Skip to main content
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2005 Apr;76(4):469–475. doi: 10.1136/jnnp.2004.054635

Depression in multiple sclerosis: a review

R Siegert 1, D Abernethy 1
PMCID: PMC1739575  PMID: 15774430

Abstract

Several studies have reported high rates of depression in multiple sclerosis (MS) with a lifetime prevalence of ∼50% and an annual prevalence of 20% not uncommon. Concern about the potential of new drug treatments to exacerbate or precipitate depression in MS has led to increased interest in the relation between MS and depression. This review on MS and depression identifies the following key issues: How common is depression in people with MS? Is depression in MS associated with lesions in specific regions of the central nervous system? Is there an increased risk of suicide in MS? Is there a higher than expected incidence of anxiety disorders in MS? Are fatigue and depressed mood related in MS? Is there a relation between depression and cognitive impairment in MS? Which psychosocial variables affect the development of depression in MS? Does treatment with interferon increase the risk of depression? How effective are treatments for MS patients with depression? Each of these issues is briefly reviewed with critical commentary, and some priorities for future research are suggested.

Full Text

The Full Text of this article is available as a PDF (89.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aikens J. E., Reinecke M. A., Pliskin N. H., Fischer J. S., Wiebe J. S., McCracken L. M., Taylor J. L. Assessing depressive symptoms in multiple sclerosis: is it necessary to omit items from the original Beck Depression Inventory? J Behav Med. 1999 Apr;22(2):127–142. doi: 10.1023/a:1018731415172. [DOI] [PubMed] [Google Scholar]
  2. Andrews G., Henderson S., Hall W. Prevalence, comorbidity, disability and service utilisation. Overview of the Australian National Mental Health Survey. Br J Psychiatry. 2001 Feb;178:145–153. doi: 10.1192/bjp.178.2.145. [DOI] [PubMed] [Google Scholar]
  3. Arnett P. A., Higginson C. I., Randolph J. J. Depression in multiple sclerosis: relationship to planning ability. J Int Neuropsychol Soc. 2001 Sep;7(6):665–674. doi: 10.1017/s1355617701766027. [DOI] [PubMed] [Google Scholar]
  4. Arnett P. A., Higginson C. I., Voss W. D., Bender W. I., Wurst J. M., Tippin J. M. Depression in multiple sclerosis: relationship to working memory capacity. Neuropsychology. 1999 Oct;13(4):546–556. doi: 10.1037//0894-4105.13.4.546. [DOI] [PubMed] [Google Scholar]
  5. Arnett P. A., Higginson C. I., Voss W. D., Wright B., Bender W. I., Wurst J. M., Tippin J. M. Depressed mood in multiple sclerosis: relationship to capacity-demanding memory and attentional functioning. Neuropsychology. 1999 Jul;13(3):434–446. doi: 10.1037//0894-4105.13.3.434. [DOI] [PubMed] [Google Scholar]
  6. Avasarala Jagannadha R., Cross Anne H., Trinkaus Kathryn. Comparative assessment of Yale Single Question and Beck Depression Inventory Scale in screening for depression in multiple sclerosis. Mult Scler. 2003 Jun;9(3):307–310. doi: 10.1191/1352458503ms900oa. [DOI] [PubMed] [Google Scholar]
  7. Bakshi R., Shaikh Z. A., Miletich R. S., Czarnecki D., Dmochowski J., Henschel K., Janardhan V., Dubey N., Kinkel P. R. Fatigue in multiple sclerosis and its relationship to depression and neurologic disability. Mult Scler. 2000 Jun;6(3):181–185. doi: 10.1177/135245850000600308. [DOI] [PubMed] [Google Scholar]
