title: Insufficient treatment of severe depression in neuromyelitis optica spectrum disorder.
abstract: OBJECTIVE
  To investigate depression frequency, severity, current treatment, and interactions with somatic symptoms among patients with neuromyelitis optica spectrum disorder (NMOSD).
  
  
  METHODS
  In this dual-center observational study, we included 71 patients diagnosed with NMOSD according to the International Panel for NMO Diagnosis 2015 criteria. The Beck Depression Inventory (BDI) was classified into severe, moderate, or minimal/no depressive state category. We used the Fatigue Severity Scale to evaluate fatigue. Scores from the Brief Pain Inventory and the PainDETECT Questionnaire were normalized to estimate neuropathic pain. Psychotropic, pain, and immunosuppressant medications were tabulated by established classes.
  
  
  RESULTS
  Twenty-eight percent of patients with NMOSD (n = 20) had BDI scores indicative of moderate or severe depression; 48% of patients (n = 34) endorsed significant levels of neuropathic pain. Severity of depression was moderately associated with neuropathic pain (r= 0.341,p< 0.004) but this relationship was confounded by levels of fatigue. Furthermore, only 40% of patients with moderate or severe depressive symptoms received antidepressant medical treatment. Fifty percent of those treated reported persistent moderate to severe depressive symptoms under treatment.
  
  
  CONCLUSIONS
  Moderate and severe depression in patients with NMOSD is associated with neuropathic pain and fatigue and is insufficiently treated. These results are consistent across 2 research centers and continents. Future research needs to address how depression can be effectively managed and treated in NMOSD.
authors: NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany.
authors: Velina S
authors: VS
authors: Chavarro
authors: NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany.
authors: Maureen A
authors: MA
authors: Mealy
authors: NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany.
authors: Alexandra
authors: A
authors: Simpson
authors: NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany.
authors: Anna
authors: A
authors: Lacheta
authors: NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany.
authors: Florence
authors: F
authors: Pache
authors: NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany.
authors: Klemens
authors: K
authors: Ruprecht
authors: NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany.
authors: Stefan M
authors: SM
authors: Gold
authors: NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany.
authors: Friedemann
authors: F
authors: Paul
authors: NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany.
authors: Alexander Ulrich
authors: AU
authors: Brandt
authors: NeuroCure Clinical Research Center (V.S.C., A.L., F. Pache, F. Paul, A.U.B.), Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology (F. Pache, K.R., F. Paul), and Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (S.M.G.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.A.M., A.S., M.L.), Johns Hopkins University, Baltimore, MD; Experimental and Clinical Research Center (F. Paul), Max Delbrueck Center for Molecular Medicine, Berlin; and Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (S.M.G.), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Germany.
authors: Michael
authors: M
authors: Levy