IMPRESS: Impacto da Depressão de Base em Doentes com Esclerose Múltipla que Iniciaram Tratamento com Interferão β-1a
DOI:
https://doi.org/10.46531/sinapse/AO/230009/2023Palavras-chave:
Esclerose Múltipla/ complicações, Esclerose Múltipla/tratamento farmacológico, Interferão beta-1aResumo
Introdução: Alguns estudos sugerem uma associação entre as terapias com interferão beta (IFNβ) e o desenvolvimento de sintomas de depressão na esclerose múltipla (EM). Este estudo teve como objetivo avaliar o impacto da depressão basal (DB) na variação do score de depressão aos 24 meses (m) em doentes com EM a iniciar tratamento com IFNβ-1a.Métodos: Estudo observacional, prospetivo, multicêntrico em doentes com diagnóstico recente de EM surto-remissão ou síndrome clinicamente isolada, a iniciar tratamento com IFNβ-1a por via intramuscular. O médico e o doente completaram um questionário em cada visita (baseline, 6, 12, 18 e 24 m), incluindo dados demográficos e clínicos, incapacidade, depressão, fadiga, equilíbrio, estado mental, sonolência e coping, adesão ao tratamento de EM, descontinuação do tratamento e eventos adversos.
Resultados: Foram incluídos 110 doentes na análise, 20% com DB. Os grupos de doentes (com e sem DB) foram distribuídos de forma semelhante relativamente a características demográficas e clínicas basais, exceto na EDSS, que foi mais elevada em doentes com DB (EDSS mediana de 1,25 ± 1,75 vs 1,0 ± 1,5; p = 0,047). Em doentes com DB, apenas a gravidade da depressão variou significativamente ao longo das cinco avaliações (p = 0,034), com uma diminuição acentuada aos 6 meses. Em doentes sem DB, não foram observadas variações significativas. A DB teve um efeito significativo na variação da gravidade da depressão aos 24 m (p = 0,0253) e a fadiga basal foi um bom preditor para a fadiga global durante o período de estudo (p = 0,0399).
Conclusão: Apesar do seu impacto nos doentes com EM, a depressão é frequentemente subdiagnosticada e subtratada. Os resultados do IMPRESS sugerem que os scores de depressão e fadiga basais em doentes com EM influenciam as variações dos scores durante o período de tratamento. Estudos adicionais sobre a associação entre depressão e EM podem levar a uma melhor compreensão sobre esta relação.
Downloads
Referências
Hemmer B, Nessler S, Zhou D, Kieseier B, Hartung HP. Immunopathogenesis and immunotherapy of multiple sclerosis. Nat Clin Pract Neurol. 2006;2(:201–11.
Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple Sclerosis. N Engl J Med. 2000;343:938–52.
Rudick RA, Sandrock A. Natalizumab: 4-integrin antagonist selective adhesion molecule inhibitors for MS. Expert Rev Neurother. 2004;4:571–80.
Rudick RA, Stuart WH, Calabresi PA, Confavreux C, Galetta SL, Radue E-W, et al. Natalizumab plus Interferon Beta-1a for Relapsing Multiple Sclerosis. N Engl J Med. 2006;354:911–23.
Pugliatti M, Rosati G, Carton H, Riise T, Drulovic J, Vecsei L, et al. The epidemiology of multiple sclerosis in Europe. Eur J Neurol. 2006;13:700–22.
Group GC. The Goldman Consensus statement on depression in multiple sclerosis. Mult Scler J. 2005;11:328–37.
World Health Report. Mental Health, New Understanding, New Hope. Geneva: World Health Organization; 2001.
Minden SL, Feinstein A, Kalb RC, Miller D, Mohr DC, Patten SB, et al. Evidence-based guideline: Assessment and management of psychiatric disorders in individuals with MS: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2014;82:174–81. doi: 10.1212/WNL.0000000000000013.
Pandya R, Metz L, Patten SB. Predictive Value of the CES-D in Detecting Depression Among Candidates for Disease-Modifying Multiple Sclerosis Treatment. Psychosomatics. 2005;46:131–4.
Fisk JD, Morehouse SA, Brown MG, Skedgel C, Jock Murray T. Hospital-based Psychiatric Service Utilization and Morbidity in Multiple Sclerosis. Can J Neurol Sci. 1998;25:230–5.
