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Treating depressed multiple sclerosis patients

Stephanie Ameis and Anthony Feinstein

Approximately one in two multiple sclerosis patients will develop a major depression over the course of their lifetime. This is associated with a decreased quality of life and a high risk of completed suicide. A literature review suggests pharmacotherapy with a selective serotonin-reuptake inhibitor or tricyclic antidepressant is effective, the former likely better tolerated. Limited data show that psychotherapy, namely cognitive–behavioral and insight-oriented therapies, is effective, although cognitive–behavioral therapy is the only modality shown to rival medication in bringing about symptom response. Electroconvulsive therapy should be reserved for severe cases of depression as it may increase the risk of multiple sclerosis exacerbation. In treating the depressed multiple sclerosis patient, clinicians should always be on the lookout for comorbid anxiety.