Effects of treatment for depression on fatigue in multiple sclerosis.
OBJECTIVE
There has long been a belief that depression contributes to fatigue in multiple sclerosis (MS) although supporting data are minimal at best. Clinical guidelines for the treatment of fatigue include recommendations for the treatment of depression in the absence of clear empirical support. The goal of this study was to examine the effects of treatment for depression on fatigue in MS.


METHODS
Sixty patients with a relapsing form of MS and moderate to severe depression were randomly assigned to one of three validated 16-week treatments for depression: individual cognitive behavioral therapy, group psychotherapy, or sertraline. Assessments at baseline and treatment cessation included the primary outcome measure, fatigue assessment instrument (FAI), and Beck depression inventory (BDI).


RESULTS
The total FAI and the global fatigue severity subscale were significantly reduced over the course of treatment (p values <.02). Other subscales did not change significantly. Secondary analyses showed change in global fatigue severity was associated with change in BDI (p =.03) but change in total FAI was only marginally related to change in BDI (p =.05). These relationships were due entirely to change in mood (p values <.02) and not to change in cognitive or vegetative symptoms (p values >.17).


CONCLUSIONS
These findings suggest that treatment for depression is associated with reductions in the severity of fatigue symptoms, and that this relationship is due primarily to treatment related changes in mood.
Mohr
David C
DC
University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, California 94121, USA. dmohr@itsa.ucsf.edu
Hart
Stacey L
SL
Goldberg
Alison
A
D000328:Adult; D000339:Affect / Q000187:drug effects; D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D005221:Fatigue / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000523:psychology; D011615:Psychotherapy, Group; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D020280:Sertraline / Q000494:pharmacology / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline