Highlights
- •Psychiatric side effects are frequently reported in multiple sclerosis (MS) patients after high-dose corticosteroids (HDC).
- •We explored the HDC effect on mood and factors that influence mood changes in MS.
- •Our results indicated caution in HDC use for MS patients with bipolar symptoms.
- •An accurate screening for mood disorders is useful prior to pulse steroid therapy initiation.
Abstract
Background
Several reports suggest a higher risk of psychiatric disorders after high-dose corticosteroids
(HDC), routinely used to treat clinical relapses in multiple sclerosis (MS).
The present study aimed to examine the possible effect of HDC on mood in patients
with MS and to determine the specific factors that influence mood changes.
Methods
The study included MS patients prior to receive HDC. The presence of depressive and
bipolar symptoms was determined with the Beck Depression Inventory-Second Edition
(BDI-II) and the Mood Disorder Questionnaire (MDQ). These assessments were made at
three time points: prior to HDC initiation, after HDC completion, and 1 month after
HDC.
Results
The study included 101 MS patients. At baseline, 32 (31.7%) patients had depressive
symptoms (BDI-II scores ≥ 14) and 20 (19.8%) patients had bipolar symptoms (MDQ scores
≥ 7). While it was observed a reduction of BDI-II scores after HDC, an increase in
MDQ score was found in patients with MDQ positivity at baseline, resulting associated
with a higher number of HDC infusions (p 0.018).
Conclusions
Our results emphasize the importance of accurate screening for mood disorders in patients
with MS prior to HDC initiation, and indicate that HDC should be used with caution
in patients with MDQ positivity.
Keywords
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References
- Quality of life in multiple sclerosis: the impact of depression, fatigue and disability.Mult. Scler. 2001; 7: 340-344
- Beck Depression Inventory: Manual. 2nd ed. The Psychological Corporation, San Antonio, Tex, USA1996
- Mood and cognitive changes during systemic corticosteroid therapy.Prim. Care Companion J. Clin. Psychiatry. 2001; 3: 17-21
- Multiple sclerosis and bipolar disorders: the burden of comorbidity and its consequences on quality of life.J. Affect. Disord. 2014; 167: 192-197
- The risk of bipolar disorders in multiple sclerosis.J. Affect. Disord. 2014; 155: 255-260
- Psychiatric issues in multiple sclerosis.Psychiatr. Clin. N. Am. 2007; 30: 803-817
- Multiple sclerosis, interferon beta-1b and depression A prospective investigation.J. Neurol. 2002; 249: 815-820
- Multiple sclerosis and depression.Mult. Scler. 2011; 17: 1276-1281
- Psychiatric disorders and depression in multiple sclerosis outpatients: impact of disability and interferon beta therapy.Neurol. Sci. 2005; 26: 255-262
- The Goldman consensus statement on depression in multiple sclerosis.Mult. Scler. 2005; 11: 328-337
- The topograpy of demyelination and neurodegeneration in the multiple sclerosis brain.Brain. 2016; 139: 807-815
- Validation of the Italian version of the "mood disorder questionnaire" for the screening of bipolar disorders.Clin. Pract. Epidemiol. Ment. Health. 2005; 1: 8
- Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).Neurology. 1983; 33: 1444-1452
- Steroid-induced psychiatric syndromes. A report of 14 cases and a review of the literature.J. Affect. Disord. 1983; 5: 319-332
- Progressive multiple sclerosis and mood disorders.Neurol. Sci. 2015; 36: 1625-1631
- The burden of multiple sclerosis and patients' coping strategies.BMJ Support Palliat. Care. 2017;
- Defining the clinical course of multiple sclerosis: the 2013 revisions.Neurology. 2014; 83: 278-286
- Depression's multiple comorbidities explained by (neuro)inflammatory and oxidative & nitrosative stress pathways.Neuro Endocrinol. Lett. 2011; 32: 7-24
- Differences in the burden of psychiatric comorbidity in MS vs the general population.Neurology. 2015; 85: 1972-1979
- A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview.Mult. Scler. 2015; 21: 263-281
- Physical comorbidities increase the risk of psychiatric comorbidity in multiple sclerosis.Brain Behav. 2016; 6: e00493
- Depression in the early phase of MS: influence offunctional disability, cognitive impairment and brain abnormalities.Acta Neurol. Scand. 1992; 86: 354-358
- Depression and hypomania symptoms are associated with high dose corticosteroids treatment for MS relapses.J. Affect. Disord. 2015; 187: 142-146
- Psychopathological and neuropsychological effects of 8-days' corticosteroid treatment. A prospective study.Psychoneuroendocrinology. 1996; 21: 25-31
- Adjustment to multiple sclerosis: application of a stress and coping model.Health Psychol. 1999; 18: 383-392
- Neurobiological mechanisms underlying emotional processing in relapsing-remitting multiple sclerosis.Brain. 2009; 132: 3380-3391
- Exogenous corticosteroids and major depression in the general population.J. Psychosom. Res. 2000; 49: 447-449
- Psychiatric side effects of interferon treatment.Curr. Drug Saf. 2006; 1: 143-150
- Depression in multiple sclerosis.Int. Rev. Psychiatry. 2017; 29: 463-472
- Health-related quality of life and depression in an Italian sample of multiple sclerosis patients.J. Neurol. Sci. 2003; 211: 55-62
- Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.Ann. Neurol. 2011; 69: 292-302
- Treating nonspecific anxiety and anxiety disorders in patients with bipolar disorder: a review.J. Clin. Psychiatry. 2011; 72: 81-90
- Neuroinflammation drives anxiety and depression in relapsing-remitting multiple sclerosis.Neurology. 2017; 89: 1338-1347
- The importance of biological oscillators for hypothalamic-pituitary-adrenal activity and tissue glucocorticoid response: coordinating stress and neurobehavioural adaptation.J. Neuroendocrinol. 2015; 27: 378-388
- EFNS guideline on treatment of multiple sclerosis relapses: report of an EFNS task force on treatment of multiple sclerosis relapses.Eur. J. Neurol. 2005; 12: 939-946
- Short-term safety of pulse steroid therapy in multiple sclerosis relapses.Clin. Neuropharmacol. 2013; 36: 1-3
- Natural history of multiple sclerosis: have available therapies impacted long-term prognosis.Neurol. Clin. 2011; 29: 309-321
- Recurrent cases of corticosteroid-induced mood disorder: clinical characteristics and treatment.J. Clin. Psychiatry. 2000; 61: 261-267
- Corticosteroid-induced psychotic and mood disorders: diagnosis defined by DSM-IV and clinical pictures.Psychosomatics. 2001; 42: 461-466
- The association of depression with disease course in multiple sclerosis.Neurology. 2005; 64: 359-360
Article info
Publication history
Published online: January 19, 2018
Accepted:
January 14,
2018
Received in revised form:
January 11,
2018
Received:
December 31,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
