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Depression With MS Can Be a Fatal Mix

By Denise Mann
HealthDay Reporter

THURSDAY, Sept. 2, 2021 (HealthDay News) -- Depression and multiple sclerosis (MS) tend to travel together, new research finds, and when they do the chances of dying during the next decade can be up to five times greater than it is for those with neither condition.

Although it is unclear why this combination can be so deadly, Dr. Raffaele Paladino of Imperial College London, who is a researcher, said that there may be several contributing factors. For starters, depression is associated with inflammation and other brain changes that increase stroke risk.

"People with psychiatric disorders may not have their cardiovascular risk factors managed as well, and depression is associated with poorer health behaviors [diet, physical activity] which can negatively affect MS as well as other aspects of health," Palladino said.

Affecting nearly 1 million people in the United States, MS occurs when the immune system misfires against the central nervous system, which is made up of the brain, spinal cord and optic nerves. Symptoms range from mild to severe and may include numbness, fatigue, bladder issues, walking difficulties, and problems with thinking and memory. Palladino explained that nearly 20% of MS sufferers also have depression.

The study involved reviewing the medical records for nearly 85,000 MS patients. They tracked who developed vascular disease or died over a 10-year period. At the start of the study, 21% of the people with MS were depressed, as were 9% of those folks without MS.

People with MS and depression were more than five times as likely to die of any cause during the next decade when compared to people with neither condition after researchers controlled for other factors that could affect the risk of dying such as smoking and diabetes.

The study found that people with both MS and depression were three times more likely to get vascular disease than those without either condition.

We also saw a decrease in mortality risk if there was a history or MS. According to the study, people suffering from MS without any depression were four times more likely than those who suffered from neither. People with MS without MS had nearly twice the risk of dying. And people living with MS without MS had nearly twice as much chance.

It's too early to say whether treating depression in people with MS will help improve vascular risk factors such as inflammation in the brain and lower the chances of dying. Awareness about the symptoms of depression in MS and family support are critical, Palladino said.

Common symptoms of depression may include feelings of sadness, tearfulness; irritability; loss of interest in normal activities; sleep disturbance; fatigue; changes in appetite; feelings of guilt; trouble thinking, and frequent thoughts of death, he said.

"Appropriate mental health screening followed by timely, effective intervention is an essential step to mitigate [depression's] burden," Palladino said.

The study appears in the Sept. 1 issue of Neurology.

The study was not conducted by two experts. They stressed the importance to recognize signs and treatment for vascular disease and depression in MS patients.

This study identifies the relationship between MS and depression "and highlights the impact of this combination on incident vascular risk and all-cause mortality," said Dr. Emily Pharr, an assistant professor of neurology at Wake Forest Baptist Medical Center in Winston-Salem, N.C. "These findings emphasize the importance of close monitoring of symptoms of depression and vascular risk factors in our patients living with MS."

Julie Fiol, associate vice president of health care access at the National MS Society, agreed. These findings will have immediate clinical consequences. She said that it is crucial to treat and screen MS patients.

Fiol said that MS depression is more than just an outcome of having a chronic disease.

Fiol said, "It is also something biological that happens beyond the person's reach." "Left untreated, depression reduces quality of life, makes other MS symptoms -- including fatigue, pain, cognitive changes -- feel worse, and may be life-threatening."

More information

Learn more about depression and MS at the National MS Society.

SOURCES: Raffaele Palladino, MD, PhD, research associate, Imperial College London, United Kingdom; Emily Pharr, MD, assistant professor, neurology, Wake Forest Baptist Medical Center, Winston-Salem, N.C.; Julie Fiol, associate vice president, health care access, National MS Society, New York City; Neurology, Sept.1, 2021