Treating Depression in Multiple Sclerosis

Treating depression in patients with multiple sclerosis is tricky.

Writing in Journal Frontiers in Neurology on January 25, 2016, Yuwen Hung, of the Martinos Imaging Center at the McGovern Institute for Brain Research in Cambridge, Massachusetts, and Pavel Yarmak of the Neuroscience Research Center at St. Michael’s Hospital in Toronto offer a framework for optimizing treatment for patients with multiple sclerosis (MS) and depression or other emotional problems.

Depression often goes hand-in-hand with MS, according to the authors who say, “approximately half of all the patients with multiple sclerosis (MS) experience clinically significant depression at least once in their lifetimes and even more exhibit emotional symptoms.” However, few MS patients are treated for depression either through psychotherapy or pharmaceutical therapy, partly because “the side effect profile of conventional antidepressant treatments can complicate MS management," they noted. Yet, there are some practical strategies for treatment.

The authors suggest that “it is advisable to consider combining psychotherapy with neurocognitive rehabilitation in current MS treatment options to optimize treatment outcomes.” It is likely that patients with MS need help in developing strategies for coping with stress, such as those provided in cognitive behavioral therapy (CBT). “CBT corrects the MS patients’ negative attention and perception toward daily challenges as well as adjusting their maladaptive ways of thinking” which helps patients “learn to cope with existing and continuing cognitive impairments," the team concluded.

Neurocognitive rehabilitation “aims to retrain the impaired cognitive functions and allow the brain to maximize cognitive capacity,” they wrote. When used in conjunction with CBT, neurocognitive rehabilitation could be helpful as it “may also facilitate the effects of CBT through positive feedback that increases the patients’ sellf-efficacy,” they said.

When the two therapies are provided together as a form of early preventative intervention they could “potentially lower the substantial incidence of depression in MS,” the researchers said.

The authors suggest that multimodal approaches should be researched in the future.