Depression in multiple sclerosis: Review and theoretical proposal

Abstract

Because of its high prevalence and implications for quality of life and possibly even disease progression, depression has been intensively studied in multiple sclerosis (MS) over the past 25 years. Despite the publication of numerous excellent empirical research papers on this topic during that time, the publication of theoretical work that attempts to explain depression in a comprehensive way is scarce. In this study, we present a theoretical model that attempts to integrate existing work on depression in MS and provide testable hypotheses for future work. The model suggests that risk for depression begins with the onset of MS. MS results in disease-related changes such as increased lesion burden0brain atrophy and immunological anomalies that are associated with depression in MS, but explain only a relatively limited proportion of the variance. Common sequelae of MS including fatigue, physical disability, cognitive dysfunction, and pain, have all been shown to have an inconsistent or relatively weak relationship to depression in the literature. In the model, we propose that four variables-social support, coping, conceptions of the self and illness, and stress-may moderate the relationship between the above common MS sequelae with depression and help to explain inconsistencies in the literature. (JINS, 2008, 14, 691-724.)

Palliative Care for Severely Affected Patients with Multiple Sclerosis: When and Why? Results of a Delphi Survey of Health Care Professionals

“…More than half of cases of depression among patients with MS go undiagnosed. 6 Our research showed that patients with MS are interested in communicating about issues concerning death and dying, 7,8 especially since the burden of the disease can sometimes produce suicidal ideation 9 as reflected in alarming rates of euthanasia and assisted suicide for patients with MS. 10,11 MS may be complicated by cognitive impairment, swallowing, or speech problems. Managing MS requires assistance from a wide range of health care specialists throughout the patient's life.…”

Differential diagnosis, discerning depression from cognition

“…33 On the whole, twelve of those had negative findings. However, these studies were conducted on small samples, using scales with overlapping vegetative symptoms and cognitive tests with low sensitivity.…”

Effects of music and music therapy on mood in neurological patients

“…The few population-based studies have reported a high prevalence of depression, despite using different methods of data collection. The lifetime risk of major depression in people with MS has been estimated to be as high as 50% compared to 10% to 15% in the general population [24,25] . In a recent cross-sectional, population-based study conducted in Stockholm county, the authors reported a prevalence rate of depression of 19% [Beck Depression Inventory (BDI) > 13] among patients suffering of MS.…”