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Treatment of Depression Improves Adherence to Interferon Beta-1b Therapy for Multiple Sclerosis

Treatment of Depression Improves Adherence to Interferon Beta-1b Therapy for Multiple Sclerosis Abstract Objectives: To examine the relationship between patient-reported depression and adherence to therapy with interferon beta-lb (IFNβ-1b) and to test the hypothesis that treatment of depression is associated with improved adherence. Design: Patients with multiple sclerosis were followed up 6 months after initiating therapy with IFNβ-1b. Setting: A university outpatient multiple sclerosis center, an academic group practice, and a health maintenance organization. Patients: Eighty-five patients with clinically evident multiple sclerosis taking IFNβ-1b. Main Outcome Measure: Follow-up questionnaire. Results: Thirty-five (41%) of the 85 patients reported new or increased depression within 6 months of initiating therapy with IFNβ-1b. Patients experiencing symptoms of depression were more likely to discontinue therapy. Among the patients reporting new or increased depression, 86% who received psychotherapy or antidepressant medication and 38% of the patients who received no therapy for depression continued the IFNβ-1b therapy (P=.003). Although psychotherapy was used as a treatment option more frequently in university and academic group practice—based multiple sclerosis clinics than in the health maintenance organization (P=.02), the treatment adherence patterns were similar across sites. Conclusions: These findings support previous findings that patients report increased depression after initiating therapy with IFNβ-1b. Although the source of this depression is unclear, these findings suggest that treating patient-reported depression increases adherence to treatment. References 1. Paty DW, Li DKB, UBC MS/MRI Study Group, and the IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis, II: MRI analysis results of a multicenter, randomized, double-blind, placebocontrolled trial . Neurology . 1993;43:662-667.Crossref 2. The IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsingremitting multiple sclerosis, I: clinical results of a multicenter, randomized, double-blind, placebo-controlled trial . Neurology . 1993;43:655-661.Crossref 3. Stone LA, Frank JA, Albert PS, et al. The effect of interferon-β on blood-brain barrier disruptions demonstrated by contrast-enhanced magnetic resonance imaging in relapsing-remitting multiple sclerosis . Ann Neurol . 1995;37:611-619.Crossref 4. Goodkin DE. Interferon beta treatment for multiple sclerosis: persisting questions . Multiple Sclerosis . 1996;1:321-324. 5. Mohr DC, Goodkin DE, Likosky W, et al. Therapeutic expectations of patients with multiple sclerosis upon initiating interferon beta-1b: relationship to adherence to treatment . Multiple Sclerosis . 1996;2:222-226. 6. Neilley LK, Goodin DS, Goodkin DE, Mohr DC, Hauser SL. Side effect profile of interferon beta 1-b (Betaseron) . Neurology . 1996;46:552-554.Crossref 7. Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis . Ann Neurol . 1983;13:227-231.Crossref 8. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) . Neurology . 1983;33:1422-1427.Crossref 9. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition. Washington DC: American Psychiatric Association; 1994. 10. Sherbourne CD, Wells KB, Hays RD, Rogers W, Burnam MA, Judd LL. Subthreshold depression and depressive disorder: clinical characteristics of general medical and mental health specialty outpatients . Am J Psychiatry . 1994; 151:1777-1784. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Treatment of Depression Improves Adherence to Interferon Beta-1b Therapy for Multiple Sclerosis

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1997.00550170015009
Publisher site
See Article on Publisher Site

Abstract

Abstract Objectives: To examine the relationship between patient-reported depression and adherence to therapy with interferon beta-lb (IFNβ-1b) and to test the hypothesis that treatment of depression is associated with improved adherence. Design: Patients with multiple sclerosis were followed up 6 months after initiating therapy with IFNβ-1b. Setting: A university outpatient multiple sclerosis center, an academic group practice, and a health maintenance organization. Patients: Eighty-five patients with clinically evident multiple sclerosis taking IFNβ-1b. Main Outcome Measure: Follow-up questionnaire. Results: Thirty-five (41%) of the 85 patients reported new or increased depression within 6 months of initiating therapy with IFNβ-1b. Patients experiencing symptoms of depression were more likely to discontinue therapy. Among the patients reporting new or increased depression, 86% who received psychotherapy or antidepressant medication and 38% of the patients who received no therapy for depression continued the IFNβ-1b therapy (P=.003). Although psychotherapy was used as a treatment option more frequently in university and academic group practice—based multiple sclerosis clinics than in the health maintenance organization (P=.02), the treatment adherence patterns were similar across sites. Conclusions: These findings support previous findings that patients report increased depression after initiating therapy with IFNβ-1b. Although the source of this depression is unclear, these findings suggest that treating patient-reported depression increases adherence to treatment. References 1. Paty DW, Li DKB, UBC MS/MRI Study Group, and the IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis, II: MRI analysis results of a multicenter, randomized, double-blind, placebocontrolled trial . Neurology . 1993;43:662-667.Crossref 2. The IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsingremitting multiple sclerosis, I: clinical results of a multicenter, randomized, double-blind, placebo-controlled trial . Neurology . 1993;43:655-661.Crossref 3. Stone LA, Frank JA, Albert PS, et al. The effect of interferon-β on blood-brain barrier disruptions demonstrated by contrast-enhanced magnetic resonance imaging in relapsing-remitting multiple sclerosis . Ann Neurol . 1995;37:611-619.Crossref 4. Goodkin DE. Interferon beta treatment for multiple sclerosis: persisting questions . Multiple Sclerosis . 1996;1:321-324. 5. Mohr DC, Goodkin DE, Likosky W, et al. Therapeutic expectations of patients with multiple sclerosis upon initiating interferon beta-1b: relationship to adherence to treatment . Multiple Sclerosis . 1996;2:222-226. 6. Neilley LK, Goodin DS, Goodkin DE, Mohr DC, Hauser SL. Side effect profile of interferon beta 1-b (Betaseron) . Neurology . 1996;46:552-554.Crossref 7. Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis . Ann Neurol . 1983;13:227-231.Crossref 8. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) . Neurology . 1983;33:1422-1427.Crossref 9. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition. Washington DC: American Psychiatric Association; 1994. 10. Sherbourne CD, Wells KB, Hays RD, Rogers W, Burnam MA, Judd LL. Subthreshold depression and depressive disorder: clinical characteristics of general medical and mental health specialty outpatients . Am J Psychiatry . 1994; 151:1777-1784.

Journal

Archives of NeurologyAmerican Medical Association

Published: May 1, 1997

References