Treatment of depression in multiple sclerosis: Review and meta-analysis.

The aim of this article is to review the results of outcome studies of the treatment of depression in patients with multiple sclerosis (MS) using meta-analysis. All treatments for depression in MS were found to be significantly more effective than no treatment. Patients in control groups that received no treatment, as opposed to minimal treatment, tended to become more depressed over time, suggesting that untreated depression worsens without treatment. There appears to be no significant difference in efficacy between psychotherapy and antidepressant medication. Psychothera-pies that focus on improving coping skills are more effective at reducing depression than psychotherapies that focus on increasing insight. We conclude that patients with MS should be evaluated routinely for depression. Patients reporting symptoms of depression should be referred for treatment since active intervention is effective at reducing depression and untreated symptoms are likely to worsen.