  8. Benedict R. H. B., Fishman I., McClellan M. M., Bakshi R., Weinstock-Guttman B. Validity of the Beck Depression Inventory-Fast Screen in multiple sclerosis. Mult Scler. 2003 Aug;9(4):393–396. doi: 10.1191/1352458503ms902oa. [DOI] [PubMed] [Google Scholar]
  9. Brassington J. C., Marsh N. V. Neuropsychological aspects of multiple sclerosis. Neuropsychol Rev. 1998 Jun;8(2):43–77. doi: 10.1023/a:1025621700003. [DOI] [PubMed] [Google Scholar]
  10. Butler Michelle A., Bennett Thomas L. In search of a conceptualization of multiple sclerosis: a historical perspective. Neuropsychol Rev. 2003 Jun;13(2):93–112. doi: 10.1023/a:1023884322540. [DOI] [PubMed] [Google Scholar]
  11. Chwastiak Lydia, Ehde Dawn M., Gibbons Laura E., Sullivan Mark, Bowen James D., Kraft George H. Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry. 2002 Nov;159(11):1862–1868. doi: 10.1176/appi.ajp.159.11.1862. [DOI] [PubMed] [Google Scholar]
  12. DeLuca J., Gaudino E. A., Diamond B. J., Christodoulou C., Engel R. A. Acquisition and storage deficits in multiple sclerosis. J Clin Exp Neuropsychol. 1998 Jun;20(3):376–390. doi: 10.1076/jcen.20.3.376.819. [DOI] [PubMed] [Google Scholar]
  13. Deale A., Chalder T., Marks I., Wessely S. Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial. Am J Psychiatry. 1997 Mar;154(3):408–414. doi: 10.1176/ajp.154.3.408. [DOI] [PubMed] [Google Scholar]
  14. Demaree H. A., DeLuca J., Gaudino E. A., Diamond B. J. Speed of information processing as a key deficit in multiple sclerosis: implications for rehabilitation. J Neurol Neurosurg Psychiatry. 1999 Nov;67(5):661–663. doi: 10.1136/jnnp.67.5.661. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Demaree Heath A., Gaudino Elizabeth, DeLuca John. The relationship between depressive symptoms and cognitive dysfunction in multiple sclerosis. Cogn Neuropsychiatry. 2003 Aug;8(3):161–171. doi: 10.1080/13546800244000265. [DOI] [PubMed] [Google Scholar]
  16. Drevets W. C. Neuroimaging studies of mood disorders. Biol Psychiatry. 2000 Oct 15;48(8):813–829. doi: 10.1016/s0006-3223(00)01020-9. [DOI] [PubMed] [Google Scholar]
  17. Feinstein A. Multiple sclerosis, disease modifying treatments and depression: a critical methodological review. Mult Scler. 2000 Oct;6(5):343–348. doi: 10.1177/135245850000600509. [DOI] [PubMed] [Google Scholar]
  18. Feinstein A., Roy P., Lobaugh N., Feinstein K., O'Connor P., Black S. Structural brain abnormalities in multiple sclerosis patients with major depression. Neurology. 2004 Feb 24;62(4):586–590. doi: 10.1212/01.wnl.0000110316.12086.0c. [DOI] [PubMed] [Google Scholar]
  19. Feinstein Anthony. An examination of suicidal intent in patients with multiple sclerosis. Neurology. 2002 Sep 10;59(5):674–678. doi: 10.1212/wnl.59.5.674. [DOI] [PubMed] [Google Scholar]
  20. Feinstein Anthony, O'Connor Paul, Feinstein Karen. Multiple sclerosis, interferon beta-1b and depression A prospective investigation. J Neurol. 2002 Jul;249(7):815–820. doi: 10.1007/s00415-002-0725-0. [DOI] [PubMed] [Google Scholar]
  21. Feinstein Anthony. The neuropsychiatry of multiple sclerosis. Can J Psychiatry. 2004 Mar;49(3):157–163. doi: 10.1177/070674370404900302. [DOI] [PubMed] [Google Scholar]
  22. Folkman Susan, Moskowitz Judith Tedlie. Coping: pitfalls and promise. Annu Rev Psychol. 2004;55:745–774. doi: 10.1146/annurev.psych.55.090902.141456. [DOI] [PubMed] [Google Scholar]
