Vol 9, No 2 - Neuropsychiatric Manifestations of Neurodegenerative Disease
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Historical perspective on multiple sclerosis and depression ultiple  sclerosis  (MS)  is  characterized  by inflammation, demyelination, axonal injury, and gliosis (scarring), and can involve the brain, spinal cord, and optic nerves. The course of MS can be relapsing-remit- ting or progressive, but typically involves insults that are multiphasic and multifocal (ie, disseminated in time and T r a n s l a t i o n a l   r e s e a r c h M Copyright © 2007 LLS SAS.  All rights reserved www.dialogues-cns.org Neuropsychiatric manifestations of depression in multiple sclerosis: neuroinflammatory, neuroendocrine, and neurotrophic mechanisms in the pathogenesis of immune-mediated depression Michele L. Pucak, PhD; Katherine A. L. Carroll, MA; Douglas A. Kerr, MD, PhD; Adam I. Kaplin, MD, PhD Keywords:  cytokine; hypothalamic-pituitary-adrenal axis; interferon; treatment; neuroimaging; inflammation Author affiliations: Department of Psychiatry and Behavioral Sciences (Michele L.  Pucak,  Katherine  A.  L.  Carroll,  Adam  I.  Kaplin);  Department  of  Neurology (Katherine A. L. Carroll, Douglas A. Kerr); Johns Hopkins University School of Medicine,  Baltimore,  Maryland,  USA;  Department  of  Molecular  Microbiology and   Immunology,  Bloomberg  School  of  Public  Health  and  Johns   Hopkins University School of Medicine, Baltimore, Maryland, USA (Douglas A. Kerr) Address for correspondence: Adam I. Kaplin, The Johns Hopkins Hospital, 600 N. Wolfe St., Meyer 121, Baltimore, MD 21287, USA (e-mail: akaplin@jhmi.edu) Evidence suggests that depression in multiple sclerosis (MS) is largely biologically mediated by some of the same processes involved in the immunopathogenesis of this neurologic disease. In particular, the increase in proinflamma- tory cytokines, activation of the hypothalamic-pituitary-adrenal (HPA) axis, and reduction in neurotrophic factors that occur in MS may each account for the increased rate of depression seen in MS. The possible contributions of these neu- roinflammatory, neuroendocrine, and neurotrophic mechanisms suggest a diverse array of novel treatment strategies for depression, both in the context of inflammatory conditions as well as in idiopathic depression. Furthermore, if such processes in MS play a causative role in the pathogenesis of depression, and depression in turn has affects on neuro- physiological processes related to immune function, then treatment of depression might have a positive effect on MS disease progression. This makes treating MS depression a neuropsychiatric imperative.      © 2007, LLS SAS Dialogues Clin Neurosci. 2007;9:125-139.