Depression and anxiety in multiple sclerosis. A clinical and MRI study in 95 subjects

Abstract

The aim of the present study was to investigate the relationship between involvement of specific areas of the brain and the occurrence of depression and anxiety in patients with multiple sclerosis. We studied 95 patients (62 women and 33 men, mean age 39.5 years, SD 11.2) with definite MS, 97 patients (65 women and 32 men, mean age 40.7, SD 11.9) suffering from chronic rheumatoid diseases and 110 healthy subjects (71 women and 39 men, mean age 40.1, SD 12.7). The disability, the independence, the cognitive performances, the depressive and anxiety symptoms were assessed. The diagnosis of major depression was made according to the DSM-IV. The patients with multiple sclerosis underwent a 1.5 Tesla magnetic resonance examination including T1 and T2 weighted images. Calculation of regional and total lesion loads and brain volumes were performed. The number (%) of subjects with a diagnosis of major depression was 18 (18.9) among MS cases, 16 (16.5) among controls with chronic disease (p=NS), and 4 (3.6) among healthy volunteers (p < 0.0001). The Hamilton Depression and Anxiety rating scales median scores were 5 and 18, respectively in the MS patients, 5 (p= NS) and 14 (p= NS) in the chronic rheumatoid diseases controls, and 3 (p= < 0.0001) and 6 (p= < 0.0001) in the healthy controls. Both severity of depressive symptoms and diagnosis of major depression correlated, albeit weakly, with right frontal lesion load (r=0.22, p=0.035, and r=0.23, p=0.026, respectively) and right temporal brain volume (r=0.22, p=0.005 and r=0.22, p=0.036, respectively). The severity of depression was related significantly also with total temporal brain volume (r=0.26, p=0.012), right hemisphere brain volume (r=0.25, p=0.015), disability (r=0.30, p=0.003) and independence of MS cases (r=-0.26, p=0.01). The anxiety did not correlate significantly with any of the measures of regional and total lesion loads and brain volume or with any of the considered clinical variables. The similar frequency of depression and severity of depressive symptoms in MS patients and in chronic disease patients, the significant difference in this respect with the normal controls, and the significant correlation between depression and the disability measures would suggest a psychological reaction to the impact of the disease but the relationship between depression and the alterations in the frontal and temporal lobes of the right hemisphere supports, on the contrary, the causative role of organic brain damage. The lack of any significant association between symptoms of anxiety and either MRI abnormalities or clinical variables led us to the opinion that anxiety is a reactive response to the psychosocial pressure put on the patients.

A reply to Gallagher, O'Donnell, Minescu, & Muldoon's commentary on ‘The effects of identification with a support group on the mental health of people with multiple sclerosis’

“…Conducting t-tests across the whole sample revealed that males were significantly more depressed and anxious than females, and had significantly lower life satisfaction. Intriguingly, these findings are generally inconsistent with the literature, which tends to show that females (regardless of whether or not they have multiple sclerosis) are more likely to experience mental health problems such as depression and anxiety [4,5].…”

Psychiatric Issues in Multiple Sclerosis

“…[32][33][34] The prevalence of clinically significant depressive symptoms is much higher [35] than the prevalence of major depressive disorder, but few studies have evaluated other depressive disorders such as dysthymia. [36] The depressive syndromes associated with MS occur throughout the natural history of the disease, including in patients with very mild forms of MS. [37] Some studies have found associations between depression and severity of MS as reflected by degree of disability [38], but other studies have not replicated these findings. [33,39] The association of depression with the duration of MS illness is also unclear, with most studies finding no correlation [38][39], but others reporting a greater risk of depression in the first year after diagnosis [35] and in patients younger than 35.…”

“…[36] The depressive syndromes associated with MS occur throughout the natural history of the disease, including in patients with very mild forms of MS. [37] Some studies have found associations between depression and severity of MS as reflected by degree of disability [38], but other studies have not replicated these findings. [33,39] The association of depression with the duration of MS illness is also unclear, with most studies finding no correlation [38][39], but others reporting a greater risk of depression in the first year after diagnosis [35] and in patients younger than 35. [40] Most studies have not found a correlation between depression and female gender among persons with MS. [35,[38][39] …”

“…[33,39] The association of depression with the duration of MS illness is also unclear, with most studies finding no correlation [38][39], but others reporting a greater risk of depression in the first year after diagnosis [35] and in patients younger than 35. [40] Most studies have not found a correlation between depression and female gender among persons with MS. [35,[38][39] …”

Psychiatric manifestations of multiple sclerosis and acute disseminated encephalomyelitis

“…Correlation with lesion load in the temporal regions has also been suggested [21]. The type of clinical course does not influence the affective or cognitive state of MS patients [22], but depression is one of the strongest predictor of reduced quality of life [23], although as a rule the symptoms respond well to standard treatment [24].…”