  23. Ford H., Trigwell P., Johnson M. The nature of fatigue in multiple sclerosis. J Psychosom Res. 1998 Jul;45(1):33–38. doi: 10.1016/s0022-3999(98)00004-x. [DOI] [PubMed] [Google Scholar]
  24. Harrison Paul J. The neuropathology of primary mood disorder. Brain. 2002 Jul;125(Pt 7):1428–1449. doi: 10.1093/brain/awf149. [DOI] [PubMed] [Google Scholar]
  25. Hartlage S., Alloy L. B., Vázquez C., Dykman B. Automatic and effortful processing in depression. Psychol Bull. 1993 Mar;113(2):247–278. doi: 10.1037/0033-2909.113.2.247. [DOI] [PubMed] [Google Scholar]
  26. Hickie I. B., Hooker A. W., Hadzi-Pavlovic D., Bennett B. K., Wilson A. J., Lloyd A. R. Fatigue in selected primary care settings: sociodemographic and psychiatric correlates. Med J Aust. 1996 May 20;164(10):585–588. doi: 10.5694/j.1326-5377.1996.tb122199.x. [DOI] [PubMed] [Google Scholar]
  27. Hickie I. B., Wilson A. J., Wright J. M., Bennett B. K., Wakefield D., Lloyd A. R. A randomized, double-blind placebo-controlled trial of moclobemide in patients with chronic fatigue syndrome. J Clin Psychiatry. 2000 Sep;61(9):643–648. doi: 10.4088/jcp.v61n0909. [DOI] [PubMed] [Google Scholar]
  28. Hickie I., Hadzi-Pavlovic D., Ricci C. Reviving the diagnosis of neurasthenia. Psychol Med. 1997 Sep;27(5):989–994. doi: 10.1017/s0033291797004893. [DOI] [PubMed] [Google Scholar]
  29. Honer W. G., Hurwitz T., Li D. K., Palmer M., Paty D. W. Temporal lobe involvement in multiple sclerosis patients with psychiatric disorders. Arch Neurol. 1987 Feb;44(2):187–190. doi: 10.1001/archneur.1987.00520140053017. [DOI] [PubMed] [Google Scholar]
  30. Jacobs L. D., Beck R. W., Simon J. H., Kinkel R. P., Brownscheidle C. M., Murray T. J., Simonian N. A., Slasor P. J., Sandrock A. W. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. N Engl J Med. 2000 Sep 28;343(13):898–904. doi: 10.1056/NEJM200009283431301. [DOI] [PubMed] [Google Scholar]
  31. Janardhan Vallabh, Bakshi Rohit. Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J Neurol Sci. 2002 Dec 15;205(1):51–58. doi: 10.1016/s0022-510x(02)00312-x. [DOI] [PubMed] [Google Scholar]
  32. Janssens A. C. J. W., van Doorn P. A., de Boer J. B., van der Meché F. G. A., Passchier J., Hintzen R. Q. Impact of recently diagnosed multiple sclerosis on quality of life, anxiety, depression and distress of patients and partners. Acta Neurol Scand. 2003 Dec;108(6):389–395. doi: 10.1034/j.1600-0404.2003.00166.x. [DOI] [PubMed] [Google Scholar]
  33. Joffe R. T., Lippert G. P., Gray T. A., Sawa G., Horvath Z. Mood disorder and multiple sclerosis. Arch Neurol. 1987 Apr;44(4):376–378. doi: 10.1001/archneur.1987.00520160018007. [DOI] [PubMed] [Google Scholar]
  34. Klapper J. A. Interferon beta treatment of multiple sclerosis. Neurology. 1994 Jan;44(1):188–190. doi: 10.1212/wnl.44.1.188-a. [DOI] [PubMed] [Google Scholar]
  35. Krupp L. B., Alvarez L. A., LaRocca N. G., Scheinberg L. C. Fatigue in multiple sclerosis. Arch Neurol. 1988 Apr;45(4):435–437. doi: 10.1001/archneur.1988.00520280085020. [DOI] [PubMed] [Google Scholar]
  36. Krupp L. B., LaRocca N. G., Muir-Nash J., Steinberg A. D. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989 Oct;46(10):1121–1123. doi: 10.1001/archneur.1989.00520460115022. [DOI] [PubMed] [Google Scholar]
