Brain lesion volume and neuropsychological function predict efficacy of treatment for depression in multiple sclerosis.
This study examined the effects of brain lesions and neuropsychological impairment on the efficacy of treatment for depression in patients with comorbid diagnoses of multiple sclerosis (MS) and major depressive disorder (MDD). Thirty patients meeting criteria for MS and MDD received 1 of 3 16-week treatments for depression and were followed for 6 months following treatment cessation. T2-weighted magnetic resonance imaging and neuropsychological evaluations were also obtained. End-of-treatment Beck Depression Inventory (BDI; A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) results residualized for baseline BDI were related to right temporal periventricular lesion volume (R2=.32, p=.002) and left temporal grey-white junction lesion volume (R2=.19, p=.02) but were not statistically related to lesion volume in any other brain region or to neuropsychological function. BDI results at 6-month follow-up, residualized for end-of-treatment BDI, were predicted by total lesion volume (R2=.22, p=.005), lesion volume in many discrete areas, and neuropsychological functioning (R2=.29, p=.0009). The effect of total lesion volume on 6-month follow-up BDI results was fully mediated by neuropsychological function.
Mohr
David C
DC
Department of Psychiatry & Neurology, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, CA, USA. dmohr@itsa.ucsf.edu
Epstein
Lucy
L
Luks
Tracy L
TL
Goodkin
Donald
D
Cox
Darcy
D
Goldberg
Alison
A
Chin
Cynthia
C
Nelson
Sarah
S
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology*; D002552:Cerebral Ventricles / Q000473:pathology; D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D009460:Neurologic Examination / Q000706:statistics & numerical data; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care; D010555:Personality Inventory / Q000706:statistics & numerical data; D011379:Prognosis; D011594:Psychometrics; D011615:Psychotherapy, Group; D015203:Reproducibility of Results; D020280:Sertraline / Q000627:therapeutic use*; D013702:Temporal Lobe / Q000473:pathology
D000928:Antidepressive Agents; D020280:Sertraline