Bruno Antonio, Dolcetti Ettore, Annovazzi Pietro, Clerico Marinella, Cocco Eleonora, Conte Antonella, Marfia Girolama Alessandra, Salvetti Marco, Tomassini Valentina, Clerici Valentina Torri, Totaro Rocco, Nicoletti Ferdinando, Centonze Diego
Neurology Unit - IRCCS Neuromed, Pozzilli (IS), Italy.
Neuroimmunology Unit - Multiple Sclerosis Centre ASST Valle Olona - Gallarate Hospital, Gallarate (VA), Italy.
Front Psychiatry. 2025 Jun 30;16:1557335. doi: 10.3389/fpsyt.2025.1557335. eCollection 2025.
In multiple sclerosis (MS), depression represents one of the most frequent psychiatric comorbidities, significantly impacting patients' quality of life and disease progression. However, the diagnosis and management of depression in MS remain challenging due to overlapping symptoms and the lack of specific treatment guidelines. This Delphi study aims to achieve a shared consensus among Italian MS experts regarding the clinical manifestations, diagnosis, and treatment of depression in MS.
An online Delphi survey with 35 questions covering the epidemiology, clinical features, diagnostic criteria, and treatment of depression in MS was anonymously administered to a panel of 51 expert neurologists across Italy. The consensus was based on a two-round Delphi process.
Consensus was reached on 100% of the statements. Positive consensus was achieved on 90.6% of the statements, while 9.4% reached negative consensus. Key findings include the strong link between depression and MS, with depressive symptoms often preceding MS onset. The panel agreed that the DSM-5 diagnostic criteria should be adapted to capture the specific mood disturbances seen in MS. Regarding treatment, antidepressants were widely prescribed, but concerns about their efficacy in the MS population remain. Non-pharmacological interventions, such as cognitive behavioral therapy (CBT), were considered essential components of comprehensive care.
This Delphi study highlights the need for tailored diagnostic tools and integrated treatment approaches for managing depression in MS. Further studies are required to refine guidelines for the use of antidepressants and explore the role of disease-modifying therapies (DMTs) in treating depression in this population.
在多发性硬化症（MS）中，抑郁症是最常见的精神共病之一，对患者的生活质量和疾病进展有显著影响。然而，由于症状重叠以及缺乏具体的治疗指南，MS中抑郁症的诊断和管理仍然具有挑战性。这项德尔菲研究旨在使意大利MS专家就MS中抑郁症的临床表现、诊断和治疗达成共同共识。
对意大利51名神经科专家组成的小组进行了一项在线德尔菲调查，共35个问题，涵盖MS中抑郁症的流行病学、临床特征、诊断标准和治疗，调查以匿名方式进行。共识基于两轮德尔菲过程。
所有陈述均达成共识。90.6%的陈述达成了积极共识，9.4%达成了消极共识。主要发现包括抑郁症与MS之间的紧密联系，抑郁症状通常先于MS发病出现。专家小组一致认为，应调整《精神疾病诊断与统计手册》第5版（DSM-5）的诊断标准，以涵盖MS中出现的特定情绪障碍。关于治疗，抗抑郁药被广泛使用，但对其在MS患者中的疗效仍存在担忧。非药物干预，如认知行为疗法（CBT），被认为是综合治疗的重要组成部分。
这项德尔菲研究强调了需要有针对性的诊断工具和综合治疗方法来管理MS中的抑郁症。需要进一步研究以完善抗抑郁药使用指南，并探索疾病修正疗法（DMTs）在该人群抑郁症治疗中的作用。
