Psychiatric Issues in Multiple Sclerosis
Section snippets
Overview
Multiple sclerosis (MS) is the most common chronic disabling disease of the central nervous system in young adults, affecting 1 in 1000 people in Western countries [1]. MS is a demyelinating disease of the central nervous system; a diagnosis of MS requires the occurrence of at least two neurologic events consistent with demyelination in the central nervous system that are separated temporally and anatomically. Early onset (typically between 20 and 40 years of age) and long duration of disease
Impact of Psychiatric Disorders on Multiple Sclerosis
The most compelling reason to investigate psychiatric disorders among persons who have MS is that reported rates of completed suicide in MS populations are high [10], and psychiatric disorders seem to be the major risk factor for suicidality [11]. Death certificate–based reviews indicate that suicide may be the cause of death as many as 15% of MS clinic patients [12]. In retrospective analyses of completed suicides in MS populations, depression has been the most important risk factor for
Psychiatric Effects of Treatment of Multiple Sclerosis
Pharmacologic treatments for MS include corticosteroids, beta interferon (IFNβ), glatiramer acetate, and immunosuppressants. Corticosteroids, which are used in high doses for short courses to treat acute exacerbations, have been associated with a variety of neuropsychiatric side effects, including increased energy, decreased sleep, and significant mood symptoms such as mood lability, euphoria, and depressed mood [21], [22]. Epidemiologic studies suggest an incidence of neuropsychiatric side
Epidemiology and Clinical Correlates of Depression
Depression may be more common in MS than in other chronic neurologic conditions [36]. The 12-month prevalence of major depressive disorder (MDD) among persons who have MS is 15.7%, nearly double the prevalence of MDD in persons who do not have MS (7.4%) [37]. Reports of the lifetime risk for MDD in MS populations have ranged from 27% to 54% [36], [37], [38]. The prevalence of clinically significant depressive symptoms is much higher [39] than the prevalence of MDD, but few studies have
Anxiety Disorders in Multiple Sclerosis
In contrast to the extensive literature on depression in patients who have MS, less attention has been paid to anxiety disorders. Several studies using self-report scales of anxiety symptoms have found a point prevalence of clinically significant anxiety ranging from 25% to 41% [42], [64], [65]. Only two studies have used structured clinical interviews to evaluate formal diagnoses of anxiety disorders, and both of these found lifetime prevalence rates of 36% [14], [66], which is much higher
Serious Mental Illness in Multiple Sclerosis
Numerous case reports have documented an association between bipolar disorder and MS [68], [69], [70], [71]. Bipolar symptoms may precede other neurologic signs of MS, and there have been reports of MS presenting as frank mania [70], [71]. Affective lability, in particular, may occur in tandem with an MS exacerbation. Some researchers have hypothesized that the comorbidity of bipolar disorder may be related to the location of the MS lesions [69]. Several clinical studies have identified
Substance Use Disorders in Multiple Sclerosis
Alcohol and illicit drug use may be more problematic in people who have MS than in the general population, potentially causing further neurologic damage to an already compromised central nervous system or leading to dangerous interactions with prescription medications. Heavy alcohol use can magnify the subtle cognitive impairment associated with MS [77] and has been shown to cause persistent cognitive impairment, even in persons who do not meet the criteria for alcohol abuse or dependence [78]
Pseudobulbar Affect
In addition to mood disorders, MS patients also may experience disorders of affect, typically an expression of affect that is not representative of the underlying emotion [94]. Some MS patients may laugh or cry out of proportion to or in the absence of the expected feeling, a phenomenon that has been referred to as “pathological laughing and crying,” or pseudobulbar affect (PBA). PBA has been recognized in association with MS for many years, but even today its causes are not well understood.
Resilience and Posttraumatic Growth
Although psychiatric conditions are highly prevalent among individuals living with MS, many persons who have MS do not exhibit clinically significant levels of depression, anxiety, or other serious mental illness. The ability to maintain psychologic well being and functioning in the face of adversity such as loss, trauma, and serious medical illness often is referred to as “resilience” [99]. Being resilient does not mean that the individual never experiences any negative emotions, thoughts, or
Summary
MDD and anxiety disorders are highly prevalent among persons who have MS and have been associated with decreased adherence to MS treatment and poorer functional status and quality of life. Effective treatment is available for MDD, but this disorder continues to be underdetected and undertreated by MS providers. Treatment with pharmacotherapy is particularly challenging in this patient population, given the somatic symptom overlap between MS and depression and the increased burden of side
References (100)
- et al.
The epidemiology of multiple sclerosis
Mayo Clin Proc
(1997) - et al.
The epidemiology of generalized anxiety disorder
Psychiatr Clin North Am
(2001) - et al.
Depression, cognitive impairment and social stress in multiple sclerosis
J Psychosom Res
(1994) - et al.
