Depression in epilepsy: Etiology, diagnosis and treatment

Author/s Rita D’Amico
Publishing Year 2018 Issue 2018/3
Language Italian Pages 20 P. 24-43 File size 251 KB
DOI 10.3280/PDS2018-003002
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

People with epilepsy have a high risk of comorbid diseases, including depression. Nev-ertheless, depression is often poorly recognized and inadequately treated, with negative con-sequences on patients’ quality of life and the risk of suicide. This review of literature aims to present the most interesting results regarding the prevalence of depression in people with epilepsy, the complexity of causes, diagnosis and treatment. The results show that depression is one of the most common disorders in epilepsy patients, but the diagnosis is complex, as the effects of the crisis on emotion regulation and mood states can be confused with depressive symptoms. Accordingly, particularly important is the use of appropriate diagnostic tools. The literature reviewed suggests the following causes: the side effects of anticonvulsants; some neurological elements (type, frequency, severity of the crises) and some psychosocial issues (stigma, impact of stressful events of the epileptic condition, recurrent crisis experienced as unforeseeable and uncontrollable events). The importance of psychosocial issues has emerged in many studies, as well as the need for interventions aimed at acquiring cognitive, behavioral and social skills useful for dealing positively with the disease. Traditionally, the management of depression in epilepsy has involved drug treatments, but recently the opinions in this regard are discordant. Instead, numerous studies have highlighted the effectiveness of cognitive-behavioral psychotherapy. Antidepressants are especially recommended for those at risk of suicide. Since epilepsy is mainly treated by neurologists, it is important for them to pay attention to their patients’ psychological conditions, and to cooperate with psychologists and psychotherapists.

Keywords: Depression in epilepsy, diagnosis, psychosocial causes, side effects of antiepileptic drugs, psychotherapy, health psychology

  1. Agrawal N., Bird J.S., von Oertzen T.J., Cock H., Mitchell A.J. and Mula M. (2016). Depression correlates with quality of life in people with epilepsy independent of the measures used. Epilepsy & Behavior, 62: 246-250.
  2. Asadi-Pooya A.A., Schilling C.A., Glosser D., Tracy J.I. and Sperling M.R. (2008). Health locus of control in patients with epilepsy and its relationship to anxiety, depression, and seizure control. Epilepsy & Behavior, 11: 347-350.
  3. Asato M.R., Caplan, R. and Herman B.P. (2014). Epilepsy and comorbidities: What are we waiting for? Epilepsy & Behavior, 31: 127-128.
  4. Azuma H. and Akechi T. (2014). Effects of psychosocial functioning, depression, seizure frequency, and employment on quality of life in patients with epilepsy. Epilepsy & Behavior, 41: 18-20.
  5. Bautista R.E.D. and Erwin P.A. (2013). Analyzing depression coping strategies of patients with epilepsy: A preliminary study. Seizure, 22(9): 686-691.
  6. Bautista R.E.D., Rundle-Gonzalez V., Awad R.G. and Erwin P.A. (2013). Determining the coping strategies of individuals with epilepsy. Epilepsy & Behavior, 27: 286-291.
  7. Beck A.T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Hoeber medical division (trad. it: La depressione. Torino: Bollati Boringhieri, 1978).
  8. Beck A.T., Ward C.H., Mendelson M., Mock J. and Erbaugh J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4: 561-579.
  9. Blaszczyk B. and Czuczwar S.J. (2016). Epilepsy coexisting with depression. Pharmacological reports, 68: 1084-1092.
  10. Wagner J. (2014). A 15 -year snapshot of the behavioral and psychosocial aspects of epilepsy. Epilepsy & Behavior, 40: 108-109.
  11. Chaytor N., Ciechanowski P., Miller J.R.F., Russo J., Unutzer J. and Gilliam F. (2011). Long-term outcomes from the PEARLS randomized trial for the treatment of depression in patients with epilepsy. Epilepsy & Behavior, 20: 545-9.
