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New guideline on emotional disorders

by Liza Berger

The American Academy of Neurology (AAN) in January 2014 released a new clinical guideline, “Assessment and Management of Psychiatric Disorders in Individuals with Multiple Sclerosis.” To develop the guideline, a panel of experts reviewed and rated 115 research studies that met strict AAN criteria for methodological rigor—culled from thousands of research abstracts—to create recommendations for identifying, diagnosing and treating emotional disorders in individuals with MS.

This guideline is important because individuals with MS are at increased risk of emotional disorders, such as depressed mood, anxiety and pseudobulbar affect (PBA). If not detected and treated, these disorders can worsen functioning and quality of life and lead to other negative outcomes, including suicide.

Treatment findings
The panel found insufficient evidence in the research literature either for or against most types of cognitive-behavioral therapy (CBT) used for treating depressed mood or anxiety. One type—administered by telephone—was found to be possibly effective.

Similarly, there was not enough evidence in the literature either for or against the use of antidepressants for treating depressed mood. The panel found that a specific medication, dextromethorphan with quinidine (DM/Q), was possibly effective for treating PBA, an emotional disorder that occurs in up to 10 percent of people with MS. There was not enough evidence for or against other medications that are used for PBA.

The lack of conclusive evidence stems from several factors, says Dr. Sarah Minden, a psychiatrist and the lead author. First, while there is evidence supporting the effectiveness of pharmacologic and non-pharmacologic therapies for depressed mood and anxiety in the general population, many of these therapies have not yet been studied in people with MS. In addition, not all studies have broad relevance, such as those on telephone-administered CBT, because so few therapists use CBT in this way, she said.

“Our most important finding was that there are gaps in the literature and that so much more research is needed,” Dr. Minden added, noting that publishing the guideline might stimulate funding for new investigations.

Screening and diagnostic tools
The experts also found that some existing questionnaires are possibly effective for identifying individuals who may have emotional disorders common in MS. More research on new and existing screening tools is needed to improve identification of individuals with symptoms of emotional disorders who need further evaluation and treatment. The panel concluded that, overall, more high-quality research is needed in each of these areas.

“The great news is that the American Academy of Neurology found that the topic of emotional disorders among people with MS was important enough to produce the guideline,” Dr. Minden said. “The other really good news is that we found evidence for things that do work, such as a particular type of CBT and one treatment for PBA. But the findings do beg for more research because they are just the tip of the iceberg.”

If you suspect that you are experiencing depression, anxiety or another emotional disorder, talk to your healthcare professional about treatments that can work for you, and call 1-800-344-4867 to talk to an MS Navigator for more support and resources in your area.

Learn more about the new AAN guideline.
For more information on mood disorders and treatments, such as CBT, see Emotional currents: The shifting tides of moods in MS .
Read how others in the MS community feel about the guideline on the MS Connection Blog.

Tags: Summer 2014