Research: Depression and MS


Depression is very common in multiple sclerosis
(MS) but the underlying biological mechanisms are poorly understood.
The hippocampus plays a key role in mood regulation and is implicated in
the pathogenesis of depression. This study utilizes volumetric and
shape analyses of the hippocampus to characterize neuroanatomical
correlates of depression in MS. 
A cross-section of 109 female patients
with MS was evaluated. Bilateral hippocampi were segmented from MRI
scans (volumetric T(1) -weighted, 1 mm(3) ) using automated tools. Shape
analysis was performed using surface mesh modeling. Depression was
assessed using the Center for Epidemiologic Studies-Depression (CES-D)
scale. Eighty-three subjects were classified as low depression (CES-D
0-20) versus 26 subjects with high depression (CES-D ≥ 21). Right
hippocampal volumes (P = 0.04) were smaller in the high depression
versus the low depression groups, but there was no significant
difference in left hippocampal volumes. Surface rendering analysis
revealed that hippocampal shape changes in depressed patients with MS
were clustered in the right hippocampus. Significant associations were
found between right hippocampal shape and affective symptoms but not
vegetative symptoms of depression. Our results suggested that regionally
clustered reductions in hippocampal thickness can be detected by
automated surface mesh modeling and may be a biological substrate of MS
depression in female patients
The hippocampus
(after the shape of a seahorse) is the site of memory formation there
are two on on the left and one on the right of the brain. This study
suggests that the right hippocampus is smaller in more depressed MSers.
This was associated with affective symptoms, which are mood and
emotions, rather than vegetative (sleep eating etc). The levels of
significant differences was small. This study suggests that the size of the hippocampus may influence  depression.

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  • Very interesting – I have suffered from depression for a very long time and always have felt that it must be 'organic' i.e. related to some brain changes. It would be interesting to know if depression in female MSers is among the FIRST signs of developping MS (maybe at CIS stage).

  • What about that if your memory is being affected in multiple ways, and finding words and constructing sentences the way you know you used to is difficult and odd, then conducting a conversation is altered and then identity is being impacted and it is your identity being warped that gets you depressed?
    It is not known for its euphoria in anyone to have an increasing gap going on between how we think of ourselves and how we manifest ourselves – is that not demoralising and disheartening for anyone? In the study most had 'low' depression.

    Measuring the hippocampus mostly put me in mind of phrenology when it comes to cause and effect – but hey maybe that's just my ms making tetchy.

  • I think one issue that neurologists must address is this: how to separate the issue of depression/anxiety from reported symptoms. Particularly early in the disease.

    I have had a history of depression ever since (I believe) my disease first emerged. But my disease was subclinical (though I had L'hermittes) and so all I was diagnosed with was depression. Then when I went to my doctor with twitching fingers… he just dismissed it as anxiety.

    It took me 3 neurologists and 5 doctor visits for one to spot lesions on my MRI spine.

    But my doctor still thinks my anxiety is the main issue, not my MS.

    He might be right. But I think my MS is the root cause of it. When I have no relapses I am not depressed. When I relapse I get depressed. That's the way it rolls with me. But this sentiment doesn't seem to stick with my medical advisors.

  • I'm sure my depression is 'reactive' because it can be sorted pretty much by medical reassurance, although I am also on long-term antidepressants. It's when the 'black dog' of emerging or recurrent symptoms come on me, I can feel myself become less rational. Although I know I'm over-reacting, I do it and can't stop myself till someone in a white coat/white coat equivalent puts the thing in perspective. I got something right at the start of all this – I changed neuro teams to go to a really good one, where the support is always there. It's frightening to think of the consequences of being without that support….

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