What condition is a 25-year-old woman with multiple sclerosis (MS) at greatest risk for developing over the next 2 years, given her corrected visual acuity of 20/50 in the right eye and 20/20 in the left eye, muscle strength of 4/5 in the left upper extremity, and decreased sensation to touch over the lower extremities?

From the Guidelines

The patient is at greatest risk for development of major depressive disorder during the next 2 years. This is because patients with multiple sclerosis (MS) have a significantly higher risk of developing major depressive disorder compared to the general population, with approximately 50% of MS patients experiencing clinical depression during the course of their illness 1. The increased risk is due to both the psychological impact of living with a chronic, potentially disabling neurological condition and the direct neurobiological effects of MS-related inflammation and demyelination on brain regions involved in mood regulation.

Some key points to consider in this patient's case include:

• The patient's current symptoms, such as visual impairment, muscle weakness, and sensory deficits, indicate active disease that may progress over time, further increasing depression risk.
• The patient is not on disease-modifying therapy to slow progression, which may also contribute to a higher risk of developing major depressive disorder.
• While other neuropsychiatric complications can occur in MS, major depressive disorder represents the most common psychiatric comorbidity and the greatest risk during the next two years for this patient.
• Studies have shown that brain volume changes, which can be assessed using MRI, can be an important measure of tissue damage in patients with MS and are associated with cognitive impairment, fatigue, and disability progression over the long term 1.

Overall, considering the patient's condition and the available evidence, major depressive disorder is the most likely condition to develop in this patient during the next 2 years.

From the Research

Conditions Associated with Multiple Sclerosis

The patient in question has multiple sclerosis (MS) and is at risk for developing various conditions due to her disease. Considering her current health status and the available evidence, the following conditions are potential risks:

• Major depressive disorder: Studies have shown that patients with MS are at a higher risk of developing depression, with prevalence rates ranging from 36% to 54% 2, 3.
• Other conditions such as anorexia, bulimia, complex partial seizures, mania, and visual hallucinations are not directly linked to MS in the provided evidence.

Risk Factors for Depression in MS

Several factors contribute to the development of depression in MS patients, including:

• Biological mechanisms, such as hippocampal microglial activation, lesion burden, and regional atrophy 2.
• Psychosocial stress, focal demyelinating lesions, and immune dysfunction 4.
• The stressors, threats, and losses that accompany living with an unpredictable and often disabling disease 2.

Management of Depression in MS

While there is no single, gold-standard treatment for depression in MS, available evidence supports the effectiveness of standard treatment approaches, including:

• Cognitive behavioral therapies 5, 3.
• Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) 3.
• Combinatory treatments, which may be considered for the management of depression in MS, although more research is needed to support their efficacy 5.