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MS Depression – Multifactorial Aetiology — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS Depression – Multifactorial AetiologySCE Neurology

A 55-year-old man with MS and EDSS 6.0 develops depression. His PHQ-9 score is 18 (moderately severe). He asks whether his depression could be related to his MS or his MS medication (interferon beta-1a). What is the correct answer?

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Correct answer: C — Depression can be caused by both MS itself (neuroinflammatory and neurodegenerative mechanisms affecting mood-regulating circuits) AND by interferon beta (which has depression as a known side effect) — both should be considered

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · A = shown as D

Depression in MS is multifactorial: (1) reactive (to chronic illness, disability, uncertainty), (2) neurobiological (demyelination and neurodegeneration affecting frontal-subcortical mood circuits, hippocampal atrophy, inflammatory cytokines), (3) medication-related (interferon beta is associated with depression, though the NICE evidence review concluded the risk is modest). Both MS-related and medication-related factors should be considered. If depression is temporally related to interferon initiation, switching to an alternative DMT may be appropriate. Treatment follows NICE CG90/NG222. A: Depression is very common in MS (~50% lifetime). C/D: Both contribute. E: Active treatment is essential.

Reference: NICE NG100 MS; NICE CG90 Depression; BNF – Interferon Beta