Current perspectives on co-morbid depression and multiple sclerosis

ABSTRACT

Introduction

Depression is a common comorbidity in multiple sclerosis. Depression in MS often requires treatment due to its negative impact on quality of life, functioning, and MS outcomes. However, there have been very few randomized controlled trials of treatment of depression in MS. Most reviews of this topic have consequently presented a predominantly negative assessment of antidepressant treatment, concluding, for example, that there is insufficient evidence to guide treatment or that evidence only exists for a few uncommon antidepressant medications or forms of treatment.

Areas covered

This review will provide a summary of currently available literature on depression in MS, with an emphasis on the clinical utility of available information. This includes information from published therapeutic trials, but also how general aspects and principles of depression treatment can guide neurotherapeutics in this area.

Expert opinion

Management of depression in MS should be guided primarily by available evidence on depression treatment and not exclusively by the small and inadequate literature of randomized controlled trials. Differential diagnosis is important since depression manifests across a broad spectrum of morbidity in MS, a reality that has real-world implications for treatment. Basic guiding principles can support management of depression in people with MS.

KEYWORDS:

• Depression
• depressive symptoms
• depressive disorders
• treatment
• major depression

Article highlights

• Depression is a common and burdensome occurrence in MS. It can undermine the goals of medical management

• The syndrome of depression comprises a heterogeneous set of conditions. Differential diagnosis is important to treatment planning

• Depression remains a misunderstood and stigmatized condition, complicating its clinical management

• Barriers to effective management of depression include a limited evidence base, but also (and perhaps even more importantly), attitudinal and structural issues

Declaration of interest

SB Patten holds the Cuthbertson and Fischer Chair in Pediatric Mental Health at the University of Calgary. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.