Therapeutic Advances in Neurological Disorders (Sep 2023)

Factors associated with depressive mood at the onset of multiple sclerosis - an analysis of 781 patients of the German NationMS cohort

  • Anke Salmen,
  • Robert Hoepner,
  • Vinzenz Fleischer,
  • Milena Heldt,
  • Barbara Gisevius,
  • Jeremias Motte,
  • Klemens Ruprecht,
  • Ruth Schneider,
  • Anna Lena Fisse,
  • Thomas Grüter,
  • Carsten Lukas,
  • Achim Berthele,
  • Katrin Giglhuber,
  • Martina Flaskamp,
  • Mark Mühlau,
  • Jan Kirschke,
  • Stefan Bittner,
  • Sergiu Groppa,
  • Felix Lüssi,
  • Antonios Bayas,
  • Sven Meuth,
  • Cristoph Heesen,
  • Corinna Trebst,
  • Brigitte Wildemann,
  • Florian Then Bergh,
  • Gisela Antony,
  • Tania Kümpfel,
  • Friedemann Paul,
  • Sandra Nischwitz,
  • Hayrettin Tumani,
  • Uwe Zettl,
  • Bernhard Hemmer,
  • Heinz Wiendl,
  • Frauke Zipp,
  • Ralf Gold

DOI
https://doi.org/10.1177/17562864231197309
Journal volume & issue
Vol. 16

Abstract

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Background: Depression has a major impact on the disease burden of multiple sclerosis (MS). Analyses of overlapping MS and depression risk factors [smoking, vitamin D (25-OH-VD) and Epstein-Barr virus (EBV) infection] and sex, age, disease characteristics and neuroimaging features associated with depressive symptoms in early MS are scarce. Objectives: To assess an association of MS risk factors with depressive symptoms within the German NationMS cohort. Design: Cross-sectional analysis within a multicenter observational study. Methods: Baseline data of n = 781 adults with newly diagnosed clinically isolated syndrome or relapsing-remitting MS qualified for analysis. Global and region-specific magnetic resonance imaging (MRI)-volumetry parameters were available for n = 327 patients. Association of demographic factors, MS characteristics and risk factors [sex, age, smoking, disease course, presence of current relapse, expanded disability status scale (EDSS) score, fatigue (fatigue scale motor cognition), 25-OH-VD serum concentration, EBV nuclear antigen-1 IgG (EBNA1-IgG) serum levels] and depressive symptoms (Beck Depression Inventory-II, BDI-II) was tested as a primary outcome by multivariable linear regression. Non-parametric correlation and group comparison were performed for associations of MRI parameters and depressive symptoms. Results: Mean age was 34.3 years (95% confidence interval: 33.6–35.0). The female-to-male ratio was 2.3:1. At least minimal depressive symptoms (BDI-II > 8) were present in n = 256 (32.8%), 25-OH-VD deficiency (<20 ng/ml) in n = 398 (51.0%), n = 246 (31.5%) participants were smokers. Presence of current relapse [coefficient ( c ) = 1.48, p = 0.016], more severe fatigue ( c = 0.26, p < 0.0001), lower 25-OH-VD ( c = −0.03, p = 0.034) and smoking ( c = 0.35, p = 0.008) were associated with higher BDI-II scores. Sex, age, disease course, EDSS, month of visit, EBNA1-IgG levels and brain volumes at baseline were not. Conclusion: Depressive symptoms need to be assessed in early MS. Patients during relapse seem especially vulnerable to depressive symptoms. Contributing factors such as fatigue, vitamin D deficiency and smoking, could specifically be targeted in future interventions and should be investigated in prospective studies.