How are fear, anxiety and depression in amyotrophic lateral sclerosis (ALS) treated?

Updated: Jan 02, 2020
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Ryan O Stephenson, DO  more...
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Psychological symptoms are common and are indirectly related to the disease and its progression. Patients with amyotrophic lateral sclerosis (ALS) generally have preserved cognitive functioning with a progressive loss of control over their disease process and daily functioning. This can be very distressing to the patient and his/her caregivers, and symptoms of fear, anxiety, and depression may manifest. If left untreated, these symptoms may result in a decline in the patient's functioning out of proportion to disease severity. [1, 47]  A study by Körner et al found that in patients with ALS, depression influenced quality of life, independent of physical impairment. The study involved 159 patients with ALS, who were evaluated with the Beck Depression Inventory-II, the 36-Item Short Form Health Survey, and the ALS Functional Rating Scale-Revised (ALSFRS-R). [48]

Early recognition of psychological disorders is important. This allows appropriate interventions to be made to provide support to the patient and caregivers. Interventions can be provided through individual and family psychotherapy, as well as through psychoactive medications. Selective serotonin reuptake inhibitors (SSRIs) most commonly are used for the treatment of depression. In some patients with anxiety, SSRIs also may be beneficial, but in patients with severe anxiety that limits function, anxiolytic medications, including benzodiazepines, should be considered. Thought should be given to the potential respiratory depressive effects of any medication used.

Assistance of a psychologist is recommended early on to help identify and treat clinical symptoms. [49] Psychotherapy and counseling can be used alone or in combination with medications, but treatment with medications alone is not recommended. Symptoms such as anxiety and fear can be treated through role-playing and relaxation techniques. Other potential problems, such as caregiver burnout and patient loss of control, also may be identified and treated through the assistance of a psychologist. In addition, psychologists can aid the patient in developing advance directives, addressing financial concerns, and assisting in planning for total care.

Incidence of suicide is surprisingly rare in patients with ALS. This may be attributed to the fact that in the early stages of the disease, the patient either denies or does not fully comprehend the impact of the disease. Once the patient realizes fully the devastation caused by his or her illness, the individual may be too weak to perform the act of suicide.

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