Multiple sclerosis and affective psychopathology in the adult and pediatric population: depression, mania and pseudobulbar syndrome

Psychiatric comorbidity in patients diagnosed with multiple sclerosis is present in more than half of the cases (60%). The pathogenesis
is complex and its treatment not only improves the patient’s quality of life, but it even seems that it could improve the evolution
reducing the inflammatory process and demyelination.
Major depressive episode is the most frequently diagnosed affective disorder in patients with multiple sclerosis. Cognitive-behavioral
therapy and selective serotonin reuptake inhibitor antidepressants are the first treatment of choice.
The risk of developing bipolar spectrum disorder is twice as high in this group of patients. The most recommended treatments
would be lithium and atypical antipsychotics, especially quetiapine and aripiprazole.
Pseudobulbar syndrome occurs in up to 10% of cases. Selective serotonin reuptake inhibitors are also the treatment of first choice,
although their pathogenesis and response to treatment differ from depressive disorders.
The prevalence of affective disorders in the pediatric population diagnosed with multiple sclerosis varies greatly according to the
different series consulted. The most frequent symptoms are fatigue, as in adults, depressive mood and cognitive disturbances.