DEPRESSION IN MULTIPLE-SCLEROSIS

Background: An association between multiple sclerosis (MS) and depress ion has been recognized for several decades and has attracted consider able attention in research. However, there are considerable gaps in th e current state of knowledge. In this review, the literature concerned with: (1) the burden of depression in MS; (2) the etiology of depress ion in MS, and (3) the treatment of depression in MS are critically ex amined. Method: The literature review utilized Medline (1966-1996), an d was supplemented by citations extracted from the papers originally u ncovered. Results: Numerous studies have identified elevated depressiv e symptom scores in MS patients relative to nonclinical and (some) cli nical control groups. Furthermore, studies of depressive disorders hav e clearly documented elevated prevalence rates in MS samples. The lite rature does not identify any specific pattern of neurological involvem ent as being consistently associated with depressive symptoms or disor ders. Psychosocial risk factors contribute to the etiology of depressi on in MS, but the relative importance of various risk factors is yet t o be determined. A single randomized controlled clinical trial, and ad ditional anecdotal evidence, suggests that antidepressant pharmacother apy is effective for depressive disorders in MS. Conclusions: Future e pidemiological studies should not restrict their evaluation of risk fa ctors to those specific factors that are closely related to the diseas e process. In particular, future researchers should resist the temptat ion to focus too exclusively on neuropathology. Biological, psychologi cal and social risk factors are all potentially important. Additional empirical efforts to refine the various treatment approaches would be a welcome addition to this literature.