  12. Chen H.F., Tsai Y.F., Hsi M.S. and Chen J.C. (2016) Factors affecting quality of life in adults with epilepsy in Taiwan: A cross-sectional, correlational study. Epilepsy & Behavior, 58: 26-32.
  13. Cleary R.A., Baxendale S.A., Thompson P.J. and Foong J. (2013). Predicting and preventing psychopathology following temporal lobe epilepsy surgery. Epilepsy & Behavior, 26 (3): 322-334.
  14. Cotterman-Hart S. (2010). Depression in epilepsy: Why aren’t we treating? Epilepsy & Behavior, 19: 419-421.
  15. D’Amico R., Cipulli M. e Giancristofaro L. (2010). Vivere con l’epilessia. Aspetti clinici, psicologici e culturali. Milano: FrancoAngeli.
  16. Danzer S.C. (2012). Depression, stress, epilepsy and adult neurogenesis. Experimental Neurology, 233: 22-32.
  17. Dewurst E., Novakova B. and Reuber M. (2015). A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy. Epilepsy & Behavior, 46: 234-241.
  18. Di Capua D., Garcia-Garcia M.E., Reig-Ferrer A., Fuentes-Ferrer M., Toledano R., Gil-Nagel A., Ptaceck S., Kurtis M., Kanner A.M. and Garcia-Morales I. (2012). Validation of the Spanish version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Epilepsy & Behavior, 24 (4): 493-496.
  19. DiIorio C., Bamps Y., Walker E. and Escoffery C. (2011). Results of a research study evaluating WebEase, an online epilepsy self-management program. Epilepsy & Behavior, 22(3): 469-74.
  20. Fernandes P.T., Snape D.A., Beran R.G. and Jacoby A. (2011). Epilepsy stigma: What do we know and where next? Epilepsy & Behavior, 22: 55-62.
  21. Fernie B.A., Kollman J. and Brown R.G. (2015). Cognitive behavioral interventions for depression in chronic neurological conditions: A systematic review. Journal of Psychosomatic Research, 78: 411-419.
  22. Fiest K.M., Dykeman J., Patten S.B., Wiebe S., Kaplan G.G., Maxwell C.J., Bulloch A.G.M. and Jette N. (2013). Depression in epilepsy a systematic review and meta-analysis. Neurology, 80(6): 590-599.
  23. Fiest K.M., Patten S.B., Altura K.C., Bulloch A.G.M., Maxwell C.J., Wiebe S., Macrodimitris S. and Jetté N. (2014). Patterns and frequency of the treatment of depression in persons with epilepsy. Epilepsy & Behavior, 39: 59-64.
  24. Gandy M., Sharpe L. and Perry K.N. (2012). Psychosocial predictors of depression and anxiety in patients with epilepsy: A systematic review. Journal of Affective Disorders, 140: 222-32.
  25. Gandy M., Sharpe L. and Perry K.N. (2013a). Cognitive behavior therapy for depression in people with epilepsy: A systematic review. Epilepsia, 54(10): 1725-1734.
  26. Gandy M., Sharpe L., Perry K.N, Miller, L. Thayer Z., Boserio J. and Mohamed A. (2013b). The psychosocial correlates of depressive disorders and suicide risk in people with epilepsy. Journal of Psychosomatic Research, 74: 227-232.
  27. Gandy M., Sharpe L., Perry K.N., Thayer Z., Miller L., Boserio J. and Mohamed A. (2014). Cognitive Behavioral Therapy to Improve Mood in People with Epilepsy: A randomized Controlled Trial. Cognitive Behavior Therapy, 43(2): 153-66. DOI: 10.1080/16506073.2014.892530
  28. Gaus V., Kiep H., Holtkamp M., Burkert S. and Kendel F. (2015). Gender differences in depression, but not in anxiety in people with epilepsy. Seizure, 32: 37-42.
