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Abstract：
Background and Objectives: The association between myasthenia gravis (MG) and depression is intricate and characterized by bidirectional causality. In this regard, MG can be a contributing factor to depression and, conversely, depression may worsen the symptoms of MG. This study aimed to identify any differences in the progression of the disease among patients with MG who were also diagnosed with depression as compared to those without depression. Our hypothesis focused on the theory that patients with more severe MG symptoms may have a higher likelihood of suffering depression at the same time. Materials and Methods: One hundred twenty-two male and female patients (N = 122) aged over 18 with a confirmed diagnosis of autoimmune MG who were admitted to the Neurology II department of Myasthenia Gravis, Clinical Institute Fundeni in Bucharest between January 2019 and December 2020, were included in the study. Patients were assessed at baseline and after six months. The psychiatric assessment of the patients included the Hamilton Depression Rating Scale-17 items (HAM-D), and neurological status was determined with two outcome measures: Quantitative Myasthenia Gravis (QMG) and Myasthenia Gravis Activities of Daily Life (MG-ADL). The patients were divided into two distinct groups as follows: group MG w/dep, which comprised 49 MG patients diagnosed with depressive disorder who were also currently receiving antidepressant medication, and group MG w/o dep, which consisted of 73 patients who did not have depression. Results: In our study, 40.16% of the myasthenia gravis (MG) patients exhibited a comorbid diagnosis of depression. Among the MG patients receiving antidepressant treatment, baseline assessments revealed a mean MG-ADL score of 7.73 (SD = 5.05), an average QMG score of 18.40 (SD = 8.61), and a mean Ham-D score of 21.53 (SD = 7.49). After a six-month period, a statistically significant decrease was observed in the MG-ADL (2.92, SD = 1.82), QMG (7.15, SD = 4.46), and Ham-D scores (11.16, SD = 7.49) (p < 0.0001). These results suggest a significant correlation between MG severity and elevated HAM-D depression scores. Regarding the MG treatment in the group with depression, at baseline, the mean dose of oral corticosteroids was 45.10 mg (SD = 16.60). Regarding the treatment with pyridostigmine, patients with depression and undergoing antidepressant treatment remained with an increased need for pyridostigmine, 144.49 mg (SD = 51.84), compared to those in the group without depression, 107.67 mg (SD = 55.64, p < 0.001). Conclusions: Our investigation confirms that the occurrence of depressive symptoms is significantly widespread among individuals diagnosed with MG. Disease severity, along with younger age and higher doses of cortisone, is a significant factor associated with depression in patients with MG. Substantial reductions in MG-ADL and QMG scores were observed within each group after six months, highlighting the effectiveness of MG management. The findings suggest that addressing depressive symptoms in MG patients, in addition to standard MG management, can lead to improved clinical outcomes.
摘要：
背景与目的：重症肌无力（MG）与抑郁症之间的关系错综复杂，具有双向因果关系。在这方面,MG可能是抑郁症的一个促成因素，相反,抑郁症可能会加重MG的症状。这项研究旨在确定与没有抑郁症的患者相比，也被诊断患有抑郁症的MG患者在疾病进展中的任何差异。我们的假设集中在这样的理论上，即MG症状更严重的患者可能同时患抑郁症的可能性更高。材料和方法：132名年龄在18岁以上的男性和女性患者（N=122）确诊为自身免疫性MG，这些患者被纳入重症肌无力神经内科II科，2019年1月至2020年12月在布加勒斯特的临床研究所Fundeni被纳入研究。在基线和6个月后对患者进行评估。患者的精神病学评估包括汉密尔顿抑郁量表17项（HAM-D），通过两个结果指标确定神经系统状态：定量重症肌无力（QMG）和重症肌无力日常生活活动（MG-ADL）。将患者分为以下两个不同的组：MGw/dep组，其中包括49名被诊断患有抑郁症的MG患者，他们目前也在接受抗抑郁药物治疗，和MG组w/odep，其中包括73名没有抑郁症的患者。结果：在我们的研究中，40.16％的重症肌无力（MG）患者表现出抑郁症的共病诊断。在接受抗抑郁治疗的MG患者中，基线评估显示MG-ADL平均得分为7.73（SD=5.05），QMG平均得分为18.40（SD=8.61），平均Ham-D评分为21.53(SD=7.49)。六个月后，在MG-ADL中观察到统计学上的显着下降（2.92，SD=1.82），QMG（7.15，SD=4.46），和Ham-D评分(11.16,SD=7.49)(p<0.0001)。这些结果表明，MG严重程度与HAM-D抑郁评分升高之间存在显着相关性。关于抑郁症组的MG治疗，在基线，口服糖皮质激素的平均剂量为45.10mg(SD=16.60).关于用吡啶斯的明治疗，患有抑郁症并接受抗抑郁治疗的患者对吡啶斯的明的需求仍然增加，144.49毫克（SD=51.84），与没有抑郁症的人相比，107.67mg(SD=55.64,p<0.001)。结论：我们的调查证实，抑郁症状的发生在诊断为MG的个体中非常普遍。疾病严重程度,随着年龄的年龄和更高剂量的可的松，是与MG患者抑郁相关的重要因素。6个月后，各组患者的MG-ADL和QMG评分均显著降低，突出MG管理的有效性。研究结果表明，解决MG患者的抑郁症状，除了标准的MG管理，可以改善临床结果。
