RT Journal Article
SR Electronic
T1 Disability worsening among persons with multiple sclerosis and depression
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e2216
OP e2223
DO 10.1212/WNL.0000000000008617
VO 93
IS 24
A1 Binzer, Stefanie
A1 McKay, Kyla A.
A1 Brenner, Philip
A1 Hillert, Jan
A1 Manouchehrinia, Ali
YR 2019
UL http://n.neurology.org/content/93/24/e2216.abstract
AB Objective Depression is common in multiple sclerosis (MS), but its impact on disability worsening has not yet been determined. We explored the risk of disability worsening associated with depression in a nationwide longitudinal cohort.Methods This retrospective cohort study used linked data from 3 Swedish nationwide registries: the MS Register, National Patient Register, and Prescribed Drug Register. Two incident cohorts were developed: cohort 1 included all registered cases of MS in the MS Registry (2001–2014) with depression defined as ≥1 ICD-10 code for depression; and cohort 2 comprised all cases of MS in the MS Registry (2005–2014) with depression defined as ≥1 prescription filled for an antidepressant. Cox regression models were used to compare the risk of reaching sustained disability milestone scores of 3.0, 4.0, and 6.0 on the Expanded Disability Status Scale (EDSS) between persons with MS with and without depression.Results Cohort 1 included 5,875 cases; 502 (8.5%) had depression. Cohort 2 had 3,817 cases; 1,289 (33.8%) were prescribed an antidepressant. Persons with depression were at a significantly higher risk of reaching sustained EDSS scores of 3.0, 4.0, and 6.0, with hazard ratios of 1.50 (95% confidence interval [CI] 1.20–1.87), 1.79 (95% CI 1.40–2.29), and 1.89 (95% CI 1.38–2.57), respectively. A similar increased risk among persons exposed to antidepressants was observed, with hazard ratios of 1.37 (95% CI 1.18–1.60), 1.93 (95% CI 1.61–2.31), and 1.86 (95% CI 1.45–2.40) for sustained EDSS scores of 3.0, 4.0, and 6.0, respectively.Conclusion Persons with MS and comorbid depression had a significantly increased risk of disability worsening. This finding highlights the need for early recognition and appropriate treatment of depression in persons with MS.ATC=Anatomic Therapeutic Classification; CI=confidence interval; DMT=disease-modifying therapy; EDSS=Expanded Disability Status Scale; HR=hazard ratio; ICD-9/10=International Classification of Diseases, 9th/10th revision; MS=multiple sclerosis; NPR=National Patient Register; PDR=Prescribed Drug Register; SMSreg=Swedish MS register; SPMS=secondary progressive multiple sclerosis