  37. Landrø Nils Inge, Celius Elisabeth Gulowsen, Sletvold Helge. Depressive symptoms account for deficient information processing speed but not for impaired working memory in early phase multiple sclerosis (MS). J Neurol Sci. 2004 Feb 15;217(2):211–216. doi: 10.1016/j.jns.2003.10.012. [DOI] [PubMed] [Google Scholar]
  38. Lobentanz I. S., Asenbaum S., Vass K., Sauter C., Klösch G., Kollegger H., Kristoferitsch W., Zeitlhofer J. Factors influencing quality of life in multiple sclerosis patients: disability, depressive mood, fatigue and sleep quality. Acta Neurol Scand. 2004 Jul;110(1):6–13. doi: 10.1111/j.1600-0404.2004.00257.x. [DOI] [PubMed] [Google Scholar]
  39. Lynch S. G., Kroencke D. C., Denney D. R. The relationship between disability and depression in multiple sclerosis: the role of uncertainty, coping, and hope. Mult Scler. 2001 Dec;7(6):411–416. doi: 10.1177/135245850100700611. [DOI] [PubMed] [Google Scholar]
  40. McAlpine Donna D., Wilson Amy R. Screening for depression in primary care: what do we still need to know? Depress Anxiety. 2004;19(3):137–145. doi: 10.1002/da.20000. [DOI] [PubMed] [Google Scholar]
  41. McCabe Marita P., McKern Suzanne, McDonald Elizabeth. Coping and psychological adjustment among people with multiple sclerosis. J Psychosom Res. 2004 Mar;56(3):355–361. doi: 10.1016/S0022-3999(03)00132-6. [DOI] [PubMed] [Google Scholar]
  42. McIntosh-Michaelis S. A., Roberts M. H., Wilkinson S. M., Diamond I. D., McLellan D. L., Martin J. P., Spackman A. J. The prevalence of cognitive impairment in a community survey of multiple sclerosis. Br J Clin Psychol. 1991 Nov;30(Pt 4):333–348. doi: 10.1111/j.2044-8260.1991.tb00954.x. [DOI] [PubMed] [Google Scholar]
  43. Messmer Uccelli M., Mancuso Mohr L., Battaglia M. A., Zagami P., Mohr D. C. Peer support groups in multiple sclerosis: current effectiveness and future directions. Mult Scler. 2004 Feb;10(1):80–84. doi: 10.1191/1352458504ms973oa. [DOI] [PubMed] [Google Scholar]
  44. Minden S. L., Orav J., Reich P. Depression in multiple sclerosis. Gen Hosp Psychiatry. 1987 Nov;9(6):426–434. doi: 10.1016/0163-8343(87)90052-1. [DOI] [PubMed] [Google Scholar]
  45. Mohr D. C., Boudewyn A. C., Goodkin D. E., Bostrom A., Epstein L. Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. J Consult Clin Psychol. 2001 Dec;69(6):942–949. [PubMed] [Google Scholar]
  46. Mohr D. C., Classen C., Barrera M., Jr The relationship between social support, depression and treatment for depression in people with multiple sclerosis. Psychol Med. 2004 Apr;34(3):533–541. doi: 10.1017/s0033291703001235. [DOI] [PubMed] [Google Scholar]
  47. Mohr D. C., Likosky W., Dwyer P., Van Der Wende J., Boudewyn A. C., Goodkin D. E. Course of depression during the initiation of interferon beta-1a treatment for multiple sclerosis. Arch Neurol. 1999 Oct;56(10):1263–1265. doi: 10.1001/archneur.56.10.1263. [DOI] [PubMed] [Google Scholar]
  48. Mohr David C., Hart Stacey L., Goldberg Alison. Effects of treatment for depression on fatigue in multiple sclerosis. Psychosom Med. 2003 Jul-Aug;65(4):542–547. doi: 10.1097/01.psy.0000074757.11682.96. [DOI] [PubMed] [Google Scholar]
  49. Nicholl C. R., Lincoln N. B., Francis V. M., Stephan T. F. Assessment of emotional problems in people with multiple sclerosis. Clin Rehabil. 2001 Dec;15(6):657–668. doi: 10.1191/0269215501cr427oa. [DOI] [PubMed] [Google Scholar]
  50. Pakenham K. I. Adjustment to multiple sclerosis: application of a stress and coping model. Health Psychol. 1999 Jul;18(4):383–392. doi: 10.1037//0278-6133.18.4.383. [DOI] [PubMed] [Google Scholar]
