Lifestyle Factors Contribute to Depression in Patients with Multiple Sclerosis

Modifiable lifestyle factors contribute to depression in multiple sclerosis (MS) patients, according to a study published in BMC Psychiatry.

Researchers from St. Vincent's Hospital Melbourne in Victoria, Australia examined nearly 2,500 MS patients in order to understand the association between lifestyle risk factors, medication, and depression risk through the analysis of self reported data. The researchers collected data about the participants' sociodemographics, diagnostic history, level of disability, comorbidities, fatigue, depression, body mass index (BMI), and an assortment of lifestyle and health behaviors. Patients were mainly female (82.4 percent) and middle aged (median age 45 years) and most patients (61.3 percent) had relapsing remitting MS. Most participants health either a bachelor (36.5 percent) or post graduate degrees (23.5 percent) and worked either full time (32.8 percent) or part time (21.3 percent). Diagnosis occurred at a median age of 37 years and half (45.2 percent) had been recently diagnosed within the last 5 years. Mild disability was reported in 54.8 percent of the patients.

About a fifth of the patients (19.3 percent, 429 patients) screened positive for depression and 21.8 percent were taking prescription medication for depression. However, 10 percent of those taking medication for depression stated they did not have depression. Of patients who screened positive for depression, 92.9 percent also screened for clinically significant fatigue. The patients reported the following symptoms:

• Little interest of pleasure in doing things: 18.9 percent
• Feeling down, depressed, or hopeless more than half the days or every day: 14.5 percent
• Depression as a comorbidity: 30.9 percent
• Of those who cited depression as a comorbidity, 70.6 percent reported receiving treatment for the condition
• Depression limits their activities: 39.1 percent

The following lifestyle factors were associated with low risks of screening positive for depression:

• Never smoking, but risk increased with former smokers and again in current smokers.
• Moderate alcohol intake, but risk increased in patients with low alcohol intake
• Exercise saw a dose response effect and was linked to lower risk of screening for depression
• Taking vitamin D was associated with low odds
• Using both omega 3 or fish oil supplements showed low odds, but flaxseed oil demonstrated the lowest odds
• Mediation, but not isolation, was associated with lower odds
• Obese patients screened positive more often than patients with normal BMI
• Increasingly poor diet and taking interferons also increased odds for positive screenings of depression

“This study demonstrates a strong clinically and statistically significant association between modifiable lifestyle factors and risk of depression,” the authors concluded. “Diet, smoking, exercise, omega 3 supplementation - particularly flaxseed oil - fish consumption, social support, vitamin D supplementation, BMI, alcohol intake, meditation and choice of medication are important modifiable factors in depression risk for people with MS. It is important for clinicians and people with MS to be aware of the wide range of modifiable lifestyle factors that may reduce depression risk as part of a comprehensive secondary and tertiary preventive medical approach to managing MS.”