Depression in Multiple Sclerosis: A Case Report and Review of Clinical Considerations

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system that can result in various neuropsychiatric manifestations, particularly mood disorders. Depression is the most prevalent psychiatric comorbidity in MS, often preceding the neurological diagnosis. We present the case of a 23-year-old female referred for depressive symptoms including low mood, tearfulness, asthenia, anorexia, and insomnia. She responded favorably to Sertraline and Alprazolam, but two months later developed progressive vision loss. Brain MRI revealed demyelinating lesions, and a diagnosis of MS was established. Corticosteroid therapy followed by interferon beta-1a led to visual recovery and further improvement of mood. This case illustrates how depression can precede or mask the neurological presentation of MS. The pathophysiology of depression in MS is multifactorial, involving both psychological and neurobiological mechanisms, including cytokine imbalances and lesion localization. While interferons may trigger or worsen depressive symptoms in susceptible individuals, their role remains controversial. The overlap of MS symptoms with those of depression complicates diagnosis, underscoring the importance of comprehensive clinical and neurological evaluation. Early psychiatric intervention and careful monitoring during immunomodulatory therapy are critical to improving outcomes and quality of life in patients with MS.