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Depression often complicates multiple sclerosis (MS). Estimates vary, but 50 to 60% of MS patients develop some degree of depression and, like depression in general, it responds to treatment. In the most recent issue of Neurology, two articles shed new light on the problems of depression and suicide in MS. Feinstein studied 140 patients attending an MS clinic in Toronto, Canada. He found that 40 (29%) patients had thought about committing suicide and nine had attempted suicide. Among the entire group of 140 patients, about one-third had a history of major depression at some time. In comparing the 40 patients who had a history of suicidal intent with the 100 who did not, Feinstein discovered that there were no differences between the two groups in age, sex, duration or type of MS, physical disability, or cognitive impairment. However, the group with a history of suicidal intent were much more likely to have problems with depression. About one-third of the suicidal group had evidence of significant depression at the time of study, compared with only 2% in the nonsuicidal group. In addition, 83% of the suicidal group had a history of major depression at some time in their lives compared with only 18% of the nonsuicidal group. The three most important factors that seemed to predict suicidal intent were living alone, severe depression, and history of alcohol abuse.
The study by Patten and Metz addressed the concern that a commonly used treatment for MS, ß-interferon, might cause depression as a side effect. As part of a 3-year study comparing placebo vs one type of ß-interferon, Patten and Metz assessed 365 MS patients every 6 months for depression. They found that patients receiving ß-interferon were no more likely to be depressed than those receiving placebo, indicating that depression is not a common side effect of ß-interferon treatment. They discovered that depression among MS patients fluctuates over time. This suggests that it is important for physicians caring for MS patients to evaluate for depression at each clinic visit. This is important because severe depression among MS patients often goes untreated, yet MS patients with depression do respond to treatment with antidepressants and psychotherapy
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