title: Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis.
abstract: BACKGROUND
  Depression and anxiety are common in persons with multiple sclerosis (MS), and adversely affect fatigue, medication adherence, and quality of life. Though effective treatments for depression and anxiety exist in the general population, their applicability in the MS population has not been definitively established.
  
  
  OBJECTIVE
  To determine the overall effect of psychological and pharmacological treatments for depression or anxiety in persons with MS.
  
  
  METHODS
  We searched the Medline, EMBASE, PsycINFO, PsycARTICLES Full Text, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and Scopus databases using systematic review methodology from database inception until March 25, 2015. Two independent reviewers screened abstracts, extracted data, and assessed risk of bias and strength of evidence. We included controlled clinical trials reporting on the effect of pharmacological or psychological interventions for depression or anxiety in a sample of persons with MS. We calculated standardized mean differences (SMD) and pooled using random effects meta-analysis.
  
  
  RESULTS
  Of 1753 abstracts screened, 21 articles reporting on 13 unique clinical trials met the inclusion criteria. Depression severity improved in nine psychological trials of depression treatment (N=307; SMD: -0.45 (95%CI: -0.74, -0.16)). The severity of depression also improved in three pharmacological trials of depression treatment (SMD: -0.63 (N=165; 95%CI: -1.07, -0.20)). For anxiety, only a single trial examined psychological therapy for injection phobia and reported no statistically significant improvement.
  
  
  CONCLUSIONS
  Pharmacological and psychological treatments for depression were effective in reducing depressive symptoms in MS. The data are insufficient to determine the effectiveness of treatments for anxiety.
authors: Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, 820 Sherbrook Street, Winnipeg, Canada R3A1R9.
authors: K M
authors: KM
authors: Fiest
authors: Department of Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Canada R3E3N4.
authors: J R
authors: JR
authors: Walker
authors: Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, 820 Sherbrook Street, Winnipeg, Canada R3A1R9.
authors: C N
authors: CN
authors: Bernstein
authors: Department of Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Canada R3E3N4.
authors: L A
authors: LA
authors: Graff
authors: Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, 820 Sherbrook Street, Winnipeg, Canada R3A1R9; George and Fay Yee Centre for Health Care Innovation, University of Manitoba, 820 Sherbrook Street, Winnipeg, Canada R3A1R9.
authors: R
authors: R
authors: Zarychanski
authors: George and Fay Yee Centre for Health Care Innovation, University of Manitoba, 820 Sherbrook Street, Winnipeg, Canada R3A1R9.
authors: A M
authors: AM
authors: Abou-Setta
authors: Departments of Community Health Sciences and Psychiatry, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Canada T2N4Z6.
authors: S B
authors: SB
authors: Patten
authors: Department of Psychiatry, College of Medicine, Faculty of Health Sciences, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Canada R3E3N4.
authors: J
authors: J
authors: Sareen
authors: Department of Psychiatry, College of Medicine, Faculty of Health Sciences, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Canada R3E3N4.
authors: J M
authors: JM
authors: Bolton
authors: Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, 820 Sherbrook Street, Winnipeg, Canada R3A1R9.
authors: J J
authors: JJ
authors: Marriott
authors: Departments of Psychiatry, Medicine, Psychology & Neuroscience, Dalhousie University, 6299 South Street, Halifax, Canada B3H4R2.
authors: J D
authors: JD
authors: Fisk
authors: Department of Family Medicine, University of Manitoba, 400 Tache Avenue, Winnipeg, Canada R2H3E1.
authors: A
authors: A
authors: Singer
authors: Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, 820 Sherbrook Street, Winnipeg, Canada R3A1R9; Department of Community Health Sciences, College of Medicine, University of Manitoba, 820 Sherbrooke Street, Winnipeg, Canada R3A1R9. Electronic address: rmarrie@hsc.mb.ca.
authors: R A
authors: RA
authors: Marrie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000150:complications* / Q000188:drug therapy / Q000628:therapy*; D002986:Clinical Trials as Topic; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000150:complications* / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D011613:Psychotherapy; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anxiety; Depression; Meta-analysis; Multiple sclerosis; Systematic review; Treatment