title: The link between multiple sclerosis and depression.
abstract: Depression--be it a formal diagnosis based on consensus clinical criteria, or a collection of symptoms revealed by a self-report rating scale--is common in patients with multiple sclerosis (MS) and adds substantially to the morbidity and mortality associated with this disease. This Review discusses the prevalence and epidemiology of depression in patients with MS, before covering aetiological factors, including genetics, brain pathology, immunological changes, dysregulation of the hypothalamic-pituitary-adrenal axis, and psychosocial influences. Treatment options such as antidepressant drugs, cognitive-behavioural therapy, mindfulness-based therapy, exercise and electroconvulsive therapy are also reviewed in the context of MS-related depression. Frequent comorbid conditions, namely pain, fatigue, anxiety, cognitive dysfunction and alcohol use, are also summarized. The article then explores three key challenges facing researchers and clinicians: what is the optimal way to define depression in the context of diseases such as MS, in which the psychiatric and neurological symptoms overlap; how can current knowledge about the biological and psychological underpinnings of MS-related depression be used to boost the validity of this construct; and can intervention be made more effective through use of combination therapies with additive or synergistic effects, which might exceed the modest benefits derived from their individual components?
authors.affiliation: University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A1, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Feinstein
authors.affiliation: Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Royal Victoria Hospital, 1025 Pine Avenue West, Montreal, QC H3A 1A1, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Magalhaes
authors.affiliation: Neurosciences Axis, Centre Hospitalier Universitaire de Quebec Research Centre, 2705 Boulevard Laurier, Quebec City, QC G1V 4G2, Canada.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Richard
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
authors.forename: Blair
authors.initials: B
authors.lastname: Audet
authors.affiliation: Department of Neurology and Neurosurgery, McGill University, 3801 University Street, Montreal, QC H3A 2B4, Canada.
authors.forename: Craig
authors.initials: C
authors.lastname: Moore
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D006801:Humans; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D015995:Prevalence
chemical_list: D000928:Antidepressive Agents
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