Fatigue and depression in multiple sclerosis: pharmacological and non-pharmacological interventions

Abstract

Multiple sclerosis (MS) is a neuroinflammatory condition with a prominent progressive neurodegenerative facet that typically affects young-or middle-aged adults. Although physical disabilities have been in the foreground by being easier to assess, there is an increasing interest in mental disabilities and psychiatric co-morbidities, which have a disproportionally high impact on important outcome measures such as quality of life and occupational disability. In particular, cognitive impairment, depression and mental fatigue, which mutually interact with each other, seem to be of importance in this context. In recent decades, major efforts have been invested in developing more effective disease modulatory treatments. This has resulted in novel therapeutic options and awareness of the importance of early intervention. In comparison, good quality and adequately powered studies on symptomatic treatments of fatigue and psychiatric co-morbidities in MS are rare, and awareness of treatment options is much lower. We here review the existing evidence base for symptomatic treatment of fatigue and depression in MS patients. With regard to fatigue, off-label prescription of alertness improving drugs is common, in spite of all but absent evidence of efficacy. In contrast, a number of smaller studies suggest that physical exercise and fatigue management courses may have some clinical benefit. Very few studies have addressed the efficacy of antidepressants and non-pharmaceutical interventions specifically in MS patients. Therefore, treatment guidelines largely rely on data from non-MS populations. In the future, there is a strong motive to direct additional resources to the study of these important aspects of MS. K E Y W O R D Scognitive symptoms, depression, fatigue, multiple sclerosis, treatment

Open study with (−)-OSU6162 in multiple sclerosis-related fatigue

“…The prevalence of MS is highest in the Northern hemisphere and altogether about 1.3 million people globally have the disease . In Sweden, the prevalence has been estimated to 189/100 000 (almost 20 000 individuals) and the incidence to 10/100 000/year . One of the most prominent and most commonly reported symptom of MS is fatigue which is reported to occur in 70%‐80% of MS patients and is considered to be one of the most disabling symptoms at all stages of MS .…”

“…In Sweden, the prevalence has been estimated to 189/100 000 (almost 20 000 individuals) and the incidence to 10/100 000/year . One of the most prominent and most commonly reported symptom of MS is fatigue which is reported to occur in 70%‐80% of MS patients and is considered to be one of the most disabling symptoms at all stages of MS . MS fatigue can be described as a subjective lack of physical and/or mental energy and is a major reason for part‐time employment or early retirement .…”

Acceptance & Commitment Therapy for ME/CFS (Chronic Fatigue Syndrome) – A feasibility study

“…Importantly, the developments within the field of psychoneuroimmunology makes debate regarding the mind or the body as the "cause" of symptoms and disability obsolete, with a growing body of research showing that psychological factors, stress, inflammation, the brain and behavior affect each other in complex ways (91). More so, the importance of psychological factors for how the illness affects functioning and quality of life is presumably as important as in other longstanding somatic conditions (92)(93)(94)(95)(96)(97). That is, developing adaptive and long-term effective approaches and strategies for illness-related symptoms, emotions and thoughts should be crucial in minimizing the illness impact and alleviating suffering.…”

Sample enrichment for clinical trials to show delay of onset in huntington disease

“…Clinical trial successes in CNS disorders are primarily symptomatic treatments . Disease‐modifying interventions face a number of challenges .…”

“…Clinical trial successes in CNS disorders are primarily symptomatic treatments. [1][2][3][4][5][6] Disease-modifying interventions face a number of challenges. 7,8 One significant limitation of disease modification trials is the assumption that intervention(s) effective at one stage of a disease are equally applicable at other points in the disease course, yet many evidence-based treatment guidelines vary by disease stage, risk, and severity.…”