Depression was common in people with multiple sclerosis (MS) and was equally prevalent in patients with relapsing-remitting and progressive forms of the disease, a cross-sectional study showed.
No evidence of group differences between people with progressive MS and relapsing-remitting MS emerged in either depressive symptom severity or suicidal ideation, contrary to the study’s hypothesis, reported Lindsey Knowles, PhD, of the University of Washington and the VA Puget Sound Healthcare System in Seattle, at MS Virtual 2020, the joint ACTRIMS-ECTRIMS meeting.
This research is one of the first to look at depressive symptoms and suicidal ideation in progressive MS, Knowles said. The rehabilitation needs of persons with progressive MS are poorly understood, she pointed out. “Depression is one of the most common and impactful symptoms experienced by people with MS,” she told MedPage Today.
“Multiple sclerosis can cause depression through direct impact of lesions on the brain and immune system alterations, such as changes in cytokine levels,” noted Barry Singer MD, of the MS Center for Innovations in Care and the Missouri Baptist Medical Center in St. Louis, who wasn’t involved with the study.
“The psychological impact of living with MS, such as being newly diagnosed or struggling with disability, can trigger depression as well,” Singer told MedPage Today.
In this analysis, Knowles and colleagues evaluated a subset of data about MS participants from a survey about quality of life in people with disabilities. They studied 573 MS patients: 142 with progressive MS and 431 with relapsing-remitting disease.
Depressive symptoms and suicidal ideation were assessed by the Patient Health Questionnaire-9 (PHQ-9), which scores each of nine DSM-IV depression criteria as “0” (not at all) to “3” (nearly every day) over the past 2 weeks. PHQ-9 scores of 5, 10, 15, and 20 represent mild, moderate, moderately severe, and severe depression, respectively.
The progressive MS group was 73% female, had an average age of 59 and average MS disease duration of about 16 years. The relapsing-remitting group was 85% female with an average age of 53 and disease duration of 15 years. In both groups, 94% of participants were white.
On average, people with progressive MS reported mild depressive symptoms (mean PHQ-9 score 7.31 ± 5.87), as did people with relapsing-remitting MS (mean PHQ-9 score 7.10 ± 5.26). More than a quarter in each group — 28% of progressive and 26% of relapsing-remitting patients — reported moderate-to-severe depressive symptoms.
In both groups, about 10% of patients said that, in the past 2 weeks, they had thought they would be better off dead or of hurting themselves in some way.
Factors associated with greater depressive symptom severity were younger age, greater disability, greater speech and swallowing problems, and lower household income. Factors associated with greater suicidal ideation risk were shorter disease duration, greater disability, and greater speech and swallowing problems.
For progressive MS patients, shorter disease duration and being non-white were associated with greater depressive symptom severity, while being employed was associated with greater suicidal ideation risk.
“Consistent with current treatment guidelines for MS care, these findings highlight the importance of screening for and treating depression in all persons with MS,” Knowles said.
“People with progressive MS should be offered evidence-based depression interventions tested in the general MS population such as cognitive behavioral therapy and physical activity, which have been shown to reduce depression and improve fatigue, pain, and quality of life in persons with MS,” she noted. “Antidepressants have also been shown to provide benefits, though there is less research compared to nonpharmaceutical interventions,” she added.
Neurologists should ask routinely about anxiety and depression symptoms with an empathetic, nonjudgmental approach at office visits, Singer said.
“Patients should be advised to reach out if any changes in mood,” he added. “Connecting patients with therapists and psychiatrists with MS experience is key. Neurologists are usually able to manage mild or moderate depression and generally comfortable prescribing antidepressant medications when needed.”
Last Updated September 14, 2020
The project was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research and the National Multiple Sclerosis Society.
The researchers disclosed no relevant relationships with industry.