Fast Five Quiz: Multiple Sclerosis and Depression

Medscape

a day ago

Depression is among the most common comorbidities of multiple sclerosis (MS), leading to psychological quality-of-life issues that can further exacerbate a patient's functional capacity. The significant burden of depression in patients with MS is typically associated with neuroinflammatory processes which are directly correlated to depression severity. Understanding the relationship between depression and MS is crucial for healthcare providers, to develop effective treatment strategies that address both the neurologic and psychological aspects of the disease.
What do you know about the interplay of MS and depression? Check your knowledge with this quick quiz.
The prevalence of depression in the general population is approximately 13%, according to the Centers for Disease Control and Prevention (CDC). Other data indicate that it falls between 25% and 54% in patients with MS. Depression, along with other disorders such as anxiety and fatigue, are among the most common comorbidities of MS. These comorbidities further degrade quality of life in patients who are already affected by the functional disabilities caused by the diseases. A multidisciplinary approach can help to holistically manage MS to ensure that quality of life is optimized across specific healthcare needs.
Learn more about guidelines for MS.
A recent systematic review reported that depression symptoms do not significantly improve after smoking cessation in patients with MS, although these patients do see improvements in anxiety. The same review noted that depression is associated with a 1.3- to 2.3-fold increased prevalence in patients with MS who also smoke tobacco. Although smoking cessation is known to cause short-term mood changes, a recent cross-sectional analysis of the NHANES study found that longer duration of cessation is associated with lower risk for depression. However, the persistence of depression in former smokers with MS might be due to depression's strong association with MS, and clinicians should not assume that depression symptoms will improve when a patient quits smoking.
Learn more about tobacco product use and depression.
Though depression and anxiety can occur in any subtype of MS, an extensive review and meta-analysis found that both were more prevalent in progressive MS (defined by the researchers as PPMS and SPMS) compared with RRMS. In contrast, the same meta-analysis reported that patients with MS and an Expanded Disability Status Scale (EDSS) score of less than 3 had higher rates of depression compared with patients with an EDSS score of greater than 3, while the prevalence of anxiety was higher in patients with an EDSS score greater than 3 compared with an EDSS score below 3.
Proinflammatory cytokines in MS have been shown to disrupt the monoaminergic system, which is a component of the pathogenesis of depression. As such, treatments that enhance monoamine neurotransmission (such as SSRIs, SNRIs, and dopaminergic psychostimulants) are indicated for use in depression and MS-associated depression.
Learn more about the pathophysiology of MS.
Although comorbid depression in MS often presents similarly to fatigue, several characteristics can help clinicians distinguish between the two and guide appropriate treatment. According to a recent review, patients with depression typically have better functioning in the evening while those with fatigue typically have better functioning in the morning. Other characteristics of depression tend to include hypersomnia and hopelessness; patients with fatigue usually experience insomnia and strong hopefulness for recovery.
Learn more about symptom management of depression and fatigue in MS.
According to a systematic review and meta-analysis assessing exercise best practices for depression in MS, programs implementing ergometer training protocols had the largest effect size. The data reviewed indicated immediate improvements in depression scores with exercise, and depression symptoms were found to improve regardless of exercise frequency, duration, or activity. This is consistent with another review that cited a range of nonpharmacologic interventions for improving depression in MS, including exercise as well as cognitive-behavioral therapy, yoga, dietary habits, and sleep hygiene.
Further, data on Hatha yoga, circuit training at moderate intensity, and resistance training with active rest periods in patients with MS and depression are limited.
Learn more about exercise for depression.
Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.