Lifestyle Factors Tied to MS-related Depression, Large Study Finds

Changeable lifestyle factors influence the risk and severity of depression associated with multiple sclerosis (MS), a study based on a large group of patients shows.

According to the study, alcohol consumption in particular was linked negatively with depression incidence and severity. In addition, a healthy diet and vitamin D and omega-3 supplementation had a somewhat positive influence on changes in depression score.

The study “Longitudinal Associations of Modifiable Lifestyle Factors With Positive Depression-Screen Over 2.5-Years in an International Cohort of People Living With Multiple Sclerosis” was published in the journal Frontiers in Psychiatry.

It is estimated that about 50 percent of MS patients experience an episode of depression. But to date, little is known about the treatment options against MS-related depression, and most of the treatments available are based on psychiatric or pharmacological interventions.

More knowledge about the effects of lifestyle factors on MS-associated depression potentially could improve the prevention and treatment of the condition.

As part of a wider Health Outcomes and Lifestyle In a Sample of people with Multiple Sclerosis (HOLISM) study, researchers investigated the influence of changeable lifestyle factors on depression risk, severity, and changes in MS patients.

In total, 2,224 MS patients were recruited online and completed a Patient Health Questionnaire (PHQ) testing for depressive episodes. Of this initial group, 1,401 patients completed the 2.5-year follow-up with concluding PHQs.

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Depression was evaluated using two types of questionnaires: PHQ-2, which assesses the frequency of depressed mood over the past two weeks, and PHQ-9, which assesses the severity of depression.

By comparing data from baseline and follow-up, researchers could determine if lifestyle factors were associated with changes in depression risk and severity between timepoints. The lifestyle factors assessed included smoking, alcohol consumption, diet, supplementation with vitamin D or omega-3, and physical activity.

The analysis at the 2.5-year follow-up showed an overall depression risk incidence of 14.5% and 21.7% in MS patients, according to PHQ-2 and PHQ-9 reports, respectively.

Interestingly, when studying lifestyle factors, researchers found an inverse association between all six lifestyle factors assessed and depression risk (seen in either one or both PHQs).

Researchers scored depression as normal (score 0-4), minimal depression (5-9), mild major depression (10-14), moderate major depression (15-19), and severe major depression (equal or greater than 20). All lifestyle factors were associated with major depression.

Alcohol consumption was the only factor that could be associated with the three parameters tested: an increased depression risk, increased severity depression score, and greater change in depression from baseline to follow-up.

The team found that moderate alcohol consumption was associated with a greater probability of becoming depression-free, and reduced the risk of becoming depressed. The results were established by comparing PHQ-2 data changes between baseline and the 2.5-year follow-up.

Researchers noted “there was no association of high alcohol consumption with change in depression state, suggesting these associations are particular to moderate alcohol intake,” and added, “[h]eavy alcohol use or alcohol dependence, on the other hand, is harmful for general health and increases the prevalence of depression,” they wrote.

The team also found that meditation at least once a week was associated with a decrease in depression risk.

Although high-quality diet and supplementation with vitamin D or omega-3 showed some association with depression changes, overall the team did not find a strong association between the depression risk and diet, vitamin D and omega-3 supplementation, smoking, or physical activity.

Nonetheless, researchers observed that “moderate alcohol intake, being a non-smoker, diet quality, no meat or dairy intake, vitamin D supplementation, omega 3 supplement use, regular exercise, and meditation at baseline were associated with lower frequencies of positive depression-screen 2.5 years later,” they wrote.

Of note, since the study is based on self-reported evaluations, the researchers emphasized that the data may suffer from potential recall bias. Therefore, further studies are needed to validate the results.

Overall, the team “found evidence that a variety of lifestyle factors are inversely associated with depression, though of these, only alcohol, diet and supplement use were independently associated with change in depression. These results, if confirmed, suggest that some healthy lifestyle behaviors may positively impact depression risk among people living with MS.”