  51. Pandya Rupang, Patten Scott. Depression in multiple sclerosis associated with interferon beta-1a (Rebif). Can J Psychiatry. 2002 Sep;47(7):686–686. doi: 10.1177/070674370204700720. [DOI] [PubMed] [Google Scholar]
  52. Patten S. B., Beck C. A., Williams J. V. A., Barbui C., Metz L. M. Major depression in multiple sclerosis: a population-based perspective. Neurology. 2003 Dec 9;61(11):1524–1527. doi: 10.1212/01.wnl.0000095964.34294.b4. [DOI] [PubMed] [Google Scholar]
  53. Patten S. B., Metz L. M. Interferon beta-1 a and depression in relapsing-remitting multiple sclerosis: an analysis of depression data from the PRISMS clinical trial. Mult Scler. 2001 Aug;7(4):243–248. doi: 10.1177/135245850100700406. [DOI] [PubMed] [Google Scholar]
  54. Patten Scott B., Fridhandler Shanika, Beck Cynthia A., Metz Luanne M. Depressive symptoms in a treated multiple sclerosis cohort. Mult Scler. 2003 Dec;9(6):616–620. doi: 10.1191/1352458503ms960oa. [DOI] [PubMed] [Google Scholar]
  55. Patten Scott B., Metz Luanne M., SPECTRIMS Study Group Interferon beta1a and depression in secondary progressive MS: data from the SPECTRIMS Trial. Neurology. 2002 Sep 10;59(5):744–746. doi: 10.1212/wnl.59.5.744. [DOI] [PubMed] [Google Scholar]
  56. Pujol J., Bello J., Deus J., Martí-Vilalta J. L., Capdevila A. Lesions in the left arcuate fasciculus region and depressive symptoms in multiple sclerosis. Neurology. 1997 Oct;49(4):1105–1110. doi: 10.1212/wnl.49.4.1105. [DOI] [PubMed] [Google Scholar]
  57. Rabins P. V., Brooks B. R., O'Donnell P., Pearlson G. D., Moberg P., Jubelt B., Coyle P., Dalos N., Folstein M. F. Structural brain correlates of emotional disorder in multiple sclerosis. Brain. 1986 Aug;109(Pt 4):585–597. doi: 10.1093/brain/109.4.585. [DOI] [PubMed] [Google Scholar]
  58. Rao S. M., Leo G. J., Bernardin L., Unverzagt F. Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology. 1991 May;41(5):685–691. doi: 10.1212/wnl.41.5.685. [DOI] [PubMed] [Google Scholar]
  59. Rao S. M., Leo G. J., Ellington L., Nauertz T., Bernardin L., Unverzagt F. Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning. Neurology. 1991 May;41(5):692–696. doi: 10.1212/wnl.41.5.692. [DOI] [PubMed] [Google Scholar]
  60. Rao S. M. Neuropsychology of multiple sclerosis. Curr Opin Neurol. 1995 Jun;8(3):216–220. doi: 10.1097/00019052-199506000-00010. [DOI] [PubMed] [Google Scholar]
  61. Rao S. M. Neuropsychology of multiple sclerosis: a critical review. J Clin Exp Neuropsychol. 1986 Oct;8(5):503–542. doi: 10.1080/01688638608405173. [DOI] [PubMed] [Google Scholar]
  62. Ridsdale L., Darbishire L., Seed P. T. Is graded exercise better than cognitive behaviour therapy for fatigue? A UK randomized trial in primary care. Psychol Med. 2004 Jan;34(1):37–49. doi: 10.1017/s0033291703001247. [DOI] [PubMed] [Google Scholar]
  63. Ron M. A., Logsdail S. J. Psychiatric morbidity in multiple sclerosis: a clinical and MRI study. Psychol Med. 1989 Nov;19(4):887–895. doi: 10.1017/s0033291700005602. [DOI] [PubMed] [Google Scholar]
  64. Sadovnick A. D., Eisen K., Ebers G. C., Paty D. W. Cause of death in patients attending multiple sclerosis clinics. Neurology. 1991 Aug;41(8):1193–1196. doi: 10.1212/wnl.41.8.1193. [DOI] [PubMed] [Google Scholar]
