50 msfocusmagazine.org Medicine & Research Depression and Multiple Sclerosis By Ellen Whipple, Pharm.D. Depression is a common symptom associated with multiple sclerosis. Estimates of the prevalence of depression range from 40-60 percent in people with MS. By comparison, approximately 20 percent of the general population experiences depression. Because depression is one key critical determinant of quality of life, and may well be the key determining factor, it should be screened for and treated in people with MS. Depression can also contribute to other problems, including fatigue, cognitive dys- function, sexual problems, pain, and motor issues. The effect of brain lesions It was speculated that MS-related lesions in the CNS may contribute to the increased prevalence of depression in patients with MS. Data suggest that the specific location of the lesions may also be a contributing factor. One recent study reported MS patients suffering from depression had “more hyper-intense lesions in the left inferior medial frontal regions and greater atrophy of left anterior temporal regions.” According to Dr. Ben Thrower, medical director of the Andrew C. Carlos MS Institute at Shepherd Center in Atlanta, much still needs to be learned about the relationship between brain lesions and occurrence of depression. Dr. Thrower said, “There is a clear and present need for further research on this topic. Recent advances in the understanding of neuropathology, neuro- psychology, and neuroimaging of depression may help to further define the relationship between lesions or lesion load and the occurrence of depression.” The effect of fatigue Fatigue is the most common symptom affecting patients with MS. It has been reported in more than 90 percent of patients with MS. Interestingly, fatigue is a common symptom of both depression and MS. According to Dr. Thrower, “While fatigue and depression are assumed to be related in people with MS, why or how this relationship exists is not fully understood.” Studies suggest that treating depression in people with MS does seem to produce improvements in fatigue and vice versa. In many cases, it can also be possible to treat fatigue and depression simultaneously. Generally, antidepressants that are “uplifting” or give energy are preferred. Medications like bupropion (Wellbutrin®), fluoxetine (Prozac®), and venlafaxine (Effexor®) are examples of some “uplifting” antidepressants that may help also decrease the symptoms of fatigue. The effect of disease-modifying therapies Disease-modifying therapies (DMTs) have revolutionized the treatment of MS. These products decrease relapses and accumulation of disease-related damage. In theory, consistent treatment with DMTs can also decrease the RX Update