  29. Ghisi M., Flebus G.B., Montano A., Sanavio E. and Sica C. (2006). Beck Depression Inventory-II. Manuale italiano [Beck Depression Inventory-II. Italian Handbook]. Firenze: Organizzazioni Speciali.
  30. Gilbert F. (2012). The burden of normality: from ‘chronically ill’ to ‘symptom free’. New ethical challenges for deep brain stimulation postoperative treatment. Journal of Medical Ethics, 38(7): 1-5.
  31. Gill S.J., Lukmanji S., Fiest K.M., Patten S.B., Wiebe S. and Jetté N. (2017). Depression screening tools in persons with epilepsy: A systematic review of validated tools. Epilepsia, 58 (5): 695-705.
  32. Helger C.E., Johnston S.A. and Hoppe C. (2017). Diagnosing and treating depression in epilepsy. Seizure, 44: 184-193.
  33. Hoppe C. and Elger C.E. (2011). Depression in epilepsy: A critical review from a clinical perspective. Nature Review Neurology, 7: 462-472.
  34. Jackson C.F., Makin S.M. and Baker G.A. (2015). Neuropsychological and psychological interventions for people with newly diagnosed epilepsy. Cochrane Database of Systematic Reviews, 7: CDO11311.
  35. Jones N.C. and O’Brien, T.J. (2013). Stress, epilepsy and psychiatric comorbidity: How can animal model inform the clinic? Epilepsy & Behavior, 26(3): 363-9.
  36. Kanner A.M. (2011). Depression and epilepsy: A bidirectional relation? Epilepsia, 52 (1): 21-27.
  37. Kanner A.M. (2013). The treatment of depressive disorders in epilepsy: What all neurologists should know. Epilepsia, 54(1): 3-12.
  38. Kanner A.M., Schchter S.C., Barry J.J., Hersdorffer D.C., Mula M., Trimble M., Hermann B., Ettinger A.E., Dunn D., Caplan R., Ryvlin P. and Gilliam F. (2012). Depression and epilepsy: Epidemiologic and neurobiologic perspectives that may explain their high comorbid occurrence. Epilepsy & Behavior, 24(2): 156-68.
  39. Kerr M.P., Mensah S., Besag F., de Toffol B., Ettinger A., Kanemoto K., Kanner A., Kemp S. Krishnamorthy E., LaFrance W.C.J. Mula M., Schmitz B., van Elst L.T., Trollor J. and Wilson S.J. (2011). International consensus clinical practice statements for the treatment of neuropsychiatric conditions associated with epilepsy. Epilepsia, 52(11): 2133-2138.
  40. Kerr M.P. (2012). The impact of epilepsy on patients’ lives. Acta Neurologica Scandinava, 126 (194): 1-9.
  41. Krishnamoorthy E.S., Trimble M.R. and Blumer D. (2007). The classification of neuropsychiatric disorders in epilepsy: A proposal by the ILAE Commission on Psychobiology of Epilepsy. Epilepsy & Behavior, 10(3): 349-353.
  42. Kwon O.Y. and Park S.P. (2011). What is the role of depressive symptoms among other predictors of quality of life in people with well-controlled epilepsy on mono-therapy? Epilepsy & Behavior, 20 (3): 528-532.
  43. Leaffer E.B., Hesdorffer D.C. and Begley C. (2014). Psychosocial and sociodemographic associates of felt stigma in epilepsy. Epilepsy & Behavior, 37: 104-109.
  44. Lin J.J., Mula M. and Herman B.P. (2013). Uncovering the neurobehavioral comorbidities of epilepsy over the lifespan. Lancet, 389: 1189-1192. DOI: 10.1016/S0140-6736(12)61455-X
  45. Livneth H., Wilson L.M., Duchesneau A. and Antonak R.F. (2001). Psychosocial Adaptation to Epilepsy: The Role of Coping Strategies. Epilepsy & Behavior, 2: 533-544.
