Multiple sclerosis, depression, and suicide

Clinicians should pay more attention to psychopathology

Mental illness leaves patients at risk for harming or killing themselves, none more so than major depression, with which a 15% lifetime prevalence of suicide has been consistently noted.1 Less clear is how these figures translate when applied to patients with neurological disease, particularly those conditions known to be associated with a high risk of comorbid depression.

An example is multiple sclerosis, the leading neurological cause of disability in young and middle aged adults. Depressive symptoms of sufficient severity and duration to warrant a diagnosis of major depression affect up to half of patients during the course of their illness.2 This is three times the prevalence reported for major depression and psychiatric comorbidity in community based samples, and it also exceeds that for other neurological disorders.3 Depression in multiple sclerosis is not linked to a family history of affective disorder,2 nor is it more likely to occur before the start of neurological symptoms.4 While detection of brain lesions …