RELATION BETWEEN EPILEPSY AND DEPRESSION

Relation Between Epilepsy and Depression

Relation Between Epilepsy and Depression

Abstract

Depression commonly is comorbid with epilepsy and, of the depressive disorders, major depression is most common. Depression is often comorbid with an anxiety disorder (eg, generalzed anxiety, social phobia, post-traumatic stress disorder, panic disorder, or obsessive-compulsive disorder), in the general public and in persons with epilepsy (PWE). This discussion will focus on mood disorders in PWE and treatment options for those adult PWE with a unipolar mood disorder. The presentation of mood disorders forms a spectrum across patients. Mood disorders remain undiagnosed and undertreated in PWE, in part, because many healthcare providers think these disorders are a normal reaction to a chronic illness. However, recent epidemiologic studies suggest that the relationship may be bidirectional (ie, causal instead of merely comorbid), but the nature of this relationship is unclear. Under treating depression in PWE not only jeopardizes patients' psychiatric health but also undermines the patients' ability to habituate to their medical illness or follow and comply with treatment regimens.

Epilepsy and Depression

Depression in epilepsy also has been shown to decrease the patient's quality of life and increase the patient's risk for suicide. Therefore, it is important to continue research into the mechanisms of mood/anxiety disorders and epilepsy and to make their diagnoses a higher priority in the management of PWE (Carney, 2003, 241-247). There are limited evidence-based data for treating depression specifically in PWE. However, the psychiatric literature provides a framework for treatment strategies. As with treatment of depression in the general public, total remission is the treatment goal because residual symptoms are strong predictors of relapse (Feinstein, 2004, 157-163).

Relations between epilepsy and depression

It is unclear why depression and anxiety are under- diagnosed in PWE. These disorders are common in other chronic illnesses, such as heart disease, cancer, type 2 diabetes mellitus, multiple sclerosis, and stroke. The frequent presence of depression and anxiety in chronic conditions may be considered erroneously as an expected reaction to the illness rather than as an underlying disorder (Feinstein, 2004, 157-163). Therefore, patients may not seek treatment, and clinicians may not inquire about a treatment. Nonetheless, there is a clear relationship that must be addressed. The exact nature of this comorbid relationship has not been defined. Comorbidity does not necessarily imply causality. Intuitively, clinicians understand that epilepsy begets depression, but does depression beget epilepsy? Is the link bidirectional? Recent data from epidemiologic studies suggest that there may be a link between depression and epilepsy, but the nature of this rela- tionship is unclear.17-20 In a community-based epidemiologic study of inci- dent cases of a patient whose first unprovoked seizure occurred at the age of at least 55 years, a history of depression (using DSM-III-R criteria) was 6 times more frequent in those patients with seizure than among control subjects (95% confidence interval, 1.56-22; P = .003), even when controlling for age, sex, length of medical follow-up, and medical therapies for depression (Greenberg, 2004, 127-135).

Similar findings have been found in pediatric ...