The role of fingolimod in managing anxiety and depression in patients with multiple sclerosis

Anxiety and depression are common comorbidities among patients with multiple sclerosis (MS). Fingolimod, an oral disease-modifying therapy, may offer psychological benefits in addition to its immunomodulatory effects. This study aimed to evaluate the impact of fingolimod on anxiety and depression levels and to identify associated risk factors in patients with relapsing-remitting MS (RRMS).

A prospective cohort study was conducted on 61 RRMS patients who initiated fingolimod treatment for the first time at Imam Reza Clinic, Shiraz, Iran. Psychological symptoms were assessed using the Hospital Anxiety and Depression Scale at baseline and treatment. Paired t-tests were used to evaluate score changes. Logistic regression analyses identified predictors of baseline depression. ANCOVA was performed to assess post-treatment anxiety and depression while controlling for baseline scores.

After four months, mean anxiety (5.2 ± 4.2 to 4.9 ± 4.0; p = 0.50) and depression scores (5.0 ± 3.8 to 4.5 ± 3.4; p = 0.30) showed no significant changes. At baseline, MS relapses (OR = 4.7, p = 0.02) and prior medication (OR = 5.9, p = 0.03) use were associated with depression, and recent sad life events with anxiety. After controlling for baseline scores using ANCOVA, no factors were significantly associated with post-treatment anxiety or depression.

In this study, four months of fingolimod treatment was not associated with significant changes in anxiety or depression in patients with RRMS. Baseline predictors, including relapses, prior medication use, and recent sad events, were no longer significant after treatment, suggesting a potential treatment-related modulation of psychological effects. Future research in patients with higher disability and more severe symptoms is warranted.