Affective disorders in patients with multiple sclerosis - Pathophysiology and approaches to management

Affective disorders are commonly seen in the multiple sclerosis (MS) popula tion. Symptoms of MS overlap heavily with symptoms of major depression; how ever, the diagnosis of major depression is sought using the same clinical c riteria as in the general population. Treatment with pharmacological interv ention appears to have a high rate of success, although controlled studies are lacking. Both tricyclic antidepressants and selective serotonin (5-hydr oxytryptamine; 5-HT) reuptake inhibitors are commonly used in MS clinics an d are generally well tolerated for treatment of major depression. Data conc erning the efficacy of pharmacological intervention are limited yet compell ing, and we consider antidepressants an indispensable component of our drug armamentarium. Treatment of mania and bipolar disorder in the MS populatio n is more problematic, primarily due to a paucity of literature on the subj ect. We have found both lithium and valproic acid (sodium valproate) to be effective and well tolerated in these patients. Pharmacological treatment o f more nonspecific types of mood instability in affected patients with MS a ppears to be reasonably effective as well, and in this situation we have su ccessfully used both antidepressants and mood stabilisers.