Under-treatment of depression among patients with MS

Although around a quarter of all MS patients suffer depression, only a small minority is receiving the recommended treatment, according to a recent US study.The study in 260 patients with MS found that 67 (25.8%) patients met the criteria for major depressive disorder (MDD). However, 65.6% of those meeting the criteria received no antidepressant medication, 4.7% received subthreshold doses, 26.6% received doses at threshold, and only 3.1% received doses exceeding threshold.The authors note, "Depression in MS responds well to antidepressant pharmacotherapy, however, without effective treatment, depression in MS is unlikely to improve." They add that most MS patients require doses much higher than the threshold for full symptom remission, and their finding that MS patients with depression were undertreated "mirrors the larger literature from primary care that has shown that physicians who are not mental health specialists do not usually provide recommended follow-up and dose adjustment."The authors acknowledge that they did not assess whether patients chose not to initiate therapy or whether they obtained psychotherapy or other non-pharmacological forms of treatment. However, they say their findings still suggest that the recommended treatment for depression is not being delivered to those patients with MS who need it.The results do not suggest a lack of concern on the behalf of neurologists for the emotional well-being of their patients, the authors say. "Indeed, neurologists appear to be providing more pharmacotherapy for depression than anyone else for these patients," they note. Of the 70 patients receiving antidepressant medication, 55 (78.6%) received their prescriptions from their neurologists. The authors suggest that this is likely to be a reflection of the central role neurologists play in the general care of MS patients.The authors suggest strategies that may improve the treatment of MS patients with depression. One such strategy is a case-management program, involving telephone assessment and counselling by a nurse or case-manager, evaluation of adherence and response to pharmacotherapy, and feedback to the prescribing physician.Reference...