Investigating depression in multiple sclerosis: an Italian Delphi consensus on clinical manifestations, diagnosis and treatment
BackgroundIn 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...
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Frontiers Media S.A.
2025-06-01
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| author | Antonio Bruno Ettore Dolcetti Pietro Annovazzi Marinella Clerico Eleonora Cocco Antonella Conte Antonella Conte Girolama Alessandra Marfia Girolama Alessandra Marfia Marco Salvetti Marco Salvetti Valentina Tomassini Valentina Torri Clerici Rocco Totaro Ferdinando Nicoletti Ferdinando Nicoletti Diego Centonze Diego Centonze |
| author_facet | Antonio Bruno Ettore Dolcetti Pietro Annovazzi Marinella Clerico Eleonora Cocco Antonella Conte Antonella Conte Girolama Alessandra Marfia Girolama Alessandra Marfia Marco Salvetti Marco Salvetti Valentina Tomassini Valentina Torri Clerici Rocco Totaro Ferdinando Nicoletti Ferdinando Nicoletti Diego Centonze Diego Centonze |
| author_sort | Antonio Bruno |
| collection | DOAJ |
| description | BackgroundIn 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.MethodsAn 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.ResultsConsensus 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.ConclusionsThis 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. |
| format | Article |
| id | doaj-art-9f25614fde52403bbc2cf34f41b94645 |
| institution | Kabale University |
| issn | 1664-0640 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Psychiatry |
| spelling | doaj-art-9f25614fde52403bbc2cf34f41b946452025-08-20T03:29:06ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402025-06-011610.3389/fpsyt.2025.15573351557335Investigating depression in multiple sclerosis: an Italian Delphi consensus on clinical manifestations, diagnosis and treatmentAntonio Bruno0Ettore Dolcetti1Pietro Annovazzi2Marinella Clerico3Eleonora Cocco4Antonella Conte5Antonella Conte6Girolama Alessandra Marfia7Girolama Alessandra Marfia8Marco Salvetti9Marco Salvetti10Valentina Tomassini11Valentina Torri Clerici12Rocco Totaro13Ferdinando Nicoletti14Ferdinando Nicoletti15Diego Centonze16Diego Centonze17Neurology Unit - IRCCS Neuromed, Pozzilli (IS), ItalyNeurology Unit - IRCCS Neuromed, Pozzilli (IS), ItalyNeuroimmunology Unit - Multiple Sclerosis Centre ASST Valle Olona - Gallarate Hospital, Gallarate (VA), ItalyClinical and Biological Sciences Department, University of Torino, Torino, ItalyUniversity of Cagliari, Department of Medical Science and Public Health, Centro Sclerosi Multipla, Cagliari, ItalyNeurology Unit - IRCCS Neuromed, Pozzilli (IS), ItalyDepartment of Human Neurosciences, Sapienza, University of Rome, Rome, ItalyDepartment of Systems Medicine, Tor Vergata University, Rome, ItalyMultiple Sclerosis Clinical and Research Unit, Tor Vergata University Hospital, Rome, ItalyNeurology Unit - IRCCS Neuromed, Pozzilli (IS), ItalyCentre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, ItalyInstitute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy0IRCCS Istituto Neurologico C. Besta, Neuroimmunology Unit, Milan, Italy1Demyelinating Disease Center, Department of Neurology, San Salvatore Hospital, L’Aquila,, ItalyNeurology Unit - IRCCS Neuromed, Pozzilli (IS), Italy2Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, ItalyNeurology Unit - IRCCS Neuromed, Pozzilli (IS), ItalyDepartment of Systems Medicine, Tor Vergata University, Rome, ItalyBackgroundIn 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.MethodsAn 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.ResultsConsensus 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.ConclusionsThis 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.https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1557335/fullmultiple sclerosisdepressionantidepressant therapydisease-modifying therapyDSM-5disease modifying symptomatic treatment |
| spellingShingle | Antonio Bruno Ettore Dolcetti Pietro Annovazzi Marinella Clerico Eleonora Cocco Antonella Conte Antonella Conte Girolama Alessandra Marfia Girolama Alessandra Marfia Marco Salvetti Marco Salvetti Valentina Tomassini Valentina Torri Clerici Rocco Totaro Ferdinando Nicoletti Ferdinando Nicoletti Diego Centonze Diego Centonze Investigating depression in multiple sclerosis: an Italian Delphi consensus on clinical manifestations, diagnosis and treatment Frontiers in Psychiatry multiple sclerosis depression antidepressant therapy disease-modifying therapy DSM-5 disease modifying symptomatic treatment |
| title | Investigating depression in multiple sclerosis: an Italian Delphi consensus on clinical manifestations, diagnosis and treatment |
| title_full | Investigating depression in multiple sclerosis: an Italian Delphi consensus on clinical manifestations, diagnosis and treatment |
| title_fullStr | Investigating depression in multiple sclerosis: an Italian Delphi consensus on clinical manifestations, diagnosis and treatment |
| title_full_unstemmed | Investigating depression in multiple sclerosis: an Italian Delphi consensus on clinical manifestations, diagnosis and treatment |
| title_short | Investigating depression in multiple sclerosis: an Italian Delphi consensus on clinical manifestations, diagnosis and treatment |
| title_sort | investigating depression in multiple sclerosis an italian delphi consensus on clinical manifestations diagnosis and treatment |
| topic | multiple sclerosis depression antidepressant therapy disease-modifying therapy DSM-5 disease modifying symptomatic treatment |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1557335/full |
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