Beyond Conventional Scales: A Critical Reflection on the Diagnosis of Depression and Fatigue in Multiple Sclerosis

This work aims to identify quick and effective methods for assessing mood and fatigue changes in patients with Multiple Sclerosis (MS). Initially, patients were assessed through three specific questions during routine consultation for a quick evaluation of mood and fatigue. Subsequently, no more than 30 days after the first assessment, the same patients were evaluated using the MFIS and the BDI and BAI scales. This quick assessment method was developed based on responses from an interview with 20 experienced neuroimmunologists, who identified the following questions as the most effective for a preliminary assessment of mood and fatigue: 1) "Have you been feeling sad in the past few weeks?" 2) "Have you been feeling tired or without energy to do your daily activities?" 3) "Have you noticed changes in your sleep or appetite in the past few weeks?" Of the 105 patients, only 21 (exactly 20%) responded positively to some of the questions when asked informally. After 30 days from the first assessment, the same patients were evaluated using the MFIS and the BDI and BAI scales. In the BDI, most patients were classified as not depressed (53.3%), followed by mild/moderate depression (30.4%), moderate/severe depression (14.28%), and finally severe depression (1.9%). In the BAI, 44.7% of patients have minimal anxiety; 30.4% mild anxiety; 17.1% moderate anxiety, and 7.69% severe anxiety. The MFIS found that 30.4% exhibit fatigue. Only 20% of patients indicated symptoms of depression, anxiety, or fatigue when questioned informally, while structured assessments revealed that a significantly larger proportion of patients exhibited signs of mild to moderate depression, mild anxiety, and fatigue. This difference underscores the technical importance of using validated scales in clinical practice, as they offer a more systematic and sensitive approach to identifying symptoms that may be underestimated or undetected in less structured assessments.