Di Legge S, Piattella MC, Pozzilli C, Pantano P, Caramia F, Pestalozza IF, et al. Longitudinal evaluation of depression and anxiety in patients with clinically isolated syndrome at high risk of developing early multiple sclerosis. Mult Scler J. 2003;9:302–6.
Arnett PA, Barwick FH, Beeney JE. Depression in multiple sclerosis: review and theoretical proposal. J Int Neuropsychol Soc. 2008;14:691-724. doi: 10.1017/S1355617708081174.
Marrie R, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T. The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated. Mult Scler J. 2009;15:385–92.
Raskind MA. Diagnosis and treatment of depression comorbid with neurologic disorders. Am J Med. 2008;121:S28–37.
Paparrigopoulos T, Ferentinos P, Kouzoupis A, Koutsis G, Papadimitriou GN. The neuropsychiatry of multiple sclerosis: Focus on disorders of mood, affect and behaviour. Int Rev Psychiatry. 2010;22:14–21. doi: 10.3109/09540261003589323.
Göksel Karatepe A, Kaya T, Günaydn R, Demirhan A, Çe P, Gedizlioglu M. Quality of life in patients with multiple sclerosis. Int J Rehabil Res. 2011;34:290–8. doi: 10.1097/MRR.0b013e32834ad479.
Feinstein A. Multiple sclerosis, depression, and suicide. BMJ. 1997;315:691–2.
Mohr DC, Goodkin DE, Likosky W, Gatto N, Baumann KA, Rudick RA. Treatment of depression improves adherence to interferon beta-1b therapy for multiple sclerosis. Arch Neurol. 1997;54:531–3.
Tarrants M, Oleen-Burkey M, Castelli-Haley J, Lage MJ. The impact of comorbid depression on adherence to therapy for multiple sclerosis. Mult Scler Int. 2011:2011:271321. doi: 10.1155/2011/271321.
Feinstein A, Magalhaes S, Richard J-F, Audet B, Moore C. The link between multiple sclerosis and depression. Nat Rev Neurol. 2014;10:507–17. doi: 10.1038/nrneurol.2014.139.
Vattakatuchery JJ, Rickards H, Cavanna AE. Pathogenic Mechanisms of Depression in Multiple Sclerosis. J Neuropsychiatry Clin Neurosci. 2011;23:261–76. doi: 10.1176/jnp.23.3.jnp261.
Weiland TJ, Jelinek GA, Marck CH, Hadgkiss EJ, van der Meer DM, Pereira NG, et al. Clinically significant fatigue: prevalence and associated factors in an international sample of adults with multiple sclerosis recruited via the Internet. Reindl M, editor. PLoS One. 2015;10:e0115541. doi: 10.1371/journal.pone.0115541.
Solaro C, Bergamaschi R, Rezzani C, Mueller M, Trabucco E, Bargiggia V, et al. Duloxetine is effective in treating depres-sion in multiple sclerosis patients. Clin Neuropharmacol. 2013;36:114–6. doi: 10.1097/WNF.0b013e3182996400.
Penner I-K, Bechtel N, Raselli C, Stöcklin M, Opwis K, Kappos L, et al. Fatigue in multiple sclerosis: relation to depression, physical impairment, personality and action control. Mult Scler J. 2007;13:1161–7.
Lana-Peixoto MA, Teixeira AL, Haase VG. Interferon beta-1a-induced depression and suicidal ideation in multiple sclerosis. Arq Neuropsiquiatr. 2002;60:721–4.
Seggar LB, Lambert MJ, Hansen NB. Assessing clinical significance: Application to the beck depression inventory. Behav Ther. 2002;33:253–69.
MAPI Research Institute. [Accessed Jan 2022] Available at: http://www.mapi-institute.com/
Meneses RF, Ribeiro JP M da SA. Subjective daytime sleepiness in a Portuguese clinical sample: Contribution for the study of the Epworth Sleepiness Scale. Vigilia-Sueño. 2001;13.
Pais-Ribeiro J, Rodrigues AP. Questões acerca do coping: A propósito do estudo de adaptação do Brief Cope. Psicol Saúde Doenças. 2004;5:3–15.
