To the Editor.—
Depression is not uncommon in patients with multiple sclerosis, occurring in 6% to 27% of cases.1 This depression is generally secondary (reactive) and may be managed without drugs,2 but tricyclic antidepressant therapy might be considered in some cases. A patient receiving baclofen experienced increased muscle relaxant effect when given two different tricyclic drugs.
Report of a Case.—
A 54-year-old man with a 12-year history of multiple sclerosis had spastic paraplegia, marked weakness of his left arm, and neurogenic bladder. He disclosed a two-year history of "depressions," which he described as periods of withdrawal, insomnia, and loss of interest lasting four to five days and occurring about once per month. He had been treated continuously with baclofen for 18 months and at the time of admission was taking 10 mg four times a day. This dose produced good relief of spasticity but left him with sufficient