Appendices: Antidepressant Treatment for Major Depression in Multiple Sclerosis: the Evolving Efficacy Literature
AuthorPatten, Scott B.
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AbstractBackground: Major depression is now widely acknowledged as being an important clinical issue in multiple sclerosis. Antidepressant medications are generally regarded as being efficacious treatments. Unfortunately, the literature of treatment studies is small. Recently a randomized controlled trial reported negative results, raising new questions about the efficacy of these medications. The objective of this study was to revisit the question of whether antidepressant medications are efficacious in the treatment of major depression in MS. Results: A literature search uncovered only three randomized controlled trials. These studies had methodological differences including the approach to the analysis (2 of three used intention to treat analyses), measures of depression (two evaluated response as a 50% reduction in HAM-D, and 2 included the Beck Depression Inventory), methodological features (2 used blinding, one included cases of dysthymia) and duration of follow-up (ranging from one to four months). Despite this, all of the results were in the same direction, suggesting modest therapeutic benefits for the medications evaluated: desipramine, sertraline and paroxetine. Conclusions: The current literature in this field is inadequate. However, the best available evidence continues to point towards a modest positive effect of certain medications for acute treatment of depression in MS.
These are appendices accompanying a paper to be published in 2009 in the International Journal of MS Care.