Depression in amyotrophic lateral sclerosis

Abstract

Objective: To examine the relative risk of depression among patients with amyotrophic lateral sclerosis (ALS), both in terms of depression diagnosis and use of antidepressant drugs, before and after diagnosis. Methods:We conducted a nested case-control study including 1,752 patients with ALS diagnosed from July 2005 to December 2010 and 8,760 controls based on the Swedish national health and population registers, to assess the associations of depression diagnosis and use of antidepressant drugs with a subsequent risk of ALS. We further followed the patients with ALS after diagnosis to estimate the association of an ALS diagnosis with the subsequent risk of depression and use of antidepressant drugs.Results: Before diagnosis, patients with ALS were at higher risk of receiving a clinical diagnosis of depression compared to controls (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.3-2.3), and the highest risk increase was noted during the year before diagnosis (OR 3.5, 95% CI 2.1-5.6). Patients with ALS also had a highly increased risk of depression within the first year after diagnosis (hazard ratio 7.9, 95% CI 4.4-14.3). Antidepressant use was more common in patients with ALS than in controls, especially during the year before (OR 5.8, 95% CI 4.5-7.5) and the year after (hazard ratio 16.1, 95% CI 11.5-22.6) diagnosis. Approximately 30% of patients with amyotrophic lateral sclerosis (ALS) show mild cognitive impairment and 15% present with overt frontotemporal dementia (FTD). Conclusions:1,2 The overlap between ALS and FTD presents a continuum of symptoms such as memory impairment, apathy, and behavioral changes, 3,4 many of which mimic the typical symptoms of depression. 5The strong emotions evoked by receiving a serious diagnosis such as ALS may also lead to increased risk of mental illnesses, including depression. Multiple studies have shown that patients with ALS are more likely to develop depression than ALS-free individuals, although the reported prevalence of depression varies greatly.6-13 Different measurements of depression together with the varying representativeness of the patient samples used in previous studies may partly explain the different prevalences reported so far.The aim of the present study was to investigate the occurrence of depression diagnosis and use of antidepressants before and after ALS diagnosis in a nationwide sample of patients with ALS, using a matched random sample of the Swedish population as the reference.

Bidirectional Connections between Depression and Ataxia Severity in Spinocerebellar Ataxia Type 3 Patients

“…Depression is the most common psychiatric symptom and occurs in 33–70% of patients with Huntington disease [25]. The prevalence of antidepressant use was reported up to 38% among patients with ALS [26]. In patients of Alzheimer’ disease, depression is found to be an omnibus prevalence of 32% (16% in population-based Alzheimer’ disease studies, and 44.3% in hospital-based studies) [27].…”

Re: Letter written in reaction to “Pregabalin prescriptions in the United Kingdom: a drug utilisation study of The Health Improvement Network (THIN) primary care database”, by Pottegård et al. - The authors (Asomaning et al.) respond

“…Both databases have individual strengths and weaknesses, and both are considered well validated and well recognised for pharmacoepidemiologic research with numerous publications. (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) Regarding the first issue raised by Potteg ard et al, i.e. the definition of pregabalin exposure in our study, in a 2011 presentation, Thompson et al (16) demonstrated a very high correlation between prescribing recorded in THIN data and drug dispensing in England.…”

Depression in Neurological Practice

“…В отечественной лите-ратуре имеются указания на то, что такие депрессии явля-ются преимущественно нетяжелыми (нозогенные), не имеют тенденции к эндогенизации и характеризуются преобладанием тревожных симптомов [23]. Депрессии отмечаются на разных этапах заболевания: они могут предшествовать появлению первых моторных симптомов, формироваться на диагностическом этапе, а также разви-ваться после достоверного установления диагноза [35]. На позднем этапе заболевания клиническая картина депрес-сии обычно усложняется за счет присоединения псевдо-бульбарных симптомов (насильственный смех и плач) [36].…”