Psychiatric morbidity is increased in MS, with over 50 percent of patients being symptomatic at some stage. Irritability, poor concentration, depressed mood, and anxiety are the most common symptoms. The depressive symptoms may not be severe, and only a minority of patients requires medication. The treatment of depression is similar to that for people who do not have MS, and there are few randomized controlled trials of antidepressants in MS. A study of desipramine showed moderate efficacy, but the dose was limited by anticholinergic side effects.

Psychological disturbances are common in MS, and many patients have difficulty coping from the time of initial diagnosis. This may be compounded by the subsequent development of disability. Different methods for treating psychological difficulties have been described, but few have been evaluated. The role of psychotherapy in MS has been described, and the role of group psychotherapy has been evaluated in a small group of patients with MS. Some benefit was seen in relation to “locus of control,” but no effect was seen in anxiety or self-esteem. A number of small studies have suggested that exercise may improve symptoms such as depression, anxiety, and anger.

In the view of the Committee, these symptoms need to be actively identified and managed, although this may not involve drug treatment.