The spectrum of depression in multiple sclerosis. An approach for clinical management.

Twenty patients with clinically definite multiple sclerosis who experienced major depressive episodes according to Research Diagnostic Criteria are described. The heterogeneous quality of these depressive episodes is presented by categorizing the episodes according to ten Research Diagnostic Criteria depressive subtypes. Four interpersonal management strategies for such patients that are applicable within a neurologic practice setting are described. The most important feature concerning prognosis for these depressive episodes appears to be the relationship between the depressive episode and the underlying demyelinating disease. When depression occurred in the setting of clinically significant disease activity, the outcome was usually favorable.