Multiple Sclerosis-Related Depression Influenced by Modifiable Lifestyle Choices

George A. Jelinek, MBBS, MD

Lifestyle choices that an individual has the power to change can influence depression associated with multiple sclerosis (MS), according to a new study results involving more than 1000 patients.

The results lend to the notion that physicians managing patients with MS should be more aware of what’s a growing rate of literature linking unhealthy lifestyle behaviors and depression risks, as well as the means of modifying such risk factors, author George A. Jelinek, MBBS, MD, of the University of Melbourne, told MD Magazine®.

About half of all MS patients experience an episode of depression during their lifetimes, but little is known of particular treatment options. Most interventions are drug-related or psychiatric, investigators wrote.

“Depression appears to accelerate the disease process according to the best available current evidence,” Jelinek said. “It is thus very important for people with MS to be proactive about preventing and managing depression.”

To investigate potential new approaches to help MS patients address depression, investigators researchers considered modifiable lifestyle factors including diet, vitamin D and omega-3 supplementation, exercise, meditation, alcohol, and smoking. They built on their previous work with an international sample of MS patients who’d supplied detailed information on their lifestyles.

That search considered 2466 participants, of whom 2224 (88.9%) completed the Patient Health Questionnaire-2 (PHQ-2), which asks about the frequency of depressed moods over the previous 2 weeks. Of those patients, 19.3% screened positive for depression.

The results presented “strong and clinically meaningful” associations between modifiable lifestyle risk factors and depression prevalence, investigators noted. The current study considered depression in these patients 2.5 years later.

Of the original group, 1309 individuals (93.4%) completed the PHQ-2 evaluation; 1264 (90.2%) filled out a PHQ-9 questionnaire, which assesses depression risk. The prevalence of depression in this review was estimated at 14.5% using the PHQ-2, and 21.7% using the PHQ-9.

“As very few people changed their depression status, there was little possibility of identifying factors that predicted such a change,” Jelinek said. “We were only able to determine that alcohol consumption, diet quality and vitamin D supplement use were predictors of a change in depression status after adjusting for confounders.”

However, he noted that looking at the sample after 2.5 years—as the team had done at baseline in their previous paper—healthy lifestyle behaviors were again contemporaneously associated with improved depression status.

Current smokers were significantly more likely to have scores indicative of prevalent depression risk, based on both the PHQ-2 and PHQ-9 questionnaires. In addition, the positive associations of current smoking with depression risk were much stronger for major depression.

“Being or becoming a non-smoker clearly has multiple direct and indirect benefits for people with MS,” the researchers said.

Vitamin D and omega-3 supplementation were associated with lower frequencies of depression risk in both questionnaires. However, only the association of vitamin D supplementation to depression screening and severity persisted after the data were adjusted for potential confounders.

While the authors discovered no association between diet quality and depression risk, they did find an association between diet quality and depression severity.

“A whole food plant-based diet has been recommended for people with MS and more widely for general health,” they said.

Low physical activity was strongly associated with increased depression risk and severity. However, the team did not find an association between physical activity and a change in depression risk.

Meditation was associated with lower depression in the 2.5-year follow-up. But findings again did not indicate meditation to be associated with depression trajectory in this period.

Investigators noted that moderate alcohol intake results in a significant reduction of pro-inflammatory cytokines, “reducing inflammation, suggesting a mechanism of preventing and potentially treating depression.”

Moderate alcohol consumption was associated both with a greater probability of a patient becoming depression-free and a reduced risk of a patient becoming depressed at all, the Melbourne-based research team found.

Diet quality and vitamin D supplement use were also predictors of a change in depression status, Jelinek added. The team stressed that their findings need to be validated in more MS patient groups and supported in controlled trials.

“While we would expect to be able to better determine predictors over longer time periods of observation as more people change their depression status, our data add to the growing literature showing an important potential role for healthy lifestyle behaviors in preventing depression in the at-risk group,” Jelinek said.

The study, "Longitudinal Associations of Modifiable Lifestyle Factors With Positive Depression-Screen Over 2.5-Years in an International Cohort of People Living With Multiple Sclerosis," was published online in Frontiers in Psychiatry.