DOWNLOAD ~ Diagnosing Depression in MS in the Face of Overlapping Symptoms (Commentary) (Report) * by The International MS Journal ~ eBook PDF Kindle ePub Free
eBook details
- Title: Diagnosing Depression in MS in the Face of Overlapping Symptoms (Commentary) (Report)
- Author : The International MS Journal
- Release Date : January 01, 2010
- Genre: Health & Fitness,Books,Health, Mind & Body,
- Pages : * pages
- Size : 196 KB
Description
Depression is an important problem in multiple sclerosis (MS), but the diagnosis is challenging since symptoms of depression overlap with those of MS. In the past, the main strategy has been to remove physical symptoms from scales assessing depressive symptoms in MS, but these attempts have not been successful. Depression and overlapping MS symptoms may actually share pathophysiological mechanisms, so the strategy of attempting to exclude such symptoms may be fundamentally flawed. Current diagnostic criteria provide a pragmatic solution, but it may be possible to develop improved definitions. Depressive disorders occur frequently (1) and are among the most important determinants of quality of life in MS. (2) Three randomized, controlled trials have reported modest beneficial effects from short-term treatment with desipramine, (3) sertraline or cognitive behavioural therapy (4) and paroxetine. (5) These studies used diagnostic definitions from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), the latter two used criteria from the latest (fourth) edition (DSM-IV). (6) The DSM-IV definition of a Major Depressive Episode requires that one of two key symptoms be present: depressed mood or loss of interest or pleasure, or both. Further, the diagnostic criteria stipulate that at least five symptoms from a list of nine must be present. These symptoms may include: disturbances of sleep; changes in appetite; fatigue; cognitive problems; excessive guilt or worthlessness; motor changes (agitation or retardation); and persistent thoughts of death or suicide. Three of these symptoms, cognitive deficits, (7) fatigue (8) and sleep disturbance, (9) occur in a large proportion of people with MS. This combination of factors creates a dilemma for clinicians: clinical trials emphasize the need to diagnose and treat depressive disorders, but diagnostic definitions for these disorders include symptoms that overlap with MS itself and do not necessarily indicate that a depressive disorder is present.