an overview

Am J Psychiatry

(1986)

A.T. Beck et al.

An inventory for measuring depression

Arch Gen Psychiatry

(1961)

Cited by (287)

Improving the detection and treatment of depression in Australians with multiple sclerosis: A qualitative analysis
2021, Multiple Sclerosis and Related Disorders
Depression is common in people with multiple sclerosis (MS), yet often goes undetected, untreated or undertreated.
This qualitative research explored current practices, barriers and facilitators for detection and treatment of depression in Australians with MS.
Participants were 26 people with MS recruited through social media. Participants completed the Centre for Epidemiological Studies Depression-Revised (CESD-R) scale and in-depth telephone or video interviews. Interviews were analysed using framework analysis.
Scores measured on the CESD-R proposed 73% of participants were experiencing severe depression symptoms. Participants reported that depression is not regularly and formally assessed through MS healthcare services and they are offered limited information about depression in MS. Barriers to mental health support included recognition of depression, resistance to treatment and limitations of collaborative support between general practitioners and MS healthcare services. Participants expressed a need for open conversations and information about depression during neurology consultations.
Based on our findings, improved detection and treatment of depression in people with MS requires: 1) better provision of information about depression for people with MS through healthcare services and community organisations; 2) regular screening and assessment; 3) better healthcare services collaboration to improve management.
Major depressive disorder subtypes and depression symptoms in multiple sclerosis: What is different compared to the general population?
2021, Journal of Psychosomatic Research
To compare and characterize major depressive disorder (MDD) subtypes (i.e., pure atypical, pure melancholic and mixed atypical-melancholic) and depression symptoms in persons with multiple sclerosis (PwMS) with persons without MS (Pw/oMS) fulfilling the DSM-5 criteria for a past 12-month MDD.
MDD in PwMS (n = 92) from the Swiss Multiple Sclerosis Registry was compared with Pw/oMS (n = 277) from a Swiss community-based study. Epidemiological MDD diagnoses were based on the Mini-SPIKE (shortened form of the Structured Psychopathological Interview and Rating of the Social Consequences for Epidemiology). Logistic and multinomial regression analyses (adjusted for sex, age, civil status, depression and severity) were computed for comparisons and characterization. Latent class analysis (LCA) was conducted to empirically identify depression subtypes in PwMS.
PwMS had a higher risk for the mixed atypical-melancholic MDD subtype (OR = 2.22, 95% CI = 1.03–4.80) compared to Pw/oMS. MDD in PwMS was specifically characterized by a higher risk of the two somatic atypical depression symptoms ‘weight gain’ (OR = 6.91, 95% CI = 2.20–21.70) and ‘leaden paralysis’ (OR = 3.03, 95% CI = 1.35–6.82) and the symptom ‘irritable/angry’ (OR = 3.18, 95% CI = 1.08–9.39).
MDD in PwMS was characterized by a higher risk for specific somatic atypical depression symptoms and the mixed atypical-melancholic MDD subtype. The pure atypical MDD subtype, however, did not differentiate between PwMS and Pw/oMS. Given the high phenomenological overlap with MS symptoms, the mixed atypical-melancholic MDD subtype represents a particular diagnostic challenge.
Chronic fatigue and depression due to multiple sclerosis: Immune-inflammatory pathways, tryptophan catabolites and the gut-brain axis as possible shared pathways
2020, Multiple Sclerosis and Related Disorders
Chronic fatigue and major depression (MDD)-like symptoms are common manifestations of multiple sclerosis (MS), both with huge impact on quality of life. Depression can manifest itself as fatigue, and depressive symptoms are often mistaken for fatigue, and vice versa. The two conditions are sometimes difficult to differentiate, and their relationship is unclear. Whether chronic fatigue and depression occur primarily, secondarily or coincidentally with activated immune-inflammatory pathways in MS is still under debate. We have carried out a descriptive review aiming to gain a deeper understanding of the relationship between chronic fatigue and depression in MS, and the shared pathways that underpin both conditions. This review focuses on immune-inflammatory pathways, the kynurenine pathway and the gut-brain axis. It seems likely that proinflammatory cytokines, tryptophan catabolites (the KYN pathway) and the gut-brain axis are involved in the mechanisms causing chronic fatigue and MDD-like symptoms in MS. However, the evidence base is weak, and more research is needed. In order to advance our understanding of the underlying pathological mechanisms, MS-related fatigue and depression should be examined using a longitudinal design and both immune-inflammatory and KYN pathway biomarkers should be measured, relevant clinical characteristics judiciously registered, and self-report instruments for both fatigue and depression should be used.
Psychopharmacology of multiple sclerosis
2019, Handbook of Clinical Neurology
Citation Excerpt :
Depression itself may involve increased levels of inflammation (Miller and Raison, 2016), and inflammation occurs in many disorders other than MS. The occurrence of inflammatory changes, such as hippocampal microglial activation, in MS has been interpreted as a justification for using standard treatments rather than adopting a unique approach specifically in people with MS (Manning, 2016). The need to consider antidepressant medications in people with MS when they become seriously depressed, as in almost all situations in which people become depressed, is a clinical reality and important since the prevalence of major depression in MS is 2–3 times higher than that of the general population (Joffe et al., 1987; Minden et al., 1987; Sadovnick et al., 1996; Patten et al., 2003). These studies place the lifetime prevalence at approximately 50% and the annual prevalence at about 15% (Patten et al., 2017).
