Psychotherapeutic Tactics for Treating Affective Disorders in Patients with Multiple Sclerosis

Relevance . To date, there have been no evidence-based recommendations for the treatment of depressive disorders in patients with multiple sclerosis (MS), nor has a standardized treatment algorithm been developed for patients with MS and comorbid depression. Furthermore, factors determining the efficacy of specific pharmacological agents have not been sufficiently established. Timely diagnosis, pharmacotherapy, and psychotherapy of depressive disorders may provide the basis for developing comprehensive physical, psychological, and social rehabilitation programs for patients with MS. The aim. To develop a treatment program for affective disorders in patients with multiple sclerosis. Patients and methods . 203 patients with a clinically confirmed diagnosis of MS participated. Taking into account the course of the disease, MS patients were divided into 88.2 % (179 people) with remitting (RRS) type of MS and 11.8 % (24 people) with secondary progressive course (RRS). The average age of the examined patients with remitting course (RRS) ranged from 18 to 63 years, on average 38 ± 10 years. The age of the examined patients with MERS ranged from 29 to 65 years, on average (46 ± 9.00) years. The majority of patients had a disease duration of less than 20 years, on average 8.23 ± 6.57 years. The average age of onset of the disease is 30.2 ± 10.5 years. The duration of the disease was 9.84 ± 0.73 years, while the level of disability among patients (EDSS disability score) at the time of examination was 2.89 ± 0.16 points. The disability rate varied: in patients with RRMS 2.89 ± 0.16 points, in patients with VPRS (5.0 ± 0.24) points. To confirm the severity of depression, the A.T. Beck Depression Scale and the Self-Rating Depression Scale were used. The study used the following scales: the Spielberger State-Trait Anxiety Inventory (STAI) (adapted by Yu. L. Khanin), the Malikova Asthenic State Scale (adapted by T. G. Chertova), the Heim Coping Scale, and the MSQoL-54 Quality of Life Questionnaire. Results and discussion . Based on the presence or absence of depressive symptoms, patients with MS were divided into two groups: Group 1 comprised 90 patients with MS without depression, while Group 2 comprised 113 patients with MS and depression. Patients with MS and depression were found to have a reduced stress-coping capacity, altered self-perception, decreased readiness to respond to emotional stimuli, and diminished interpersonal interest. Following implementation of the developed treatment program, which included psychopharmacotherapy and psychotherapeutic interventions, the mental state of patients with MS and depression improved significantly (p < 0.001). Significant reductions in anxiety, asthenia, and depressive symptoms were observed. These changes were associated with improved quality of life, expansion of social interactions, and increased energy and functional capacity. The results obtained have prospects for further application in the framework of improving personalized approaches to the treatment of patients with multiple sclerosis with depressive disorders, contributes to improving the quality of psychiatric care in general, and increasing the effectiveness of therapeutic measures.