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Cited by 230Multiple Sclerosis Research StudiesCancer survivorship and careAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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

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Minden, Sarah L., Feinstein, Anthony, Kalb, Rosalind C., Miller, Deborah, Mohr, David C., Patten, Scott B., Bever, Christopher, Schiffer, Randolph B. +2 more·2014·Neurology
DOI 10.1212/wnl.0000000000000013PMC PMC3897434
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Abstract

OBJECTIVE: To make evidence-based recommendations for screening, diagnosing, and treating psychiatric disorders in individuals with multiple sclerosis (MS). METHODS: We reviewed the literature (1950 to August 2011) and evaluated the available evidence. RESULTS AND RECOMMENDATIONS: Clinicians may consider using the Center for Neurologic Study Emotional Lability Scale to screen for pseudobulbar affect (Level C). Clinicians may consider the Beck Depression Inventory and a 2-question tool to screen for depressive disorders and the General Health Questionnaire to screen for broadly defined emotional disturbances (Level C). Evidence is insufficient to support/refute the use of other screening tools, the possibility that somatic/neurovegetative symptoms affect these tools' accuracy, or the use of diagnostic instruments or clinical evaluation procedures for identifying psychiatric disorders in MS (Level U). Clinicians may consider a telephone-administered cognitive behavioral therapy program for treating depressive symptoms (Level C). Although pharmacologic and nonpharmacologic therapies are widely used to treat depressive and anxiety disorders in individuals with MS, evidence is insufficient to support/refute the use of the antidepressants and individual and group therapies reviewed herein (Level U). For pseudobulbar affect, a combination of dextromethorphan and quinidine may be considered (Level C). Evidence is insufficient to determine the psychiatric effects in individuals with MS of disease-modifying and symptomatic therapies and corticosteroids; risk factors for suicide; and treatment of psychotic disorders (Level U). Research is needed on the effectiveness in individuals with MS of pharmacologic and nonpharmacologic treatments frequently used in the non-MS population.

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  • The best approach to screening for depression in general MS populations is to use the BDI-II, with a cut-off score of 13.

    “The Consensus Group for depression in MS [12] and the American Academy of Neurology [13] stated that the best approach to screening for depression in general MS populations is to use the BDI-II, with a cut-off score of 13.”

    From The efficacy of a Mindfulness Based Intervention for depressive symptoms in patients with Multiple Sclerosis and their caregivers: study protocol for a randomized controlled clinical trial. (2016) · cites this paper as [13]

    The Conclusions and recommendations section says the original BDI and a two-question screen may be considered for identifying major depressive disorder in people with MS; it does not identify a best approach. The Screening and diagnosis table lists no applicable recommendation for the BDI-II. The Analysis of evidence reports a cut-point of 13 for the original BDI, while cautioning that it missed nearly 30% of cases. (LLM, conf=0.88)

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  • The AAN determined that the BDI and a two-question screen may be effective for identifying individuals with depression, but that evidence is insufficient to support or refute the use of the CES-D.

    “They determined that the BDI and a two-question screen may be effective for identifying individuals with depression, but that evidence is insufficient to support or refute the use of the CES-D.”

    From Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis (2016) · cites this paper as Minden et al., 2014

    The Conclusions and recommendations state that the BDI and a two-question screen may be considered for identifying major depressive disorder, while evidence is insufficient to support or refute the CES-D for screening depressive symptoms. Those conclusions are explicitly limited to individuals with MS; the citing sentence omits that population qualifier. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Well-developed evidence to guide the treatment of depression and anxiety in MS is lacking.

    “Well-developed evidence to guide the treatment of depression and anxiety in MS is lacking (Minden et al., 2014”

    From Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis (2016) · cites this paper as Minden et al., 2014

  • The American Academy of Neurology published guidelines on the assessment and management of psychiatric disorders in MS, specifically evaluating the evidence-base of tools for assessing symptoms and making diagnoses.

    “The American Academy of Neurology (AAN) published guidelines on the assessment and management of psychiatric disorders in MS, specifically evaluating the evidence-base of tools for assessing symptoms and making diagnoses (Minden et al., 2014”

    From Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis (2016) · cites this paper as Minden et al., 2014

  • The Goldman Consensus Conference and the American Academy of Neurology have highlighted the importance of diagnosing and treating depression in people with MS.

    “For these reasons the Goldman Consensus Conference (Goldman Consensus Group, 2005) and the American Academy of Neurology (Minden et al., 2014) have highlighted the importance of diagnosing and treating depression in people with MS.”

    From The effectiveness of a body-affective mindfulness intervention for multiple sclerosis patients with depressive symptoms: A randomized controlled clinical trial (2017) · cites this paper as Minden et al., 2014

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Research works printed but not linked: 4

  1. McIvor GP, Riklan M, Reznikoff M. Depression in multi- ple sclerosis as a function of length and severity of illness, age, remissions, and perceived social support. J Clin Psychol 1984;40:1028-1033.
  2. Stenager EN, Stenager E, Koch-Henriksen N, et al. Sui- cide and multiple sclerosis: an epidemiological investiga- tion. J Neurol Neurosurg Psychiatry 1992;55:542-545.
  3. Minden SL, Orav J, Reich P. Depression in multiple scle- rosis. Gen Hosp Psychiatry 1987;9:426-434.
  4. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute; 2002.

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Authors
Minden, S. L., Feinstein, A., Kalb, R. C., Miller, D., Mohr, D. C., Patten, S. B., Bever, C., Schiffer, R. B., Gronseth, G. S., & Narayanaswami, P.
Affiliations
Northwestern University (US)
ORCID
Venue
Neurology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-01-14
Volume
82
Issue
2
Pages
174-181
ISSN
  • 0028-3878 (ISSN-L)
  • 1526-632X
DOI
10.1212/wnl.0000000000000013
PMC
PMC3897434
OpenAlex
W2026795289
Cited by
230
References
39
Citations by year
2026: 10 · 2025: 9 · 2024: 20 · 2023: 15 · 2022: 14 · 2021: 22 · 2020: 24 · 2019: 18 · 2018: 12 · 2017: 27 · 2016: 23 · 2015: 22 · 2014: 13 · 2012: 1
FWCI
14.49
Type
journal article
Language
en
Open access
Locations
  • Neurology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • National Institutes of Health (UL1TR000150)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
multiple sclerosis, mental illness, depression, anxiety, pseudobulbar affect, screening, diagnosis, cognitive behavioral therapy, antidepressants, suicide risk, psychosis, emotional lability
MeSH terms
Affective Symptoms, Mental Disorders, Depression, Humans, Multiple Sclerosis, Psychiatric Status Rating Scales, Surveys and Questionnaires, Evidence-Based Medicine, Diagnostic and Statistical Manual of Mental Disorders

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