  65. Sadovnick A. D., Remick R. A., Allen J., Swartz E., Yee I. M., Eisen K., Farquhar R., Hashimoto S. A., Hooge J., Kastrukoff L. F. Depression and multiple sclerosis. Neurology. 1996 Mar;46(3):628–632. doi: 10.1212/wnl.46.3.628. [DOI] [PubMed] [Google Scholar]
  66. Schiffer R. B., Wineman N. M. Antidepressant pharmacotherapy of depression associated with multiple sclerosis. Am J Psychiatry. 1990 Nov;147(11):1493–1497. doi: 10.1176/ajp.147.11.1493. [DOI] [PubMed] [Google Scholar]
  67. Schreurs Karlein M. G., de Ridder Denise T. D., Bensing Jozien M. Fatigue in multiple sclerosis: reciprocal relationships with physical disabilities and depression. J Psychosom Res. 2002 Sep;53(3):775–781. doi: 10.1016/s0022-3999(02)00326-4. [DOI] [PubMed] [Google Scholar]
  68. Schwartz C. E., Coulthard-Morris L., Zeng Q. Psychosocial correlates of fatigue in multiple sclerosis. Arch Phys Med Rehabil. 1996 Feb;77(2):165–170. doi: 10.1016/s0003-9993(96)90162-8. [DOI] [PubMed] [Google Scholar]
  69. Schwid Steven R., Covington Melissa, Segal Benjamin M., Goodman Andrew D. Fatigue in multiple sclerosis: current understanding and future directions. J Rehabil Res Dev. 2002 Mar-Apr;39(2):211–224. [PubMed] [Google Scholar]
  70. Shenal Brian V., Harrison David W., Demaree Heath A. The neuropsychology of depression: a literature review and preliminary model. Neuropsychol Rev. 2003 Mar;13(1):33–42. doi: 10.1023/a:1022300622902. [DOI] [PubMed] [Google Scholar]
  71. Smith S. J., Young C. A. The role of affect on the perception of disability in multiple sclerosis. Clin Rehabil. 2000 Feb;14(1):50–54. doi: 10.1191/026921500676724210. [DOI] [PubMed] [Google Scholar]
  72. Stenager E. N., Stenager E., Koch-Henriksen N., Brønnum-Hansen H., Hyllested K., Jensen K., Bille-Brahe U. Suicide and multiple sclerosis: an epidemiological investigation. J Neurol Neurosurg Psychiatry. 1992 Jul;55(7):542–545. doi: 10.1136/jnnp.55.7.542. [DOI] [PMC free article] [PubMed] [Google Scholar]
  73. Vercoulen J. H., Hommes O. R., Swanink C. M., Jongen P. J., Fennis J. F., Galama J. M., van der Meer J. W., Bleijenberg G. The measurement of fatigue in patients with multiple sclerosis. A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects. Arch Neurol. 1996 Jul;53(7):642–649. doi: 10.1001/archneur.1996.00550070080014. [DOI] [PubMed] [Google Scholar]
  74. Voss William D., Arnett Peter A., Higginson Christopher I., Randolph John J., Campos Michael D., Dyck Dennis G. Contributing factors to depressed mood in Multiple Sclerosis. Arch Clin Neuropsychol. 2002 Feb;17(2):103–115. [PubMed] [Google Scholar]
  75. Zephir Hélène, De Seze Jérôme, Stojkovic Tanya, Delisse Brigitte, Ferriby Didier, Cabaret Marilyn, Vermersch Patrick. Multiple sclerosis and depression: influence of interferon beta therapy. Mult Scler. 2003 Jun;9(3):284–288. doi: 10.1191/1352458503ms915oa. [DOI] [PubMed] [Google Scholar]
  76. Zorzon M., de Masi R., Nasuelli D., Ukmar M., Mucelli R. P., Cazzato G., Bratina A., Zivadinov R. Depression and anxiety in multiple sclerosis. A clinical and MRI study in 95 subjects. J Neurol. 2001 May;248(5):416–421. doi: 10.1007/s004150170184. [DOI] [PubMed] [Google Scholar]
  77. van der Werf S. P., Evers A., Jongen P. J. H., Bleijenberg G. The role of helplessness as mediator between neurological disability, emotional instability, experienced fatigue and depression in patients with multiple sclerosis. Mult Scler. 2003 Feb;9(1):89–94. doi: 10.1191/1352458503ms854oa. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES