“Depression, the silent killer. Up to 50% of MSers will experience major depression in their lifetime; this is much higher than the general population or for people with other chronic disabling diseases, for example rheumatoid arthritis. Depression usually coexists with a cluster of other negative symptom, which includes anxiety, fatigue, poor sleep and pain. These symptoms can all be linked to the negative consequences of having MS, i.e. breakdowns in interpersonal relationships, social isolation, unemployment, cognitive impairment and frank dementia, poor adherence to medication, increased risk of suicide, a reduction in the quality of life and a reduction in life expectancy. Why do MSers get depressed? There are many reasons for this and it is not simply a reactive depression to getting bad news about having a chronic disease. I suspect that it is linked to some of the mechanisms that underlie MS pathogenesis, i.e. ongoing inflammation and end organ damage (progressive damage to the brain). This is why it is so important to view the treatment of depression in MS holistically.”
“What is important to know that left untreated, MS-related depression does not appear to remit spontaneously, however it is responsive to treatment using both medication and psychotherapeutic interventions. How do you know if you are depressed? You can complete a simple screening questionnaire; a commonly used one is the Beck Depression Inventory below. If you are depressed you should bring this to the attention of your neurologist or GP so that they can help you with its treatment. Please note I say help; this implies that part of the treatment of depression is self-managed, which is what CBT is; a self-management tool.”
“It is also important that co-morbidities that exacerbate depression are also addressed. It is no point in treating depression without also trying to reduce the impact of other symptoms that can make depression worse. This include poor sleep, fatigue, pain, anxiety, etc. Another strategy is prevention; depression is clearly linked to progression of disease and it is therefore important to have your MS disease activity suppressed with DMTs; treat-2-target of NEDA. It is clear that the highly-effective DMTs are much better at improving Quality of Life and reducing depression, particularly when used early.”
BACKGROUND: Depression is a common symptom in MSers. We systematically reviewed published controlled trials on the effectiveness of cognitive behavioural therapy (CBT) for the treatment of depression in people with multiple sclerosis.
METHODS: Publications were identified using MEDLINE, PsycINFO and the Cochrane Central Register of Controlled Trials to June/July 2013. We combined thesaurus and free-text terms which were synonyms of the concepts MS, depression and cognitive behavioural therapy. We included published controlled trials which compared individual, group CBT, conducted face-to-face or remotely, to no CBT. Two reviewers extracted data to calculate standardized mean differences (SMD) for self-reported symptoms of depression and weighted mean differences (WMD) for the Multiple Sclerosis Impact Scale (MSIS-29), with 95% Confidence Intervals (CIs). We investigated statistical heterogeneity using I2.
RESULTS: Seven eligible studies (n = 433) were identified, which evaluated the effect on depression of CBT delivered individually (3 studies), in a group (3 studies) and by computer (1 study). The summary effect (SMD -0.61, 95% CI -0.96 to -0.26, p=0.0006) was reduced (SMD -0.46, 95% CI -0.75 to -0.17, p=0.002) when an outlying study was removed in a sensitivity analysis to examine statistical heterogeneity. Three studies (n=213) observed a direction of effect using the MSIS-29 which was not statistically significant (WMD -4.36, 95% CI -9.33 to 0.62, p=0.09). There was no between-subgroup heterogeneity (I2=0).
CONCLUSIONS: CBT can be an effective treatment for depression in MS. Further research should explore optimal durations and modalities of treatment for patients with different characteristics.