Psychological and Behavioral Therapies in Multiple Sclerosis

Depression in multiple sclerosis (MS) is very common, with a lifetime prevalence of around 50 %, which is much higher than the 8 % reported for the general population. In this chapter, we explore some of the psychological and behavioral depression treatments that have been studied in MS. Our review shows clearly that depression in MS is treatable, via both psychotherapeutic and behavioral interventions. Randomized clinical trials (RCTs) on psychotherapy have generally revealed very large effect sizes, with the one benchmarking study (one that examines treatment as it actually occurs in clinical settings) in the literature showing a still large but somewhat smaller effect size than RCTs. Exercise appears to be a promising potential treatment of depression in MS and has been shown to be correlated with lower depression. Additionally, RCTs of exercise have revealed small to moderate effect sizes on reducing depression. One problem with psychological and behavioral treatments of depression in MS is the salience of disability and travel issues that make involvement in such intensive treatment more challenging. Thus, even though treatments are often effective, patients may avoid them in favor of other interventions. Telephone-based interventions have been shown to be very effective in treating depression in MS and could represent a promising approach that circumvents such obstacles. Even though current treatments are effective, future research should explore why nearly half of patients do not respond to available treatments. A focus on the possibility that co-morbid conditions (e.g., anxiety or personality disorders) could interfere with standard depression treatments, as well as possible mediators of treatment (e.g., fatigue, disability levels, sleep disturbance), may be promising avenues for future research.