Psychiatric side effects of steroid therapy
Psychosomatics
(1989) - et al.
Steroid-induced psychiatric syndromes. A report of 14 cases and a review of the literature
J Affect Disord
(1983) - et al.
Psychopathological and neuropsychological effects of 8-days corticosteroid treatment: a prospective study
Psychoneuroendocrinology
(1996) Steroid psychosis: a review
Gen Hosp Psychiatry
(2003)- et al.
Increased depression in multiple sclerosis patients: a meta-analysis
Psychosomatics
(1993) - et al.
Depression in multiple sclerosis
Gen Hosp Psychiatry
(1987) - et al.
Prospective study of physical activity and depressive symptoms in middle-aged women
Am J Prev Med
(2005)
Mania as a symptom of multiple sclerosis
Psychosomatics
Case study: mania associated with multiple sclerosis
J Am Acad Child Adolesc Psychiatry
The prevalence and impact of alcohol problems in major depression: a systematic review
Am J Med
Marijuana and multiple sclerosis
Lancet Neurol
Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial
Lancet
Cost and health related quality of life consequences of multiple sclerosis
Mult Scler
The survey replication epidemiology oF major depressive disorder results from the National Comorbidity Survey Replication
JAMA
Lifetime prevalence of psychotic and bipolar I disorders in a general population
Arch Gen Psychiatry
Results from the 2001 National Household Survey on Drug Abuse, volume I. Summary of national findings
Treatment of depression improves adherence to interferon beta-1b therapy for multiple sclerosis
Arch Neurol
Associations of the Expanded Disability Status Scale with anxiety and depression in multiple sclerosis outpatients
Acta Neruol Scand
Quality of life in multiple sclerosis: the impact of depression, fatigue and disability
Mult Scler
Suicide and multiple sclerosis: an epidemiological investigation
J Neurol Neurosurg Psychiatry
Risk factors for suicide in multiple sclerosis
Psychother Psychosom
Cause of death in patients attending multiple sclerosis clinics
Neurology
Multiple sclerosis, depression and suicide
BMJ
Anxiety disorders and their clinical correlates in multiple sclerosis patients
Mult Scler
An examination of suicidal intent in patients with multiple sclerosis
Neurology
The Goldman consensus statement on depression in multiple sclerosis
Mult Scler
The relationship among depression, subjective cognitive impairment, and neuropsychological performance in MS
Mult Scler
Factors related to employment status changes in individuals with multiple sclerosis
Mult Scler
Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis
BMJ
Hypomanic reactions to ACTH and prednisone treatment for multiple sclerosis
Neurology
Corticosteroid-induced adverse psychiatric effects: incidence, diagnosis and management
Drug Saf
Mood changes during prednisone bursts in outpatients with asthma
J Clin Psychopharmacol
Side effect profile of interferon beta-1b in MS: results of an open label trial
Neurology
Course of depression during initiation of interferon beta-1a treatment for multiple sclerosis
Arch Neurol
Multiple sclerosis, interferon beta 1b and depression
J Neurol
Interferon beta 1a and depression in secondary progressive MS: data from the SPECTRIMS trial
Neurology
Multiple sclerosis and depression: influence of interferon beta therapy
Mult Scler
Multiple sclerosis, disease modifying treatment and depression: a critical methodological review
Mult Scler
Management of patients receiving interferon beta-1b for multiple sclerosis: report of a consensus conference
Neurology
Major depression in multiple sclerosis: a population- based perspective
Neurology
Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample
Am J Psychiatry
Mood disorders in multiple sclerosis: diagnosis and treatment
J Neurovirol
Depression before and after diagnosis of multiple sclerosis
Mult Scler
Depression and anxiety in multiple sclerosis. A clinical and MRI study in 95 subjects
J Neurol
Correlates of cognitive impairment and depressive mood disorder in multiple sclerosis
Acta Psychiatr Scand
Biopsychosocial correlates of lifetime major depression in a multiple sclerosis population
Mult Scler
Cited by (115)
The effect of exercise on mental health and health-related quality of life in individuals with multiple sclerosis: A Systematic review and meta-analysis
2024, Multiple Sclerosis and Related DisordersPsychological symptoms in Multiple Sclerosis and the role of marital status: results from a retrospective single-center study
2023, Multiple Sclerosis and Related DisordersImpaired myelin ultrastructure is reversed by citalopram treatment in a mouse model for major depressive disorder
2023, Journal of Psychiatric ResearchThe prevalence of depression and anxiety among Iranian people with multiple sclerosis: A systematic review and meta-analysis.
2023, Multiple Sclerosis and Related DisordersPsychosocial difficulties experienced by MS patients in their quality of life: A comparative study of two countries
2023, Multiple Sclerosis and Related Disorders