Features of depressive disorders in patients with multiple sclerosis and their medical correction
Authors:   FSBEI HE Yaroslavl State Medical University of the Ministry of Health of the Russian Federation, Yaroslavl, Russia, Zarubina N. V. 
Published: October 2024

Patients with multiple sclerosis (MS) often have comorbid symptoms that reduce their quality of life; these include a high prevalence of depression, anxiety, cognitive impairment, and increased fatigue. Although these problems manifest themselves in a wide range, clinicians do not always succeed in differentiating them due to their disguise by underlying disease. The detection of depressive disorders, as well as pharmacological treatment, is an important area of therapeutic intervention. Currently, there are no clinical recommendations regulating the treatment of affective disorders in MS patients, which makes it difficult to select therapy and affects the rehabilitation potential of the patient. The purpose of this study was to investigate the manifestations of depressive disorders in patients with multiple sclerosis, as well as the choice of drug correction. Patients and methods: The study involved 113 patients with a clinically confirmed diagnosis of multiple sclerosis receiving DMTs (disease modifying therapies). The age of the patients at the time of examination ranged from 15 to 60 years (mean age 39.7±10.91). Among those examined, 77% (87 patients) were women, and 23% (26 patients) were men. Taking into account the course of the disease, the MS patients were distributed as follows: 80.5% (91 patients) had a remitting course, and 19.5% (22 patients) had a secondary progressive course. The disability indicator varied in the patients with RMS (2.89±0.16 points) and the patients (5.0±0.24 points). The A. Beck’s scale, the asthenic state scale (ASS), and the point scale for assessing the condition were used. Results and discussion: The study presents two groups of patients: with multiple sclerosis (study group), 113 participants with depressive disorders, and a group of 70 participants with depressive disorders (comparison group). The study revealed that the level of depressive disorders in the MS patients was mainly represented by mild and moderate depression, while in the comparison group moderate and severe depressive disorders were more common. Indicators of depressive manifestations in the patients in the comparison group were also higher. In almost equal proportions, the patients of the compared groups experienced: "a sense of punishment", "indecision", "loss of performance", a feeling of "increased fatigue", "decreased appetite or loss of appetite", and a feeling of being "engulfed by bodily sensations", according to the Beck questionnaire. These experiences varied and depended on the severity of depressive disorder. When selecting therapy, the neurological status of the patients as well as clinical symptoms of depression, which were combined into clinical symptomatic forms, were taken into account. Drugs that could enhance neurological disorders were excluded. The drugs from the SSRI and SNRI groups were mostly selected. Using a score assessment of the condition before and after the prescription, the MS patients evaluated the effect of the received therapy, where statistically significant differences were obtained for the following drugs: escitalopram p<0.001, sertraline, fluvoxamine, and agomelatine p<0.01, and paroxetine slightly lower than p<0.05. Conclusion: Multiple sclerosis is not only a concern for neurologists, but also psychiatrists, since anxiety and depression occur in every second patient. Timely diagnosis of depressive disorders, as well as the synthesis of knowledge in the field of the development of multiple sclerosis taking into account neurological symptoms, will help clinicians prescribe pharmacotherapy in a timely manner, thereby improving the rehabilitation potential and quality of life of MS patients.