Depression and hypomania symptoms are associated with high dose corticosteroids treatment for MS relapses.
BACKGROUND
Psychiatric side effects are known to occur with low dose corticosteroids. Standard of care for Multiple Sclerosis (MS) relapses is high dose corticosteroids (HDC), at least 1g/day for 3-5 days, and yet the relationship between this treatment and mood is not known. We sought to determine the frequency and potential predictors of (hypo)manic and depressive symptoms with HDC treatment for MS relapses.


METHODS
Consecutive MS subjects requiring HDC treatment were identified. The Mood Disorders Questionnaire (MDQ) and the Beck Depression Inventory-Fast Screen (BDIFS) were administered for (hypo)manic and depressive symptoms, respectively, prior to HDC, 3 days and one month post-HDC.


RESULTS
Eighty eight subjects completed the study. At relapse diagnosis, the mean BDIFS score was 4.2 (SD 3.1); the mean number of (hypo)manic symptoms endorsed on the MDQ was 4.3 (SD 3.5). Three days after completing HDC, 22.5% had an increase on the BDIFS and 38.2% endorsed more symptoms on the MDQ. A history of depression (p=0.006) and low reported quality of life (p=0.029) predicted an increase on the MDQ; the odds of an increase in (hypo)manic symptoms was 5.6 times higher with a history of any psychiatric disease/substance abuse (p=0.005). No predictors for worsening on the BDIFS were found.


CONCLUSIONS
Self-reported measures were used, anxiety was not evaluated and 17 subjects were lost to follow up.


CONCLUSIONS
Depressive and hypo(manic) symptoms are commonly associated with HDC for MS relapses. It is important for clinicians and MS patients to be aware of this risk.
Department of Clinical Neurological Sciences, London Health Sciences Center (LHSC), London, ON, Canada; Western University, London, ON, Canada. Electronic address: Sarah.morrow@lhsc.on.ca.
Sarah Anne
SA
Morrow
Western University, London, ON, Canada; Department of Psychiatry, LHSC, London, ON, Canada.
Jennifer
J
Barr
Department of Clinical Neurological Sciences, London Health Sciences Center (LHSC), London, ON, Canada.
Heather
H
Rosehart
Department of Psychiatry, LHSC, London, ON, Canada.
Sandra
S
Ulch
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D003527:Cyclothymic Disorder / Q000139:chemically induced*; D003863:Depression / Q000139:chemically induced*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones
Corticosteroids; Depression; Hypomania; Multiple Sclerosis; Relapses