Depression associated with multiple sclerosis - Looking beyond diagnosis to symptom expression

Background: While it is recognised that patients with multiple sclerosis ha ve a high lifetime risk for major depression, less is known about sub-syndr omal presentations of affective instability. i.e., irritability, sadness an d tearfulness and how these symptoms of emotional dyscontrol may affect a s ubject's overall degree of psychological distress. Methods: A consecutive s ample of 100 out-patients with clinically definite multiple sclerosis atten ding their yearly neurological examination were assessed for major depressi on [Structured Clinical Interview for DSM-IV(SCID-1)], pathological laughin g and crying [Pathological Laughing and Crying Scale (PLACS)], self report questionnaires documenting mood [Beck Depression Inventory (BDI)] and overa ll psychological distress [the 28 item General Health Questionnaire (GHQ)]. Results: Seventeen percent of subjects received a diagnosis of major depre ssion. 8% had pathological laughing and crying (PLC), 48% had symptoms of e motional dyscontrol without meeting criteria for a formal psychiatric diagn osis and 27% had minimal psychiatric symptoms (emotionally stable). The gro ups did not differ with respect to neurological variables. However, on a va lidated index of psychological distress (i.e., GHQ scores greater than or e qual to 5). there were significantly more subjects with major depression an d emotional dyscontrol than those deemed emotionally stable (P < 0.0001). L imitations: The small number of patients with PLC (N = 8) curtailed statist ical power when it came to analysing this sub-group. Conclusions: Clinician s should be sensitive to complaints Such as irritability and sadness in pat ients with multiple sclerosis, even when symptoms do not fulfil criteria fo r formal, psychiatric diagnoses. Our data demonstrate that such complaints are associated with levels of psychological distress that approach those ex perienced by patients with major depression. Given that these sub-syndromes of affective instability respond well to pharmacotherapy, detection and tr eatment can significantly reduce one important aspect of morbidity associat ed with multiple sclerosis. (C) 2001 Elsevier Science B.V. All rights reser ved.