According to new research over 2 in 3 patients with multiple system atrophy have depression and this influences their symptoms.

When research scientist Jose Martinez joined the Dysautonomia Center, he began asking patients about their mood, and soon started collecting surveys to rate depressive symptoms. Mr. Martinez came from a background in psychiatry, where he had been managing the clinical trials. Over the last decade, he has collected hundreds of psychological profiles of patients with different rare autonomic diseases.

While depressive symptoms in neurological diseases are not uncommon, the rates of depression in MSA appeared to be unusually high.  A staggering 69% of patients with MSA scored high on the depressive symptom scale.

As an experienced clinical trials manager, Mr. Martinez began to think how this was influencing patients when they scored their symptoms. Clinical trials are all based on being able to show patients feel better and can do more things. The better a scale is at capturing improvement, the more likely a trial will lead to a successful new drug that is approved for use. Patients with MSA are in desperate need of new therapies. But, could it be that regardless of what symptom you were trying to improve, patients with depression just felt worse?

Mr. Martinez came across an interesting observation. Patients with MSA that have problems with blood pressure control (a condition known as neurogenic orthostatic hypotension) rated their symptoms of low blood pressure much worse if they had underlying depression.

The orthostatic hypotension questionnaire (OH-Q) has become the “gold-standard” way of measuring symptoms related to low blood pressure. As blood supply to the organs becomes insufficient when standing up, patients are expected to rate their dizziness, difficulties with vision, fatigue, weakness, and pain. But what Mr. Martinez discovered was that for any given fall in blood pressure, MSA patients that had depressive symptoms rated themselves as more severe and more impacted.

It’s important information to know explained Dr. Palma. We rely on tools like the orthostatic hypotension questionnaire to tell us if new therapies we are trying do indeed improve symptoms. We don’t consider that there might be other factors that influence a way a person experiences a symptom.

The paper serves an important reminder not to overlook the possibility that people with MSA maybe suffering from depressive symptoms. Patients have a lot going on, explained Dr. Kaufmann, but it’s important to sit down to ask a person how they are actually feeling. At the end of the day, when it comes to MSA, we are looking for ways to make patients feel better. It’s become an exciting time with promising potential therapies close to or already being tested in the clinic. Dr. Kaufmann added, it’s important for us to consider as we plan clinical trials how we factor in the impact of depression on scales that are supposed to be capturing other symptoms.

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Read the paper here: https://www.ncbi.nlm.nih.gov/pubmed/32246226