Personalized therapy and its side effects in patients with multiple sclerosis with depressive disorders
Authors:   FSBEI HE Yaroslavl State Medical University of the Ministry of Health of the Russian Federation, Yaroslavl, Russia SBHI Hospital for War Veterans No. 1 of the Moscow Healthcare Department, Zarubina N. V. 
Published: October 2024

Depressive disorders in multiple sclerosis are the leading syndrome, but they have not been sufficiently studied. The clinical recommendations contain only a list of medications that were previously prescribed to patients with depression. To date, there is no description of the preferred groups of drugs for the treatment of depressive disorders, the starting dosage and timing of use, as well as possible adverse reactions when prescribing therapy to multiple sclerosis patients with depression. The purpose of this study is to search for optimal therapy for the relief of depressive disorders in patients with multiple sclerosis. Patients and methods: The study involved 203 patients with a confirmed diagnosis of multiple sclerosis (MS). The age of the patients at the time of examination ranged from 15 to 60 years, with the mean age of 39.7±10.91 years. Taking into account the type of course of the disease, MS patients were distributed as follows: 179 patients with relapsing remitting multiple sclerosis (RRMS) and 24 patients with secondary progressive multiple sclerosis (SPMS). The mean age of the examined patients with RRMS was 38±10 years; the duration of the disease was on average 8.23±6.57. The mean age of the onset of the disease was 30.2±10.5. The average disability index was EDSS 2.30±1.40. The age of the examined patients with SPMS was 46±9.00 years. The average age of onset of the disease was 33.33±8.02 years, and the level of disability was EDSS 5.70±0.30. All participants received multiple sclerosis disease modifying drugs (DMDs) and signed informed consent before being included in the study. The Beck's Depression Inventory was used to identify depression. The diagnosis of depressive disorder was established in accordance with the criteria of ICD-10 by a psychiatrist. Results and discussion: The choice of an antidepressant was made taking into account the type and degree of depression. Preference was given to the group of selective serotonin reuptake inhibitors (SSRIs), since MS patients poorly tolerate drugs with a strong sedative effect. Escitalopram was more often prescribed for anxiety depression, agomelatine for melancholic and hypochondriac depression, sertraline for asthenic depression, and fluvoxamine for adynamic depression. The starting dosage of the antidepressant in MS patients was almost twice as different from the dosage in the clinical recommendations for the treatment of depressive disorder. Due to the severity of neurological disorders, in a number of MS patients with the introduction of the starting dosage of an antidepressant, signs of sensitive ataxia, increased anxiety, and headaches were noted, therefore, the administration of an antidepressant was performed with slow titration. The association of side effects with periventricular foci in the frontal and parietal lobes of the brain has been revealed, which must be taken into account when prescribing therapy. Conclusion: Starting from the period of diagnosis of multiple sclerosis, patients need to be diagnosed for affective disorders, and risk factors that can cause depression need to be identified. When prescribing antidepressant therapy, it is necessary to take into account the type of depressive disorder, as well as the dosage of the drug, in order to exclude undesirable side effects.