Major depressive disorder is highly prevalent among persons with epilepsy (PWEs). Between 30% and 50% of PWEs suffer from depression. Many factors contribute to this prevalence, including the psychosocial impact of the diagnosis, restrictions on driving and certain types of work, and adverse effects associated with antiseizure medications. Without proper treatment, depressed PWEs have increased risks for suicide, strained relationships, lowered seizure control, and impairment in functioning. Our objective was to use the existing literature and insights from our experience in treating depression and anxiety in PWEs within an academic mood disorders center. We aimed to provide practical guidance for health care professionals who treat depression in this population.
TABLE 1 - Twelve Cases of PWEs With Depression: Clinical Characteristics and Depression Treatments Case Number Age, y Type of Epilepsy ASMs Psychiatric Diagnosis Comorbidity Psychiatric Meds Therapy Bright Light Therapy 1 38 Partial epilepsy (medical condition) Lamotrigine MDD, anxiety ADHD Sertraline, trazodone, methylphenidate Couples therapy, individual therapy 2 35 Focal epilepsy Oxcarbazepine, valproic acid MDD recurrent, GAD Venlafaxine, clonazepam Couples therapy, individual therapy Yes 3 41 Generalized epilepsy Zonisamide, clobazam, levetiracetam MDD recurrent, Mirtazapine, buspirone Individual therapy 4 30 Generalized epilepsy Lamotrigine MDD PMDD Escitalopram, trazodone Individual therapy Yes 5 42 Focal epilepsy (cancer) Clobazam, lamotrigine GAD, OCD ADHD Escitalopram, modafinil Individual therapy 6 35 Focal epilepsy Lamotrigine, oxcarbazepine MDD recurrent, Sertraline Individual therapy Yes 7 43 Simple partial epilepsy (s/p surgical procedure) Brivaracetam, lamotrigine MDD, GAD PTSD, alcohol use Venlafaxine Individual therapy 8 54 Focal epilepsy, as well as PNES Lamotrigine, clonazepam, phenytoin MDD, recurrent Trauma history Escitalopram, aripiprazole None 9 28 Paroxysmal events (epilepsy vs PNES) Lacosamine, brivaracetam, clonazepam MDD, recurrent Trauma history Duloxetine None Yes 10 57 Generalized epilepsy Zonisamide, lamotrigine, clobazepam, MDD vs PDD Fluoxetine None Yes 11 39 Focal epilepsy Lamotrigine MDD PTSD, alcohol, cannabis Duloxetine, quetiapine Therapy 12 32 Generalized epilepsy Valproic acid MDD recurrent Sertraline, trazodone NoneADHD indicates attention deficit hyperactivity disorder; GAD, generalized anxiety disorder; MDD, major depressive disorder; OCD, obsessive-compulsive disorder; PMDD, premenstrual dysphoric disorder; PNES, paroxysmal non-epileptic seizures; PTSD, posttraumatic stress disorder.
Persons with epilepsy and depression were identified by their treating psychiatrists. Their electronic health records were reviewed and compiled for this report, with a total of 12 included in this review. Records were reviewed regarding antiseizure medications, psychotropic medications, light therapy, psychotherapy, other interventions, and treatment response.
ResultsBased on our review of literature, as well as review of cases of individuals with epilepsy and comorbid psychiatric conditions, we recommend a step-wise evidence-based approach of optimizing psychiatric medication doses, augmenting with additional medication and/or implementing nonpharmacological interventions such as light therapy and psychotherapy.
ConclusionsIn PWEs, improvement in depression, other psychiatric symptoms, and function are the goals of drug and nondrug interventions. Depression care has the potential to significantly improve the quality of life of PWEs and reduce both morbidity and mortality.
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