PSYCHIATRIC ISSUES

Many patients with MSA experience depression, anxiety, panic attacks, and cognitive impairment over the course of their disease. Depression has been found in over half (60%) of MSA patients and anxiety has been found in over 75%. Both are more common in patients with MSA-P and are tied to lower quality of life. Cognitive impairment may also occur in up to 75% of patients.

1. Non-pharmacologic treatment of psychiatric issues include:

• Cognitive therapy can not only help manage the mental health symptoms associated with MSA, it has also been shown to increase memory, help slow down cognitive decline, and decrease fall risk in patients with MSA.
• Exercise has been shown to promote positive effects on cognitive function in patients with Parkinson’s Disease and may promote positive cognitive effects in MSA patients, as well.
• Electroconvulsive therapy is an option for patients with depression who have not responded to other treatment.
• Repetitive transcranial magnetic stimulation (TMS) has been studied in patients with Parkinson’s and has shown a positive effect on depression.

2. Medications used to help with psychiatric issues include:

• Selective serotonin reuptake inhibitors are effective anti-depressants and may have a lower risk of orthostatic hypotension than other drugs to treat depression.
• L-dopa or dopamine agonists may also help mood disorders in MSA.

References

1. Du JJ, Wang T, Huang P, et al. Clinical characteristics and quality of life in Chinese patients with multiple system atrophy. Brain Behav. 2018;8(12):e01135.
2. Segev-Jacubovski O, Herman T, Yogev-Seligmann G, Mirelman A, Giladi N, Hausdorff JM. The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk?. Expert Rev Neurother. 2011;11(7):1057–1075.
3. da Silva FC, Iop RDR, de Oliveira LC, et al. Effects of physical exercise programs on cognitive function in Parkinson’s disease patients: A systematic review of randomized controlled trials of the last 10 years. PLoS One. 2018;13(2):e0193113.
4. Boggio, P.S., et al. (2005), Effect of repetitive TMS and fluoxetine on cognitive function in patients with Parkinson’s disease and concurrent depression. Mov. Disord., 20: 1178-1184.