Antidepressant use in multiple sclerosis: epidemiologic study of a large community sample

Abstract

Depressive symptoms and disorders among individuals with multiple sclerosis (MS) are more common when compared to other chronic illnesses and the general population, but relatively little is known about the use of antidepressant medication in this population. In this cross-sectional study of 542 community-dwelling adults with MS, we examined the prevalence of antidepressant use and employed multivariate logistic regression modeling to identify factors significantly associated with antidepressant use. Thirty-five percent of the sample reported currently using at least one antidepressant medication. Gender, marital status, insurance status, fatigue, and use of disease modifying therapies were all significantly associated with antidepressant use. Just over half of the sample endorsed a clinically significant level of depressive symptoms, and the majority of this group was not currently taking an antidepressant. Conversely, 41% of those with depressive symptoms reported taking at least one antidepressant medication. More research is needed to better understand why people with MS and depressive symptoms use or do not use antidepressant medications and to further explore the possibility of an under-treatment of depressive disorder in this population. Rigorous studies testing the feasibility, acceptability, and efficacy of currently available therapies for depression in the MS population should also be conducted.

Impact of Multiple Sclerosis and Its Association with Depression: An Analytical Case-Control Investigation

“…In agreement with our study, patients with MS (51%) present clinically significant depressive symptoms [ 36 ]. Thus, we compared the control group with the case group, taking all the patients without considering depression as an inclusion criterion, and when reviewing the data obtained, we found that many people with MS (19%) present a mild level of depression.…”

Impact of Multiple Sclerosis and Its Association with Depression: An Analytical Case-Control Investigation

“…In agreement with our study, patients with MS (51%) present clinically significant depressive symptoms [ 36 ]. Thus, we compared the control group with the case group, taking all the patients without considering depression as an inclusion criterion, and when reviewing the data obtained, we found that many people with MS (19%) present a mild level of depression.…”

Depression Treatment among Adults with Multiple Sclerosis and Depression in Ambulatory Care Settings in the United States

“…Among individual antidepressants, fluoxetine was the most prescribed in our study population. This finding is consistent with the finding from the NMSS Spokane chapter study [12]. Preference of fluoxetine among individuals with MS is not unexpected as fluoxetine has been observed in studies to reverse axonal dysfunction in this population [26].…”

“…Our estimate of antidepressant use (55.54%) among individuals with MS and depression is higher compared to 41% estimated by the NMSS Spokane chapter study [12] and 34% by Northern California Kaiser Permanente Medical Care Group study. It is challenging to elucidate the reason for these differences in antidepressant use from the current evidence.…”

“…The visit-level prevalence of depression among individuals with MS identified in the current study (20.59%) is consistent with both a recent systematic review and meta-analysis, which estimated the prevalence of depression among individuals with MS to be around 24% [2] and the point prevalence of major depressive disorder in approximately 26% of individuals with MS observed in a study among patients recruited by Northern California Kaiser Permanente Medical Care Group [11]. However, our estimate is lower than the depression prevalence estimate of 51% among a sample of individuals with MS who were members of the Spokane (Washington) chapter of the National Multiple Sclerosis Society (NMSS) [12] in which presence of depression was self-reported by using the Center for Epidemiologic Studies Depression Scale (CES-D) [12]. Variations in the prevalence rates of depression observed in different studies can be attributed to the types of depression assessment measures used and possible underdiagnosis of depression as well as stigma associated with reporting mental disorder.…”

Depression and Anxiety in Association with Polypharmacy in Patients with Multiple Sclerosis

“…In a study by Mohr et al, two out of three MS patients with major depression were not taking antidepressant medication [ 67 ]. This outcome is similar to a study by Cetin et al of 542 MS patients, in which approximately 60% of the patients with relevant depressive symptoms were not taking antidepressants [ 68 ]. This finding demonstrates that depression is often overlooked and undertreated in clinical practice.…”

Impact of Multiple Sclerosis and Its Association with Depression: An Analytical Case-Control Investigation

“…In agreement with our study, patients with MS (51%) present clinically significant depressive symptoms [ 36 ]. Thus, we compared the control group with the case group, taking all the patients without considering depression as an inclusion criterion, and when reviewing the data obtained, we found that many people with MS (19%) present a mild level of depression.…”

Depression Treatment among Adults with Multiple Sclerosis and Depression in Ambulatory Care Settings in the United States

