Background Multiple sclerosis (MS) is a chronic disabling, demyelinating disease of the central nervous system and is often associated with psychiatric comorbidities. Some studies suggest increased prevalence of bipolar disorder (BD) in MS.
Objective To conduct a systematic review and meta-analysis assessing the prevalence of BD in adults with MS.
Methods We registered this review with PROSPERO and searched electronic databases (Ovid MEDLINE, Central, Embase, PsycINFO and Scopus) for eligible studies from earliest inception to October 2020. Prevalence data of BD in adult patients with MS were extracted. Meta-analysis was conducted using random-effects model.
Findings Of the 802 articles that were screened, 23 studies enrolling a total of 68 796 patients were included in the systematic review and meta-analysis. The pooled prevalence rate of BD in patients with MS was 2.95% (95% CI 2.12% to 4.09%) with higher prevalence in the Americas versus Europe. The lifetime prevalence of BD was 8.4% in patients with MS. Subgroup analysis showed a higher prevalence of BD in MS in females (7.03%) than in males (5.64%), which did not reach statistical significance (p=0.53).
Conclusions This meta-analysis suggests a high lifetime prevalence of BD in patients with MS. Patients with MS should be routinely screened for BD. Further assessment of bipolar comorbidity in MS through prospective studies may help in developing effective management strategies and may improve treatment outcomes in patients with MS.
- depression & mood disorders
- adult psychiatry
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Contributors All authors have contributed significantly to this manuscript and agree with its content. Study concept and design: BS, BJ and ALN. Acquisition of data: BS, BJ, ALN and NG. Analysis/interpretation of data: BS, BJ, ATA and MHM. Drafting of article: BJ, ALN, ATA, NG, MHM, MAF, WOT and BS. Revision of article: BJ, ALN, ATA, NG, MHM, MAF, WOT and BS.
Funding BS received research time support from Medibio (unrelated to the current study) and Mayo Clinic. WOT received research/grant support from Mallinckrodt Pharmaceuticals. MAF reports grant support from Assurex Health, Mayo Foundation, Medibio. Consultant (Mayo) - Actify Neurotherapies, Allergan, Intra-Cellular Therapies, Janssen, Myriad, Neuralstem, Takeda, Teva Pharmaceuticals. He reports CME/Travel/Honoraria from the American Physician Institute, CME Outfitters, Global Academy for Medical Education. Other authors have none to declare.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author on reasonable request.
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