ACTRIMS 2023: Anxiety, depression more common in MS before onset

Psychiatric problems found among patients 5 years before disease start

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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Psychiatric symptoms such as depression and anxiety are more common among multiple sclerosis (MS) patients in the five years leading up to disease onset than in people from the general population, according to a recent analysis.

Individuals who would later go on to develop clinical signs of MS also had a higher burden associated with psychiatric issues, including more doctor’s office visits, hospital admissions, and prescriptions.

The findings were presented by Anibal Chertcoff, MD, at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2023, being held Feb. 23-25 virtually and in San Diego, California. Chertcoff’s talk was titled “Psychiatric Morbidity in Multiple Sclerosis During the Prodromal Period.”

These results overall indicate that psychiatric symptoms are a significant feature of the period prior to MS onset — dubbed the MS prodrome — according to Chertcoff, a postdoctoral research fellow at the University of British Columbia and a clinical fellow at the BARLO MS Centre, St. Michael’s Hospital, Canada.

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Mental health problems, such as anxiety, depression, and mood swings, are common among MS patients after diagnosis. In fact, more than half of those with the neurodegenerative disorder are estimated to have clinically relevant depression, and about 40% to experience clinically relevant anxiety.

These statistics suggest psychiatric symptoms are occurring among MS patients at “higher rates than expected in the general population,” Chertcoff noted.

Recent research has suggested that such psychiatric symptoms may emerge even before the clinical onset of MS, which is also called the prodromal phase. In this stage, patients start to experience noticeable health changes, such as sleep disorders and pain, but have no symptoms directly suggestive of MS.

Aiming to learn more about the prevalence and burden of psychiatric symptoms in the MS prodrome, Chertcoff and his colleagues now examined administrative healthcare data from British Columbia, in Canada, looking for incidents of psychiatric symptoms in the five years before MS clinical onset.

A first analysis involved 6,863 MS patients, who were each matched in terms of sex, birth year, and area of residence with up to five people in the general population — a total of 31,865 people who served as the control group.

Overall, 73% of participants in both groups were women, and the mean age at MS clinical onset, defined as a first demyelinating event or a first symptom of MS, was 45 years. Demyelination refers to the loss of the myelin sheath that covers nerve fibers, which is a hallmark of MS.

Results from the analyses showed that patients in the MS group had a significantly higher prevalence of psychiatric symptoms — including depression, anxiety, bipolar disorder, and schizophrenia — in each of the five years before disease onset compared with the matched control group.

That difference “seemed to increase steadily as the MS onset date approached,” Chertcoff said.

Overall, 28% of the MS group and 15% of the control group experienced psychiatric symptoms over the five-year period. This represented an 88% greater risk of mental health problems among the MS group over this period.

Depression was the most commonly observed symptom, followed by anxiety, Chertcoff noted.

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Depression, anxiety most common psychiatric symptoms among patients

The relative burden of these psychiatric symptoms, including clinical visits, hospital admissions, and prescriptions related to psychiatric symptoms, also was higher in the MS group in each of the five years leading up to MS onset.

Specifically, five years before disease onset, mental health-related doctor’s office visits were about 80% more frequent among the MS group compared with controls, and visits to psychiatrists were about 130% more frequent.

This gap expanded even further in the year before MS onset, with doctor’s visits being 125% more frequent in patients than controls and psychiatrists visits almost 150% more common.

Similar trends were observed with hospital admissions, which were about 130% more frequent in the MS group five years before onset, rising to nearly 200% by one year.

Prescriptions of psychotropic medications, including antidepressants, anxiolytics, antipsychotics, and mood stabilizers, were elevated in patients by about 75% at five years and also rose to 100% at one year before disease onset.

In general, these findings were similar in a separate analysis of 966 MS patients seen at an MS clinic and 4,534 matched controls. That analysis found that MS patients had a 57% higher risk of developing psychiatric symptoms in the five years before their first MS symptoms compared with the general population.

Chertcoff noted that the findings were limited by the fact that the administrative public healthcare data only captures patients who are seeking care for their symptoms. “However, [this limitation is] expected to affect both the MS cases as well as the controls without distinction,” he said.

The findings overall demonstrated that psychiatric symptoms may commonly appear in the years prior to MS onset, according to Chertcoff, who added that these symptoms are an “important contributor to increased healthcare use in the MS prodrome.”

Note: The Multiple Sclerosis News Today team is providing in-depth coverage of the ACTRIMS Forum 2023 Feb. 23–25. Go here to see the latest stories from the conference. Follow along on Facebook, Twitter, and Instagram for live updates using the hashtag #actrims2023.