Depression as a determinant of quality of life in patients with multiple sclerosis

Abstract

Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system (CNS), which mainly affects women and young adults in their most productive years of life. Given to fact that the disease is unpredictable and has uncertain outcomes, the grater are physical and emotional efforts that an individual has to take, and that inevitably causes additional exhaustion. Assessment of disease severity based only on an objective clinical finding is not enough, because it does not give insight into the subjective experience of disease symptoms and difficulties with which these patients meet in everyday life life. Most MS sufferers most likely will experience a wide range of physical, psychological and social problems. Physical disability, fatigue, motor incapacity and sexual dysfunctions that occur with the progression of the disease, most often lead to the deterioration of the quality of life in people with MS. In addition to these factors, changes in psychological status are inevitable. Depression is the most common psychiatric comorbidity of MS that worsens the health condition of the patient. Studies on psychiatric comorbidities and ways of coping with MS generally highlight the connection between depression and alexithymia in MS. Prevalence alexithymia in MS patients goes up to 50%, it is associated with anxiety and significantly contributes to the severity and severity of depression. When it comes to the therapy of depression in MS of cognitive-behavioral psychotherapy (CBT) is recommended as the first line of treatment, but also the application of pharmacotherapy i.e. administration of sertraline and escitalopram with short-term use of alprazolam, and more recently, more and more studies are investigating neuroprotective effect of antidepressants, and recommend the use of fluoxetine. Directing preventive measures to improving social activities and prevention institutionalization ie. combining medical rehabilitation, psychosocial help and social support prevent that the disease from becoming a disability leading to complete isolation. It is also necessary to direct resources to adequate treatment of depression as determining factor of quality of life, mental health and prognostic factor of the clinical picture and course of MS.