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Journal of Neurology

, Volume 253, Issue 2, pp 219–223 | Cite as

Unrecognised symptoms of depression in a community–based population with multiple sclerosis

  • C. McGuigan
  • M. Hutchinson
ORIGINAL COMMUNICATION

Abstract

Background and aims

The association between multiple sclerosis (MS) and depression has been well established but prevalence estimates have varied widely. The aims of this study were to assess the point prevalence of previously unrecognised symptoms of depression in a community–based population with MS and examine their relationship to other disease characteristics.

Patients and methods

Three hundred and seventy six patients with clinically definite or probable MS (Poser criteria) were ascertained during the course of an epidemiological study on two counties in Ireland. Of these 211 agreed to participate in the study. Subjects were examined and a Kurtzke Expanded Disability Status Scale Score and Multiple Sclerosis Functional Composite score rated. Participants also completed a Beck's Depression Inventory–II and a Multiple Sclerosis Impact Scale.

Results

In total 60 (28%) patients had moderate or severe symptoms of depression. Only thirty–five of the 211 patients had a history of depression as defined by a medical diagnosis of depression or prescription of an anti–depressant medication at any time prior to enrolment in the present study, of the remaining 176 patients, 41 (23.3%) had moderate or severe symptoms of depression as assessed by Beck's Depression Inventory–II. The only significant clinical difference between the 41 patients with pronounced depressive symptoms and the 135 less affected was shorter disease duration in the former.

Conclusions

In this study one in four patients with MS had unrecognised and therefore untreated symptoms of depression. Disability alone is not a good indicator of the likelihood of coexistent depressive symptoms.

