This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Feinstein, A. Search for Related Content PubMed PubMed Citation Articles by Feinstein, A. Social Bookmarking                         What's this?

Multiple sclerosis, disease modifying treatments and depression: a critical methodological review

Sunnybrook and Women's College Health Science Centre, Department of Psychiatry, Room FG38, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5

Background: Major depression affects one in two patients with multiple sclerosis (MS) during the course of their lifetime. This adds to the morbidity associated with the disorder and may contribute to an increased mortality rate because of suicide. Over the past few years, with the advent of disease modifying treatments for MS, a new concern with respect to mood has arisen, namely the possibility that some of these drugs may have depression as a clinically significant side effect. Objective: To ascertain whether disease modifying treatments in MS are associated with the development of depression or the worsening of a depressive illness. Methodology: A MEDLINE and PSYCHLIT search focusing on depression and disease modifying treatments going back to 1993 (the publication date of the results of the first randomised, placebo controlled trial). The methodology pertaining to the assessment of depression is critically reviewed. Furthermore, a critical summary is provided of treatment modalities for the depressed MS patient. Results: There are conflicting data that depression may occur with some disease modifying drugs, particularly interferon beta-1b. However, all studies reveal limitations with respect to the assessment of mood. Some reports, despite omitting details of how mentation was assessed, still comment on the presence or absence of depression. Others suffer from one or more of the following shortcomings: a failure to assess premorbid risk factors for mood disorder; a reliance on one question to assess depression; the utilisation of self report mood rating scales of questionable validity; neglecting to distinguish depression as a symptom from depression as a syndrome (i.e. major depression as defined by the DMS-1V). Conclusions: Given the many methodological pitfalls inherent in all studies to date, it is premature to conclude that disease modifying drugs are associated with depression. Evidence suggests that treatment of depression, irrespective of a putative association with a disease modifying agent, is frequently effective. This applies to pharmacotherapy or psychotherapy, although the former may be preferred should depression arise during a course of treatment with a disease modifying agent.

Key Words: multiple sclerosis • depression • disease modifying treatment • research methodology

Multiple Sclerosis, Vol. 6, No. 5, 343-348 (2000)
DOI: 10.1177/135245850000600509


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S Minden, D Hoaglin, S Jureidini, L Hadden, D Frankel, Y Komatsuzaki, and J Outley Disease-modifying agents in the Sonya Slifka Longitudinal Multiple Sclerosis Study Multiple Sclerosis, June 1, 2008; 14(5): 640 - 655. [Abstract] [PDF]

				Goldman Consensus Group The Goldman Consensus statement on depression in multiple sclerosis Multiple Sclerosis, June 1, 2005; 11(3): 328 - 337. [Abstract] [PDF]

				R J Siegert and D A Abernethy Depression in multiple sclerosis: a review J. Neurol. Neurosurg. Psychiatry, April 1, 2005; 76(4): 469 - 475. [Abstract] [Full Text] [PDF]

				A. Feinstein, P. Roy, N. Lobaugh, K. Feinstein, P. O'Connor, and S. Black Structural brain abnormalities in multiple sclerosis patients with major depression Neurology, February 24, 2004; 62(4): 586 - 590. [Abstract] [Full Text] [PDF]

				H. Zephir, J. De Seze, T. Stojkovic, B. Delisse, D. Ferriby, M. Cabaret, and P. Vermersch Multiple sclerosis and depression: influence of interferon b therapy Multiple Sclerosis, June 1, 2003; 9(3): 284 - 288. [Abstract] [PDF]

				J. R Avasarala, A. H Cross, and K. Trinkaus Comparative assessment of Yale Single Q uestion and Beck Depression Inventory Scale in screening for depression in multiple sclerosis Multiple Sclerosis, June 1, 2003; 9(3): 307 - 310. [Abstract] [PDF]

				M P Amato, G Ponziani, F Rossi, C L Liedl, C Stefanile, and L Rossi Quality of life in multiple sclerosis: the impact of depression, fatigue and disability Multiple Sclerosis, October 1, 2001; 7(5): 340 - 344. [Abstract] [PDF]