Background
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
None
ADHD 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.
Methods
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.
Results
Based 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.
Conclusions
In 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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