Key words

multiple sclerosis depression Beck Depression Inventory BDI EDSS 

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References

  1. 1.
    Aikens JE, Reinecke MA, Pliskin NH, et al. (1999) Assessing depressive symptoms in multiple sclerosis: is it necessary to omit items from the original Beck Depression Inventory? J Behav Med 22:127–142PubMedGoogle Scholar
  2. 2.
    Arnett PA, Higginson CI, Voss WD, et al. (1999) Depression in multiple sclerosis: relationship to working memory capacity. Neuropsychology 13:546–556PubMedGoogle Scholar
  3. 3.
    Avasarala JR, Cross AH, Trinkaus K (2003) Comparative assessment of Yale Single Question and Beck Depression Inventory Scale in screening for depression in multiple sclerosis. Mult Scler 9:307–310PubMedGoogle Scholar
  4. 4.
    Ayuso–Mateos JL, Vazquez–Barquero JL, Dowrick C, et al. (2001) Depressive disorders in Europe: prevalence figures from the ODIN study. Br J Psychiatry 179:308–316PubMedGoogle Scholar
  5. 5.
    Beck AT, Steer RA, Brown GK (1996) Beck Depression Inventory – II. Manual, 2nd ed. Harcourt Brace and CompanyGoogle Scholar
  6. 6.
    Butt Z, Crawford P (2004) Illness severity and depression in multiple sclerosis. Am J Psychiatry 161:1504CrossRefPubMedGoogle Scholar
  7. 7.
    Campbell M, Fleming JA, Li D, et al. (1992) Sleep disturbance, depression and lesion site in patients with multiple sclerosis. Arch Neurol 49:641–643Google Scholar
  8. 8.
    Chwastiak L, Ehde DM, Gibbons LE, et al. (2002) Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry 159:1862–1868CrossRefPubMedGoogle Scholar
  9. 9.
    Cutter GR, Baier ML, Rudick RA, et al. (1999) Development of a multiple sclerosis functional composite as a clinical trial outcome measure. Brain 122:871–882CrossRefPubMedGoogle Scholar
  10. 10.
    Endicott J, Spitzer RL (1978) A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry 35:837–844PubMedGoogle Scholar
  11. 11.
    Fachenhecker P ,Kumpfel T, Kalmann B, et al. (2002) Fatigue in multiple sclerosis: a comparison of different rating scales and correlation to clinical parameters. Mult Scler 8:523–526Google Scholar
  12. 12.
    Fassbender K, Schmidt R, Mofsner R, et al. (1998) Mood disorders and dysfunction of the Hypothalamic–Pituitary– Adrenal axis in multiple sclerosis. Association with cerebral inflammation. Arch Neurol 55:66–72CrossRefPubMedGoogle Scholar
  13. 13.
    Feinstein A, Roy P, Lobaugh N, et al. (2004) Structural brain abnormalities in multiple sclerosis patients with major depression. Neurology 62:586–590PubMedGoogle Scholar
  14. 14.
    Haase CG, Tinnefeld M, Daum I, et al. (2004) Cognitive, but not mood dysfunction develops in multiple sclerosis during 7 years of follow–up. Eur Neurol 52:92–95CrossRefPubMedGoogle Scholar
  15. 15.
    Hobart J, Lamping D, Fitzpatrick R, et al. (2001) The multiple sclerosis impact scale (MSIS-29). A new patientbased outcome measure. Brain 124:962–973CrossRefPubMedGoogle Scholar
  16. 16.
    Joffe RT, Lippert GP, Gray TA (1987) Mood disorder and multiple sclerosis. Arch Neurol 44:376–378PubMedGoogle Scholar
  17. 17.
    Kroencke DC, Denning DR, Lynch SG (2001) Depression during exacerbations in multiple sclerosis: the importance of uncertainty. Mult Scler 7:237–242CrossRefPubMedGoogle Scholar
  18. 18.
    Kurtzke JF (1983) Rating neurological impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 33:1444–1452PubMedGoogle Scholar
  19. 19.
    Minden SL, Orau J, Reich P (1987) Depression in multiple sclerosis. Gen Hosp Psychiatry 9:424–434CrossRefGoogle Scholar
  20. 20.
    McGuigan C, McCarthy A, Quigley C, et al. (2004) Latitudinal variation in the prevalence of multiple sclerosis in Ireland: an effect of genetic diversity. J Neurol Neurosurg Pyschiatry 75:572–576Google Scholar
  21. 21.
    Mohr DC, Goodkin DE, Gatto N, Van Der Wende J (1997) Depression, coping and level of neurological impairment in multiple sclerosis. Mult Scler 3: 254–258PubMedGoogle Scholar
  22. 22.
    Patten SB, Metz LM, Reimer MA (2000) Biopsychosocial correlates of lifetime major depression in a multiple sclerosis population. Multiple Sclerosis 6:115–120CrossRefPubMedGoogle Scholar
  23. 23.
    Patten SB, Beck CA, Williams JVA, et al. (2003) Major depression in multiple sclerosis: A population–based perspective. Neurology 61:1524–1527PubMedGoogle Scholar
  24. 24.
    Patten SB, Fridhandler S, Beck CA, Metz LM (2003) Depressive symptoms in a treated multiple sclerosis cohort. Mult Scler 9:616–620CrossRefPubMedGoogle Scholar
  25. 25.
    Poser CM, Paty DW, Scheinberg L, et al. (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231PubMedGoogle Scholar
  26. 26.
    Robins V, Brooks BR, O'Donnell P, et al. (1986) Structural brain correlates of emotional disorder in multiple sclerosis. Brain 109:585–597Google Scholar
  27. 27.
    Sadovnick AD, Eisen K, Paty DW, Ebers GC (1991) Cause of death in patients attending multiple sclerosis clinics. Neurology 41:1193–1196PubMedGoogle Scholar
  28. 28.
    Sadovnick AD, Remick RA, Allen J, et al. (1996) Depression and multiple sclerosis. Neurology 46:628–632PubMedGoogle Scholar
  29. 29.
    Stenager EN, Stenager E, Koch-Henriksen N, et al. (1992) Suicide and multiple sclerosis. J Neurol Neurosurg Psychiatry 55:542–545PubMedGoogle Scholar
  30. 30.
    Surridge D (1969) An investigation into some psychiatric aspects of multiple sclerosis. Br J Psychiatry 115:749–762PubMedGoogle Scholar
  31. 31.
    Whitlock FA, Siskind MM (1980) Depression as a major symptom of multiple sclerosis. J Neurol Neurosurg Psychiatry 43:861–865PubMedGoogle Scholar
  32. 32.
    Zung WWK (1965) A self–rating depression scale. Arch Gen Psychiatry 12:64–71Google Scholar

Copyright information

© Steinkopff-Verlag 2005

Authors and Affiliations

  1. 1.Dept. of NeurologySt. Mary's HospitalW2 1NY, LondonUK
  2. 2.St. Vincent's University HospitalDublin 4Ireland

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