Depression and anxiety disorders in patients with multiple sclerosis: association with neurodegeneration and neurofilaments.

C.B Tauil,F.M Da Silva,C.O Brandão,A.D Rocha-Lima,C Ramari,L.L Dos Santos-Neto,L.A Machado,L.M.B Dos Santos,B.B Ferrari

doi:10.1590/1414-431x202010428

Abstract

There is increasing evidence that neurofilament light chain (NF-L) can be considered as a biomarker for neuro-axonal damage. This polypeptide can be released into the cerebrospinal fluid (CSF) and the blood, where it can be quantified. The concentration of NF-L is elevated in patients with multiple sclerosis (MS) and psychiatric disorders. We aimed to investigate the NF-L levels in the CSF from treated MS patients and the relationship with depression or anxiety. The study involved three groups: control group (individuals without inflammation), the relapse-remitting multiple sclerosis (RRMS)-untreated group, and the RRMS-Fingo group (RRMS patients who were treated with fingolimod). MS disability was assessed by the Expanded Disability Status Scale, and depression and anxiety were evaluated by a neuropsychologist, using the Hospital Anxiety and Depression Scale, the Beck Depression Inventory-II, and the Beck Anxiety Inventory. Individual CSF samples were collected to measure NF-L levels. The results of the statistical analysis on levels of NF-L in the CSF of control subjects, RRMS-untreated patients, and RRMS-Fingo patients were significant. The relationship between depression and anxiety in RRMS-Fingo patients and NF-L levels was not statistically significant. In conclusion, MS events such as anxiety and depression appear to contribute to the onset of clinical relapses, subclinical cases, and neurodegeneration.

Highlights

Multiple sclerosis (MS) is the most frequent disabling neurological disease in young adults, except for those of traumatic causes [1,2]
This study aimed to investigate the neurofilament light chain (NF-L) levels in the cerebrospinal fluid (CSF) of MS patients treated with fingolimod and the relationship with depression or anxiety
We hypothesized that MS patients with anxiety and depression have a higher neurodegenerative activity and that this may increase the levels of NF-L in the CSF during the onset of the disease

Summary

Introduction

Multiple sclerosis (MS) is the most frequent disabling neurological disease in young adults, except for those of traumatic causes [1,2]. The disease is a consequence of inflammation and neurodegeneration in the central nervous system (CNS). Relapse-remitting multiple sclerosis (RRMS) is the most frequent form of MS. Similar to other autoimmune diseases, the pathophysiology of MS involves genetic and environmental factors [3]. Events such as psychological stressors and states of anxiety and depression in RRMS appear to contribute to the onset of clinical relapses and subclinical cases [4]. New gadolinium-containing inflammatory lesions observed via magnetic resonance imaging (MRI) can be interpreted as biomarkers of unfavorable disease evolution, which includes motor, sensory, and cognitive impairments [5]

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Conclusion