“…Among individual antidepressants, fluoxetine was the most prescribed in our study population. This finding is consistent with the finding from the NMSS Spokane chapter study [12]. Preference of fluoxetine among individuals with MS is not unexpected as fluoxetine has been observed in studies to reverse axonal dysfunction in this population [26].…”

“…Our estimate of antidepressant use (55.54%) among individuals with MS and depression is higher compared to 41% estimated by the NMSS Spokane chapter study [12] and 34% by Northern California Kaiser Permanente Medical Care Group study. It is challenging to elucidate the reason for these differences in antidepressant use from the current evidence.…”

“…The visit-level prevalence of depression among individuals with MS identified in the current study (20.59%) is consistent with both a recent systematic review and meta-analysis, which estimated the prevalence of depression among individuals with MS to be around 24% [2] and the point prevalence of major depressive disorder in approximately 26% of individuals with MS observed in a study among patients recruited by Northern California Kaiser Permanente Medical Care Group [11]. However, our estimate is lower than the depression prevalence estimate of 51% among a sample of individuals with MS who were members of the Spokane (Washington) chapter of the National Multiple Sclerosis Society (NMSS) [12] in which presence of depression was self-reported by using the Center for Epidemiologic Studies Depression Scale (CES-D) [12]. Variations in the prevalence rates of depression observed in different studies can be attributed to the types of depression assessment measures used and possible underdiagnosis of depression as well as stigma associated with reporting mental disorder.…”

Depression and Anxiety in Association with Polypharmacy in Patients with Multiple Sclerosis

“…In a study by Mohr et al, two out of three MS patients with major depression were not taking antidepressant medication [ 67 ]. This outcome is similar to a study by Cetin et al of 542 MS patients, in which approximately 60% of the patients with relevant depressive symptoms were not taking antidepressants [ 68 ]. This finding demonstrates that depression is often overlooked and undertreated in clinical practice.…”

Impact of Multiple Sclerosis and Its Association with Depression: An Analytical Case-Control Investigation

“…In agreement with our study, patients with MS (51%) present clinically significant depressive symptoms [ 36 ]. Thus, we compared the control group with the case group, taking all the patients without considering depression as an inclusion criterion, and when reviewing the data obtained, we found that many people with MS (19%) present a mild level of depression.…”

Depression Treatment among Adults with Multiple Sclerosis and Depression in Ambulatory Care Settings in the United States

“…Among individual antidepressants, fluoxetine was the most prescribed in our study population. This finding is consistent with the finding from the NMSS Spokane chapter study [12]. Preference of fluoxetine among individuals with MS is not unexpected as fluoxetine has been observed in studies to reverse axonal dysfunction in this population [26].…”

“…Our estimate of antidepressant use (55.54%) among individuals with MS and depression is higher compared to 41% estimated by the NMSS Spokane chapter study [12] and 34% by Northern California Kaiser Permanente Medical Care Group study. It is challenging to elucidate the reason for these differences in antidepressant use from the current evidence.…”

“…The visit-level prevalence of depression among individuals with MS identified in the current study (20.59%) is consistent with both a recent systematic review and meta-analysis, which estimated the prevalence of depression among individuals with MS to be around 24% [2] and the point prevalence of major depressive disorder in approximately 26% of individuals with MS observed in a study among patients recruited by Northern California Kaiser Permanente Medical Care Group [11]. However, our estimate is lower than the depression prevalence estimate of 51% among a sample of individuals with MS who were members of the Spokane (Washington) chapter of the National Multiple Sclerosis Society (NMSS) [12] in which presence of depression was self-reported by using the Center for Epidemiologic Studies Depression Scale (CES-D) [12]. Variations in the prevalence rates of depression observed in different studies can be attributed to the types of depression assessment measures used and possible underdiagnosis of depression as well as stigma associated with reporting mental disorder.…”

Depression and Anxiety in Association with Polypharmacy in Patients with Multiple Sclerosis

“…In a study by Mohr et al, two out of three MS patients with major depression were not taking antidepressant medication [ 67 ]. This outcome is similar to a study by Cetin et al of 542 MS patients, in which approximately 60% of the patients with relevant depressive symptoms were not taking antidepressants [ 68 ]. This finding demonstrates that depression is often overlooked and undertreated in clinical practice.…”