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Abstracts & Commentary
Sources: Feinstein A. An examination of suicidal intent in patients with multiple sclerosis. Neurology. 2002;59:674-678; Patten SB, Metz LM. Interferon-beta1a and depression in secondary progressive MS: Data from the SPECTRIMS Trial. Neurology. 2002;59:744-746; Feinstein A, et al. Multiple sclerosis, interferon-beta1b and depression. J Neurol. 2002;249: 815-820.
In the study by Feinstein, 140 MS patients were interviewed in an outpatient MS clinic in Toronto, Canada, for lifetime prevalence of DSM-IV major depression and anxiety disorders. He found that 40 patients (29%) had thought about committing suicide and 9 had attempted suicide. The patients with suicidal ideation had a similar demographic pattern and similar levels of neurological disability from MS but were much more likely to be actively depressed (30% vs 2% in the nonsuicidal group) or have a history of major depression in their lives (83% vs 18%). Risk factors for suicidal intent were the past or current depressive history, a family history of mental illness, living alone, and a history of alcohol abuse.
Two studies examined the potential effects of interferon-beta on depression in MS patients. In a large trial, presented by Patten and Metz, of 365 patients with secondary progressive MS initiating interferon-beta1a at 2 doses (22 and 44 m TIW), there was no significant difference in depression ratings before and after drug administration, and also no significant differences compared to the placebo group. Similarly, Feinstein et al studied 40 relapsing-remitting MS patients pre- and posttreatment with interferon-beta1b. At baseline, 21% of patients were diagnosed with a major depression, and these patients were started on antidepressant medication. There was an overall decrease in depression to 11% and 6% at months 6 and 12, respectively.
The high lifetime prevalence of depression in MS, 40-60% in most series, along with other variants of mood disorder including anxiety and bipolar-affective illness, should make the psychiatric complications of MS a central component of disease management. These studies provide an additional understanding of depression and suicidal behavior in patients with MS, documenting some predictable risk factors for suicidal ideation. Two studies reassuringly demonstrate that the use of interferon-beta does not significantly aggravate depression, particularly when used with antidepressant medication. Nonetheless, psychiatric complications, including depression and suicide, of the related type I interferon-alpha used at higher doses have been well described in the medical literature. Given the variable lifetime course for depression in MS, physicians should consistently probe for worsening mood complications of MS and treat aggressively with medication and/or mental health counseling. —Brian R. Apatoff
Dr. Apatoff, Associate Professor of Neurology, New York Presbyterian Hospital-Cornell Campus, is Assistant Editor of Neurology Alert.