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J Neurol Neurosurg Psychiatry. 2011 Jul;82(7):814-8. doi: 10.1136/jnnp.2010.230029. Epub 2011 Feb 4.

Endocrine and immune substrates of depressive symptoms and fatigue in multiple sclerosis patients with comorbid major depression.

Author information

  • 1Institute for Neuroimmunology und Clinical Multiple Sclerosis Research (inims), Falkenried 94, D-20251 Hamburg, Germany. stefan.gold@zmnh.uni-hamburg.de

Abstract

OBJECTIVE:

Depression and fatigue are among the most common symptoms of multiple sclerosis (MS). These symptoms frequently co-occur and partially overlap in MS but their underlying biological substrates are unclear. In this study, the relative role of cytokines and hypothalamic-pituitary-adrenal (HPA) axis activity in depression and fatigue were examined in patients with relapsing-remitting MS (RRMS).

METHODS:

HPA axis function and frequency of stimulated cytokine (interferon γ (IFNγ) and tumour necrosis factor α (TNFα)) producing T cells was measured cross sectionally in 44 female patients with RRMS. All subjects completed a neurological examination, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and self-report questionnaires.

RESULTS:

10 patients met diagnostic criteria for major depressive disorder (MDD). MS patients with comorbid MDD showed normal morning but elevated evening salivary cortisol levels, resulting in a flattened slope. While a higher frequency of cytokine producing CD8+ T cells was also seen in MS patients with MDD, these markers were more closely associated with fatigue than depression.

CONCLUSIONS:

This study supports a role for HPA axis hyperactivity in major depression in MS. In addition, inflammatory and neuroendocrine factors may differentially mediate fatigue and depressive symptoms.

[PubMed - indexed for MEDLINE]
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