Mental health co-morbidities in pediatric multiple sclerosis

Background: Depression and other psychiatric disorders can occur in over half of adults with multiple sclerosis (MS). The prevalence of psychiatric difficulties in pediatric MS is unknown. Objective: To determine the prevalence of depression and other psychiatric disorders in a pediatric MS cohort. Methods: Pediatric MS patients (n=28) referred to a Southeastern US Pediatric MS Center from September 2007 to April 2008 were evaluated by a child psychiatrist using DSM-IV-TR criteria. All patients met the International Pediatric MS Study Group definition for MS, including five patients (18%) with CIS who fulfilled magnetic resonance imaging (MRI) criteria for dissemination in time. Psychiatric assessment was performed while patients were relapse-free and off steroids. Results: This cohort was 50% female, 46% African-American with a mean age of 15.3 plus or minus 0.6 years at the time of initial psychiatric evaluation. Most patients were recently diagnosed with MS, with 1.3 plus or minus 0.3 years since onset of symptoms and 2.9 plus or minus 0.4 relapses. Over 70% (n = 20) were diagnosed with a psychiatric co-morbidity, including depression (n=17), anxiety (n=5) and attention deficit hyperactivity disorder (n=5), with seven patients receiving two or more diagnoses. Five patients had been treated for mental health conditions prior to onset of demyelinating symptoms. Treatment included selective serotonin reuptake inhibitors (n=ll), stimulant therapy (n=2) or other psychotropic medications (n=2). All MS patients with depression or anxiety were also referred for counseling in their communities, but less than half (n=7) received psychological services. All nine patients with followup psychiatric evaluation reported improved symptoms whether treated medically or behaviorally. No correlation with psychiatric diagnoses was observed with respect to age, sex, race, disease duration or number of relapses. Conclusions: Psychiatric disorders are common in pediatric MS, affecting >70% of this pediatric MS cohort with depression being the most common diagnosis. Many of these patients had difficulty accessing local mental health services.