MS Patients Are Adequately, But Not Optimally, Treated for Depression

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Depression and MS

A new Canadian study, published in the International Journal of MS Care, has concluded that the majority of patients with concurrent multiple sclerosis (MS) and depression are receiving antidepressant treatment. Despite this, however, many of these patients continue to report depressive symptoms.

MS and depression co-occurrence is a big concern, and some reports estimate that up to 50% of MS patients suffer from depression at some time point in their life. Earlier studies have also shown that a large proportion of MS patients — up to 65% — do not receive adequate treatment for their depressive symptoms.

The new study by Aida Raissi and colleagues at Hotchkiss Brain Institute set out to investigate how many MS patients received drug treatment for depression. The study, titled Exploration of Undertreatment and Patterns of Treatment of Depression in Multiple Sclerosis, also aimed to determine which types of treatment were used and to identify characteristics of patients receiving antidepressant drugs.

Using a large number of questionnaires and assessment tools for depression, antidepressant treatment, and MS — as well as measurements for investigating neurological impairment and quality of life — researchers screened 152 people at an outpatient MS clinic in Calgary, Canada.

The study found that 13% of the participants were currently depressed, and 39% reported being depressed at some point in their lives. Of those currently depressed, 65% were taking antidepressant agents. No specific characteristics were associated with antidepressant use, but the team observed that women and older individuals were slightly overrepresented, a trend that might mirror antidepressant demographics in the general population.

Antidepressant drugs were not the sole treatment employed in this group of patients; 19% received only non-drug treatment (psychotherapy), and a further 44% combined drug use and psychotherapy.

The team then adjusted the analysis by taking into consideration patients using antidepressants without having depressive symptoms, and found that 86% of the depressed MS patients received treatment for their depression — a significant improvement from previous reports.

While the authors note a significant improvement in antidepressant treatment coverage in this MS cohort compared to previous reports, they raise some concerns regarding the generalization of their results. Canada is the world’s third leading consumer of antidepressant drugs, behind Iceland and Australia. Considering the study’s small size (152 patients), the findings might not be relevant in other countries.

The team also found that a relatively large proportion of patients were having depressive symptoms in spite of their treatment. The study, however, did not report treatment dose or duration, and the authors argue that further research is needed to explore the reasons for a lack of treatment response.

Previously developed guidelines for the treatment of depression in MS by the Canadian Network for Mood and Anxiety Treatments recommends using antidepressant drugs in combination with psychotherapy focusing on coping strategies. The authors, therefore, noted that the lack of treatment response might mirror the high proportion of patients (38%) receiving only drug therapy.

The study concludes that, since treatment seems to be reaching most depressed patients, optimization of treatment strategies should be a priority for physicians treating MS patients with concurrent depression.

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  1. Shasha says:

    Antidepression drugs may have Fluorine which can block thyroid and lower oxygen in the brain causing worse depression/suicidal thoughts. No gluten/dairy/soy/sugar/GMO…vitamins/good oils/minerals…probiotic…LDN..detoxing may help depression. Depression/anxiety/obsessing/no sleep/panic/suicidal thought can be due to low oxygen in the brain. Celiac help may help more nutrients absorb in intestines and rebuild cells to burn oxygen. Tests may not work to diagnose Celiac. My MS is due to Celiac and low oxygen in the brain. Celiac help may help MS and depression etc fast. Gluten may made antibodies to the thyroid. Many MS patients are not getting thyroid medicine maybe due to a strange TSH due to the pituitary also being affected. Getting Amour thyroid and Zinc/Se/enough iron/probiotic to convert T4 to T3 may help raise oxygen in the brain/body.

  2. Tammy DeRoche says:

    I am in the U.S., recently diagnosed with MS and and clear on positive & negative coping skills.
    I’ve been on Cymbalta for more than 2 years and gather socially more than once a week. I can walk away from a very happy moment still with the cloud and feeling of depression… Crying in the car, bathroom, bedroom have become my norm. It is not a Canadian or Autralian thing …. Count me into the mix of MS patients who suffer in silence ….

  3. Patricia Browne says:

    Reading this article i have to wonder why they did that clinical study? What was the outcome? MS patients are depressed? Please tell us something we don’t know! I live in US & what I do know is our overall treatment at our so called “MS Centers” are less than to be desired. It’s all about the MS drugs which in my opinion Do Not Work!! There is SO much focus on getting you on one of the many drugs that for the most part make us feel worse. Or if they are working so to speak my feeling is the patient is simply not that bad with the disease YET. I am 61 now & diagnosed in 2006 I suffered for 8 months with CLASSIC MS symptoms that were ignored or baffled even by a most prominent neurologist in NYC. Then it came down to finally not being able to walk because my balance & walking were SO bad I had to be hospitalized. That neurologist was so angry when I brought the MRI taken in another hospital to show him he accused me of showing him a fake or whatever he thought MRI. Yelling “this is not the MRI you showed me”! Well no kidding doc!! You missed it after I EVEN asked him point blank “do I have MS” with all of these symptoms I’m telling you about! NO WAS HIS ANSWER! This was at prior office visits. The whole entire experience was so convoluted. He then told me to go to his ER & NOT tell them I was at his office. I felt like a criminal or something but I needed help because the hospital that did diagnose me treated me with high doses of steroids that weren’t really working & I needed further testing & was told to go back to my neurologist. Anyway he admitted me & all kinds of tests were done & he called in a second opinion who came to my bed & told me I DEFINITELY had MS. I was sort of relieved because my Neuro kept telling me he didn’t believe it was MS!?! Do you know even after I was discharged & referred to my first MS specialist that neurologist called me at home & told me he STILL didn’t believe it was MS!!! How does a prominent Doctor affiliated eith a prominent hospital DO THAT to a patient? And you wonder about MS depression? You need to conduct expensive studies about it? How about using that money to really HELP US?!? Not with drugs but with REAL help in living with this horrible disease when it finally rears it’s ugly head?

    • Judy Nesbitt says:

      Some docs just aren’t that good. It doesn’t matter what hospital he/she is affiliated with, some will not diagnose you unless you fit into their little box of criteria. I had three docs tell me my ms was all in my head before my gp referred me to a good neuro. As to the depression thing, I’m curious if it’s the weight of living wth ms or if our brai neurochemicals are being screwed up by the ms.

      • Shasha says:

        Depression can be due to low oxygen in the brain. Depression/anxiety/no sleep/panic/obsessing/suicidal thoughts can be due to low oxgen in the brain due to Celiac. Gluten may hurt intestines so less nutrients absorb…then cells are not made right to work right to burn oxygen. Hair tests show good minerals/heavy metals. Detoxing may help raise oxygen. Gluten may lower the thyroid which may cause lower oxygen. No gluten/dairy/soy/sugar/GMO/hidden gluten…vitamins/good oils/minerals…probiotic..LDN..detoxing help my MS/depression.

    • Shasha says:

      MS can be due to Celiac. Cyrex labs, but not other tests may diagnose Celiac. Lyme may also make MS symptoms, but my MS is due to Celiac. Lyme symptoms are different, but Lyme may destroy brain/body eventually. Alternative doctors may help MS people fast. No gluten/dairy/soy/sugar/GMO…vitamins/good oils/minerals/probiotic…LDN..detoxing help my MS. 99% of MS people maybe helped by LDN which helps block hidden gluten and helps the immune system work right. Antibiotics may hurt MS people as it hurts the gut lining/lowers the immmue system and hurts mitochondria. Best wishes.

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