Presence of Concomitant Depression and its Effect on Clinical Course in Patients Diagnosed with Myasthenia Gravis

Abstract

Objective: Myasthenia gravis (MG) is a chronic autoimmune disease with fluctuating non-specific symptoms, and symptoms are exacerbated by stress. Many psychiatric disorders, especially depression, may accompany MG. This study aimed to determine the presence of depression accompanying MG and the effect of depression on the clinical course. Materials and Methods: Ninety-eight patients were diagnosed with MG between the ages of 18 and 65 who had a follow-up of at least 1 year at Ege University Faculty of Medicine, Department of Neurology, Muscular Diseases Outpatient Clinic and who did not have any medical or psychiatric illness that prevented communication were included in our study. Instead, of using questionnaire forms to diagnose depression, a one-to-one interview method following Structured Clinical Interview for DSM-IV Criteria (SCID-1) was preferred. The clinical course of patients with and without depression and their responses to standard symptomatic or immunosuppressive therapy was evaluated using the MG treatment response rating scale by the lead investigator, who was blind to the presence of depression in patients. Results: In the SCID-1 evaluation of our patients, depression was detected in 40.8% of the patients. Of our patients, 64.9% identified a stressor factor before the onset of disease symptoms. In the evaluation of treatment response, 19.4% of our patients had remission, and 80.6% had minimal symptoms. In evaluating the change in the clinical situation, improvement was detected in 88.8% of the patients. A statistically significant relationship was found between worse treatment response and depression (p=0.018). Conclusion: It was determined that depression was frequently present in patients with MG and the clinical course was worse in patients with depression. Therefore, it was aimed to draw attention to the importance of detecting depression in patients with MG and that treatment regulation in this direction might positively affect the course of the disease.