Antidepressant Treatment for Major Depression in Multiple Sclerosis

Abstract

Major depressive disorder (MDD) is widely acknowledged to be an important clinical issue in multiple sclerosis (MS). Although antidepressant medications are generally regarded as efficacious, few studies have been conducted on their use in MS patients. Recently a randomized controlled trial reported negative results, raising new questions about the efficacy of these medications in this population. The objective of this review was to revisit the question of the efficacy of antidepressant medications in the treatment of MDD in MS. A literature search uncovered only three randomized controlled trials on this topic. These studies differed in their methodology, including the specific antidepressants used (desipramine, sertraline, paroxetine), the approach to the analysis (two of the three used intention-to-treat analyses), measures of depression (two defined response as a 50% reduction in the Hamilton Depression Rating Scale, and two included the Beck Depression Inventory), methodological features (two used blinding, and one included cases of dysthymia), and duration of follow-up (ranging from 1 to 4 months). Nevertheless, all of the results suggested modest therapeutic benefits for the medications evaluated. Although the current literature in this field is inadequate, the best available evidence points toward a modest positive effect of certain medications in the treatment of depression in people with MS.