Efficacy of Paroxetine in treating major depressive disorder in persons with MS.

TitleEfficacy of Paroxetine in treating major depressive disorder in persons with MS.
Publication TypeJournal Article
AuthorsEhde DM, Chwastiak LA, Sullivan KM, Gibbons LE, Kraft GH
JournalInternational Journal of MS Care

The literature on pharmacotherapy for depression in MS is extremely limited and largely anecdotal. To address this gap, we conducted a double-blind, randomized, placebocontrolled clinical trial of one commonly used SSRI, paroxetine, for the treatment of depression in persons with MS. Forty-two persons with MS and a diagnosis of Major Depressive Disorder and/or paroxetine or placebo. A psychiatrist met with each participant to confirm psychiatric diagnoses, prescribe the study medications, and monitor side effects and dosing. The primary outcome measure was the Hamilton Depression Rating Scale (HAM-D). Secondary outcomes included fatigue, perceived cognitive deficits, pain, and self-reported quality of life. Measures were administered at pre-treatment, Week 6, and posttreatment. Intent-to-treat analyses revealed that both the treatment and the control groups improved from pre-treatment to post-treatment. The treatment group improved more than the control group on most measures, but few differences were statistically significant. For the primary outcome, 55% of participants in treatment had at least a 50% reduction in the HAM-D score, compared with 40% in the control group; this was not statistically significant. Controlling for age, gender, EDSS score, ABC drugs, and treatment adherence did not affect the significance of any results. Among subjects who completed the study, 79% of treatment subjects met the primary outcome criterion of a 50% reduction in Ham-D, compared with 42% of controls (p=0.073). Significant improvements in quality of life and fatigue were also found in the active treatment completers relative to controls. Our results indicate that, when using intent-to-treat analyses, paroxetine was not effective in treating depression relative to placebo. However, when examining only study completers, we found that a greater proportion of the treatment group improved. Explanations for and implications of these findings will be discussed.


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