Depression, which is one of the most common symptoms of MS, is associated with considerable morbidity and mortality (Feinstein et al 2014). Depression reduces quality of life, has a negative impact on adherence, and is known to worsen cognitive function and other MS symptoms such as fatigue and pain. Please connect your patients and their families to the National MS Society (nationalMSsociety.org/depression).
The lifetime prevalence of MS-related major depression ranges from 25 to 50% in clinic and community-based samples (Minden et al 1987; Schiffer et al 1983; Joffe et al 1987; Patten et al 2003). This rate is significantly higher than the general population (Kessler et al 2003) but similar to other neuroinflammatory diseases, suggesting that the inflammatory process may be playing an important role (Marrie et al 2015). In addition, structural brain abnormalities in the brains of those with MS have also been shown to be associated with major depression (Feinstein et al 2014).
Depression and other mood disorders in people with MS are sadly under-recognized and undertreated which is likely a contributing factor to the high rate of suicide in MS (Minden et al 2015). Two questions have been shown to be a reliable indicator of major depressive disorder in MS (Mohr et al 2007) and should be used by all MS clinicians: “During the past two weeks, have you often been bothered by:
(a) feeling down, depressed, or hopeless? or
(b) little interest or pleasure in doing things?”
A “yes” response to either or both questions should prompt further evaluation and possible treatment. Four other brief screening tools have recently been validated in MS (Patten et al, 2015); of those the PHQ-9 is in the public domain.
The Society convened a group of stakeholders in June 2015 that included researchers, clinicians, people living with MS and their care partners. Based upon the feedback from this group, the Society is establishing work groups to address:
- early identification and treatment
- suicide prevention
- research priorities
- gaps in information, resources and support programs
- workforce adequacy
Access information and resources about depression in MS for you and please connect your patients and their families to the National MS Society. Call 1-800-344-4867 or visit our website (nationalMSsociety.org/depression).