J Neurol (2001) 248 : 416–421 © Steinkopff Verlag 2001 ORIGINAL COMMUNICATION Marino Zorzon Roberto de Masi Davide Nasuelli Maja Ukmar Roberto Pozzi Mucelli Giuseppe Cazzato Alessio Bratina Robert Zivadinov Depression and anxiety in multiple sclerosis. A clinical and MRI study in 95 subjects JON 453 ■ Abstract The aim of the present study was to investigate the rela- tionship between involvement of specific areas of the brain and the occurrence of depression and anxi- ety in patients with multiple sclero- sis.We studied 95 patients (62 women and 33 men, mean age 39.5 years, SD 11.2) with definite MS, 97 patients (65 women and 32 men, mean age 40.7, SD 11.9) suffering from chronic rheumatoid diseases and 110 healthy subjects (71 women and 39 men, mean age 40.1, SD 12.7). The disability, the inde- pendence, the cognitive perfor- Received: 9 September 2000 Received in revised form: 30 November 2000 Accepted: 20 December 2000 M. Ukmar · R. Pozzi Mucelli Department of Radiology University of Trieste Trieste, Italy M. Zorzon, MD () · R. de Masi · D. Nasuelli · G. Cazzato · A. Bratina · R. Zivadinov Unit of Clinical Neurology Department of Clinical Medicine and Neurology Cattinara Hospital Strada di Fiume 447 34149 Trieste, Italy Fax: +39-0 40-91 08 61 e-mail: zivadinov@hotmail.com mances, the depressive and anxiety symptoms were assessed. The diag- nosis of major depression was made according to the DSM-IV. The patients with multiple sclerosis underwent a 1.5 Tesla magnetic resonance examination including T1 and T2 weighted images. Calcu- lation of regional and total lesion loads and brain volumes were per- formed. The number (%) of sub- jects with a diagnosis of major de- pression was 18 (18.9) among MS cases, 16 (16.5) among controls with chronic disease (p=NS), and 4 (3.6) among healthy volunteers (p < 0.0001). The Hamilton Depres- sion and Anxiety rating scales me- dian scores were 5 and 18, respec- tively in the MS patients, 5 (p= NS) and 14 (p= NS) in the chronic rheumatoid diseases controls, and 3 (p= < 0.0001) and 6 (p= < 0.0001) in the healthy controls. Both sever- ity of depressive symptoms and diagnosis of major depression correlated, albeit weakly, with right frontal lesion load (r=0.22, p=0.035, and r=0.23, p=0.026, respectively) and right temporal brain volume (r=0.22, p=0.005 and r=0.22, p=0.036, respectively). The severity of depression was related significantly also with total tempo- ral brain volume (r=0.26, p=0.012), right hemisphere brain volume (r=0.25, p=0.015), disability (r=0.30, p=0.003) and indepen- dence of MS cases (r=–0.26, p=0.01). The anxiety did not corre- late significantly with any of the measures of regional and total le- sion loads and brain volume or with any of the considered clinical variables. The similar frequency of depression and severity of depres- sive symptoms in MS patients and in chronic disease patients, the sig- nificant difference in this respect with the normal controls, and the significant correlation between de- pression and the disability mea- sures would suggest a psychologi- cal reaction to the impact of the disease but the relationship be- tween depression and the alter- ations in the frontal and temporal lobes of the right hemisphere sup- ports, on the contrary, the causative role of organic brain damage. The lack of any significant association between symptoms of anxiety and either MRI abnormalities or clini- cal variables led us to the opinion that anxiety is a reactive response to the psychosocial pressure put on the patients. ■ Key words Depression · Anxiety · MRI · Multiple sclerosis