Treatment of depression in patients with Multiple Sclerosis

BACKGROUND: Multiple sclerosis is the most common demyelinating disorder among young adults. The disease is frequently accompanied by psychiatric disturbances, of which depression is the main cause of impaired quality of life. The lifetime risk of depression among patients with multiple sclerosis is as high as 50%, and the risk of suicide is greatly increased in this subgroup. Surprisingly, despite advances in the treatment of depression, little research focusing on depressed patients with multiple sclerosis has been published. It is important that neurologists know how to approach the depressive co-morbidity. REVIEW SUMMARY: Psychotherapy, electroconvulsive treatment, pharmacotherapy, and light therapy are, alone or in combination, the treatments for depression. The emerging trend in neurological patients and patients with multiple sclerosis is to combine support group therapy and pharmacological interventions as the first-line treatment for depression. Based on tolerability and pharmacokinetic studies, the use of serotonin-specific reuptake inhibitors is recommended for patients with multiple sclerosis. Electroconvulsive therapy is efficient, but more research is needed to explore possible contraindications for this procedure, such as active lesions. CONCLUSIONS: This review allows the neurologist to better understand the approach to treatment of patients with multiple sclerosis suffering from co-morbid depression. The use of pharmacotherapy is encouraged so that quality of life, rehabilitation efforts, and risk of suicide are improved. There is urgent need for large-scale studies using the newer antidepressants now available in the United States and Europe.