Guerreiro MS, Botelho MA. Adaptação à população portuguesa da tradução do “Mini Mental State Examination” (MMSE). Rev Port Neurol. 1994;9–10.
Cetin K, Johnson KL, Ehde DM, Kuehn CM, Amtmann D, Kraft GH. Antidepressant use in multiple sclerosis: epide- miologic study of a large community sample. Mult Scler J. 2007;13:1046–53.
Mohr DC, Hart SL, Fonareva I, Tasch ES. Treatment of depression for patients with multiple sclerosis in neurology clinics. Mult Scler J. 2006;12:204–8.
Hind D, Cotter J, Thake A, Bradburn M, Cooper C, Isaac C, et al. Cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: a systematic review and meta-analysis. BMC Psychiatry. 2014;14:5. doi: 10.1186/1471-244X-14-5.
Koch MW, Glazenborg A, Uyttenboogaart M, Mostert J, De Keyser J. Pharmacologic treatment of depression in multiple sclerosis. Cochrane Database Syst Rev. 2011; 2011;CD007295. doi: 10.1002/14651858.CD007295.pub2.
Schiffer RB, Wineman NM. Antidepressant pharmacotherapy of depression associated with multiple sclerosis. Am J Psychiatry. 1990;147:1493–7.
Ehde DM, Kraft GH, Chwastiak L, Sullivan MD, Gibbons LE, Bombardier CH, et al. Efficacy of paroxetine in treating major depressive disorder in persons with multiple sclerosis. Gen Hosp Psychiatry. 2008;30:40–8.
Silberberg D, Armstrong R. Tranylcypromine in multiple sclerosis. Lancet. 1965;2:852–3.
Dean G. A double-blind trial with an antidepressant drug, imipramine, in multiple sclerosis. S Afr Med J. 1969;43:86–7.
Scott TF, Nussbaum P, McConnell H, Brill P. Measurement of treatment response to sertraline in depressed multiple sclerosis patients using the Carroll scale. Neurol Res. 1995;17:421–2.
Barak Y, Ur E, Achiron A. Moclobemide Treatment in Multiple Sclerosis Patients With Comorbid Depression. J Neuropsychiatry Clin Neurosci. 1999;11:271–3.
Shafey H. The effect of fluoxetine in depression associated with multiple sclerosis. Can J Psychiatry. 1992;37:147–8.
Thomas PW, Thomas S, Hillier C, Galvin K, Baker R. Psychological interventions for multiple sclerosis. Cochrane Database Syst Rev. 2006;2006:CD004431. doi: 10.1002/14651858.CD004431.pub2.
Zephir H, De Seze J, Stojkovic T, Delisse B, Ferriby D, Cabaret M, et al. Multiple sclerosis and depression: influence of interferon b therapy. Mult Scler J. 2003;9:284–8.
Patten SB, Francis G, Metz LM, Lopez-Bresnahan M, Chang P, Curtin F. The relationship between depression and interferon beta-1a therapy in patients with multiple sclerosis. Mult Scler J. 2005;11:175–81.
Schippling S, O’Connor P, Knappertz V, Pohl C, Bogumil T, Suarez G, et al. Incidence and course of depression in multiple sclerosis in the multinational BEYOND trial. J Neurol. 2016;263:1418–26. doi: 10.1007/s00415-016-8146-8.
Jacobs LD, Beck RW, Simon JH, Kinkel RP, Brownscheidle CM, Murray TJ, et al. Intramuscular Interferon Beta-1A Therapy Initiated during a First Demyelinating Event in Multiple Sclerosis. N Engl J Med. 2000;343:898–904. doi: 10.1056/NEJM200009283431301.
Interferon P (Prevention of R and D by, Group beta-1a S in MSS. Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group. Lancet. 1998;352:1498–504.
Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. The IFNB Multiple Sclerosis Study Group. Neurology. 1993;43:655–61.
Hunter SF, Agius M, Miller DM, Cutter G, Barbato L, McCague K, et al. Impact of a switch to fingolimod on depressive symptoms in patients with relapsing multiple sclerosis: An analysis from the EPOC (Evaluate Patient OutComes) trial. J Neurol Sci. 2016;365:190–8. doi: 10.1016/j.jns.2016.03.024.