A variety of neuropsychiatric problems can occur in people with multiple sclerosis (MS) and these are often among the most important determinants of their quality of life. Taken together, a high prevalence of depression, anxiety, fatigue, and cognitive problems means that most people with MS end up struggling with one or more of these neuropsychiatric difficulties. Although these problems manifest across a broad range of severity, this is often a burdensome struggle. Pharmacologic treatments are an important domain of therapeutic intervention. Unfortunately, the use of these medications is supported by a very limited literature. Clinicians often must make clinical decisions about the use of psychopharmacologic treatments in the absence of guidance from high quality evidence. This requires synthesizing clinical information about MS with more general principles of psychiatric and psychopharmacologic care. This chapter provides such a synthesis of available evidence as it pertains to the most important neuropsychiatric syndromes in MS. The goal is to help facilitate effective psychopharmacologic treatment, which, in turn, can translate into better quality of life for people with MS.
Depression is a predictor for balance in people with multiple sclerosis
2018, Multiple Sclerosis and Related Disorders
Citation Excerpt :
Recently, researchers have attempted to investigate factors that affect balance skills and may consequently contribute to the effectiveness of rehabilitation outcomes and reduction of risk of falling. However, balance is multifactorial and several interacting factors such as cognitive impairments (Sandroff et al., 2015a, 2015b) and fatigue (Van Emmerik et al., 2010; Wolkorte et al., 2015) are found to be associated with impaired balance in people with MS. Despite the fact that depression is the most common psychological impairment in patients with MS (LaRocca et al., 1987) and found to present in 54% of this population (Minden et al., 1987), research on the relationship between balance and depression specifically in patients with MS is deeply lacking. In a study of geriatric population, authors found a significant correlation between depression (examined using the Geriatric Depression Scale) and balance skills utilizing the Berg Balance Scale and the Get Up and Go Test (Kose et al., 2005).
Balance impairments are common and multifactorial among people with multiple sclerosis (MS). Depression is the most common psychological disorder in MS population and is strongly correlated with MS disease. Depression might be one of the factors that contribute to balance deficits in this population. However, the relationship between depression and balance impairments has not been explored in people with MS.
To investigate the association between depression and balance impairments in people with MS.
Cross sectional design was used in patients with MS. The Activities-specific Balance Confidence scale (ABC) and Berg Balance Scale (BBS) was used to assess balance. Beck Depression Inventory (BDI-II) was used to quantify depression and Kurtizki Expanded Disability Status Scale (EDSS) was utilized for the evaluation of MS disability severity. Pearson correlation coefficient was used to examine the association between depression and balance measurements. Multiple linear stepwise regressions were also conducted to find out if depression is a potential predictor for balance deficits.
Seventy-five individuals with MS (Female = 69%) with a mean age (SD) of 38.8 (10) and a mean (SD) EDSS score of 3.0 (1.4) were recruited in this study. Depression was present in 53% of the patients. Depression was significantly correlated with balance measurements and EDSS. However, multiple linear stepwise regressions found that only depression and age significantly predict balance.
Depression and balance were found frequent and associated in people with MS. Importantly depression was a significant predictor for balance impairments in individuals with MS. Balance rehabilitation may be hindered by depression. Therefore, depression should be evaluated and treated properly in individuals with MS.
Contrasting relationship between depression, quantitative gait characteristics and self-report walking difficulties in people with multiple sclerosis
2018, Multiple Sclerosis and Related Disorders
The purpose of this study was to examine the relationship between depression and walking in the multiple sclerosis (MS) community. This study included 132 people with MS (PwMS) (80 women), mean EDSS 2.9 (S.D. = 1.7). Depression was assessed by the Hospital Anxiety and Depression Scale questionnaire. Spatio-temporal parameters of gait were studied using an electronic walkway. Participants filled out a valid self-rated measure of walking ability, the Multiple Sclerosis Walking Scale (MSWS-12) questionnaire. Computerized cognitive scores were included in the analysis in a multivariable analysis. Forty PwMS (30.3%) were classified as suffering from depression. Individuals in the depressed group walked slower than those in the non-depressed group; 92.2 (S.D. = 30.5) vs. 107.9 (S.D. = 29.4) cm/s, respectively. However, after controlling for age, gender and EDSS, the difference between the groups was considered non-significant; p = 0.986. As for the MSWS-12 self-report questionnaire, regardless of the controlling factors (age, gender, EDSS), scores for participants in the depressed group were significantly elevated, indicating poor walking abilities, compared to scores in the non-depressed group; 40.8 (S.D. = 15.9) vs. 26.6 (S.D. = 13.7); p = 0.002, respectively. Furthermore, according to the linear regression model, by utilizing the self-rated measure of walking ability, we were able to explain ~20% of the variance related to depression, while spatio-temporal parameters of gait were excluded from the model. In PwMS, depressive symptoms are related to self-perception of walking, but not to quantitative gait parameters.

