Mental health can trouble MS patients 5 years before diagnosis

Anxiety, depression, and other mental health issues are nearly twice as common in people with multiple sclerosis (MS) in the five years preceding disease onset than they are in the general public, a study reports.

These findings add to growing evidence that people with MS often go through a prodromal or early phase, in which seemingly unrelated symptoms can manifest years before classic disease symptoms become evident.

Recognizing such symptoms may allow doctors to diagnose MS at an early stage, when disease treatment can be most effective.

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October 5, 2023 Columns by Benjamin Hofmeister

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Problems with mental health as potential ‘indirect’ signal of MS

“We’ve come to understand there is a whole period preceding those events where the disease presents itself in more indirect ways,” Helen Tremlett, PhD, a neurology professor at the University of British Columbia (UBC) in Canada and the study’s senior author, said in a university press release.

“If we can recognize MS earlier, treatment could begin sooner. That has tremendous potential to slow disease progression and improve quality of life,” added Tremlett, who also is a member of UBC’s Djavad Mowafaghian Centre for Brain Health.

Details, previously shared at the ACTRIMS Forum 2023, now have been published in the journal Neurology. The study is titled “Psychiatric Comorbidity During the Prodromal Period in Patients With Multiple Sclerosis.”

The immune system in MS attacks the brain and spinal cord to damage the myelin sheath, a fatty substance that wraps around nerve fibers, leading to progressive nerve cell degeneration and a range of symptoms.

Fatigue, difficulty walking, and numbness or tingling often occur early in the disease’s course, and it’s now known that pain and trouble sleeping can appear years before the disease manifests. Some of these symptoms may offer a way to diagnose MS and predict the disease’s course.

“For a long time, it was thought that MS only really began clinically when a person experienced their first demyelinating event, such as in the form of vision problems,” Tremlett said.

Work by Tremlett’s team, supported in part by the National MS Society and the MS Society of Canada, aims to better characterize the MS prodrome, a set of signs or symptoms that occur before clinical MS onset.

In this study, the team focused on mental health problems also seen in diagnosed patients. The scientists reviewed health records from across British Columbia to determine how common mental health problems such as depression, anxiety, bipolar disorder, and schizophrenia were in the five years prior to onset.

A first analysis compared data covering 6,863 patients with 31,865 people from the general population matched to patients by age, sex, and geographical location and serving as a control group.

Issues twice as common in people later diagnosed with MS than general public

Mental health issues were about twice as common in patients than in controls (28% vs. 14.9%) in the five years before a first demyelinating event.

Findings were similar in a second analysis in which researchers defined MS clinical onset as the start of symptoms. There, 213 of the 966 people (22%) who later developed MS and 638 of 4,534 controls (14.1%) had mental health issues in the five years leading up to initial MS symptoms.

In both groups, the prevalence of mental health issues across those years was 58% to 91% higher in patients than in controls.

“Psychiatric morbidity represents a significant burden before MS onset and may be a feature of the MS prodrome,” the researchers wrote.

The use of healthcare resources for psychiatric symptoms also was higher in patients in the five years before clinical disease onset, and the differences tended to increased as the time to MS symptoms shortened.

For example, psychiatrist visits were 132% higher among patients than controls five years before onset, and increased to 146% in the final year before MS onset. Similar trends were observed for general doctor visits, hospitalizations, and prescriptions.

“We see higher and higher rates of psychiatric conditions that peak in the final year before MS onset,” said Anibal Chertcoff, MD, the study’s first author and an assistant professor at the University of Manitoba.

“While we’re not suggesting that these conditions alone can be a predictor of MS, they may be one piece of the MS prodrome puzzle and a potential signal when combined with other factors,” Chertcoff added.