Multiple Sclerosis Exacerbations Require Anxiety and Depression Assessment

Patients with multiple sclerosis (MS) who are experiencing pseudoexacerbations or confirmed exacerbations of disease should be assessed and monitored for depressive and anxiety symptoms, according to researchers at the Feinberg School of Medicine at Northwestern University in Chicago and the Yale School of Medicine in New Haven, Connecticut. They suggested that confirmed exacerbations are of particular concern in patients who have a history of depression.

Burns and colleagues¹ conducted a secondary analysis of 121 patients with MS to determine whether pseudoexacerbations and confirmed MS exacerbations are preceded by or concurrent with increased anxiety or depressive symptoms.

The patients, who were observed for 48 weeks during a randomized controlled trial that compared cognitive behavioral stress management therapy with a waitlist control, completed monthly self-reports on depressive and anxiety symptoms. Patient-reported exacerbations were assessed through a telephone-administered symptom checklist and neurological examination.

Pseudoexacerbations were associated with concurrent affective depressive and anxiety symptoms, controlling for baseline symptoms, and also were associated with somatic depressive symptoms. There was a significant main effect of confirmed exacerbations on somatic depressive and anxiety symptoms and a nonsignificant trend for a main effect on affective depressive symptoms. Preexisting somatic and affective depressive symptoms predicted amplified relationships between concurrent confirmed exacerbations and these symptoms.

A standard deviation increase in anxiety symptoms relative to baseline predicted subsequent onset of pseudoexacerbations; an increase in somatic depressive symptoms predicted confirmed exacerbations.

The authors noted that baseline psychological symptoms were not predictive of subsequent pseudoexacerbations or confirmed exacerbations but rather pseudoexacerbations were predicted by recent increases in anxiety symptoms, consistent with the notion that anxiety symptoms could be mistaken for symptoms of MS exacerbations.

Reference

1. Burns MN, Nawacki E, Siddique J, et al. Prospective examination of anxiety and depression before and during confirmed and pseudoexacerbations in patients with multiple sclerosis. Psychosom Med. 2012 Nov 28. [Epub ahead of print.]