View all citing articles on Scopus

^☆: The study was supported in part by NIMH grant MH15531, the Ethel Dupont-Warren Fellowship, the Bretholtz Multiple Sclerosis Fund, the Peter B. Livingston Fellowship Fund, the Milton Fund, NIH grant RR05489 awarded to the Brigham and Women's Hospital, and the G. Gorham Peters Trust.

Copyright © 1987 Published by Elsevier Inc.

Determinants and incidence of depression in multiple sclerosis: A prospective cohort study
Journal of Psychosomatic Research, Volume 99, 2017, pp. 169-176
S.A. Berzins, …, S.B. Patten
Depression and fatigue in patients with multiple sclerosis
Journal of the Neurological Sciences, Volume 380, 2017, pp. 236-241
Emily E. Greeke, …, Bonnie I. Glanz
Systematic review of depression in patients with multiple sclerosis and its relationship to interferonβ treatment
Multiple Sclerosis and Related Disorders, Volume 17, 2017, pp. 138-143
Leila Alba Palé, …, Víctor Pérez Solà
The prevalence of anxiety and associated factors in persons with multiple sclerosis
Multiple Sclerosis and Related Disorders, Volume 19, 2018, pp. 35-39
Tram Pham, …, Scott B. Patten
Anxiety and depression in patients with multiple sclerosis: The mediating effects of perceived social support
Multiple Sclerosis and Related Disorders, Volume 27, 2019, pp. 46-51
Audrey Henry, …, Michèle Montreuil
Improving the detection and treatment of depression in Australians with multiple sclerosis: A qualitative analysis
Multiple Sclerosis and Related Disorders, Volume 56, 2021, Article 103290
Assunta Hunter, …, Lisa B. Grech