  46. Macrodimitris S., Wershler J., Hatfield M., Hamilton K., Backs-Dermott B., Mothersill K., Baxter C. and Wiebe S. (2011). Group cognitive-behavioral therapy for patients with epilepsy and comorbid depression and anxiety. Epilepsy & Behavior, 20: 83-88.
  47. McLaughlin D. and McFarland K. (2011) A randomized trial of a group based cognitive behavior therapy program for older adults with epilepsy: The impact on seizure frequency, depression and psychosocial well-being. Journal of Behavioral Medicine, 34: 201-207.
  48. Moshé S.L., Perucca E., Ryvlin P. and Tomson T. (2015). Epilepsy: New advances. Lancet, 385: 884-98. DOI: 10.1016/S0140-6736(14)40456-6
  49. Mula M., Iudice A., La Neve A., Mazza M., Bartolini E., De Caro M.F., Mazza S., Kanner A.M. and Cantello R. (2012). Validation of the Italian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Epilepsy & Behavior, 24(3): 329-331.
  50. Muzerengy S. and Moor C.C. (2013). What do we know about depression in people with epilepsy? Progress in Neurology and Psychiatry, 17(2): 20-24.
  51. Orjuela-Rojas J.M., Martínez-Juárez I.E., Ruiz-Chow A. and Crail-Melendez D. (2015). Treatment of depression in patients with temporal lobe epilepsy: A pilot study of cognitive behavioral therapy vs. selective serotonin reuptake inhibitors. Epilepsy & Behavior, 51: 176-181.
  52. Quintas R., Raggi A., Giovannetti A.M., Pagani M., Sabariego C., Cieza A. and Leonardi M. (2012). Psychosocial difficulties in people with epilepsy: A systematic review of literature from 2005 until 2010. Epilepsy & Behavior, 25(1): 60-67.
  53. Scott A.J., Sharpe L., Hunt C. and Gandy M. (2017). Anxiety and depressive disorders in people with epilepsy: A meta-analysis. Epilepsia, 58(6): 973-982.
  54. Seligman M.E.P. (1975). A series of books in psychology. Helplessness: On depression, development, and death. New York: W H Freeman/Times Books/ Henry Holt & Co.
  55. Shallcross A.J., Becker D.A., Singh A., Friedman D., Montesdeoca J., French J., Devinsky O. and Spruill T. (2015). Illness perceptions mediate the relationship between depression and quality of life in patients with epilepsy. Epilepsia, 56(11): e186-e190.
  56. Sharpe L. and Curran L. (2006). Understanding the process of adjustment to illness. Social Science & Medicine, 62: 1153-1156.
  57. Shi Y., Wang S., Ying J., Zhang M., Liu P., Zhang H. and Sun J. (2017). Correlates of perceived stigma for people living with epilepsy: A meta-analysis. Epilepsy & Behavior, 70: 198-203.
  58. Tang V., Michaelis R. and Kwanf P. (2014). Psycho-behavioral therapy for epilepsy. Epilepsy & Behavior, 32: 147-155.
  59. Taylor J., Jacoby A., Baker G.A., Marson A.G. and Whitehead M. (2011). Factors predictive of resilience and vulnerability in new-onset epilepsy. Epilepsia, 52(3): 610-8.
  60. Thompson N.J., Walker E.R., Obolensky N., Winning A., Barmon C., DiIorio C. and Compton M.T. (2010). Distance delivery of mindfulness-based cognitive therapy for depression: Project UPLIFT. Epilepsy & Behavior, 19(3): 247-254.
  61. Thompson N.J., Patel A.H., Selwa L.M., Stoll S., Begley C., Johnson E.K. and Fraser R. (2015). Expanding the efficacy of the project UPLIFT: Distance delivery of mindfulness-based depression prevention to people with epilepsy. Journal of Consulting and Clinical Psychology, 83(2): 304-313.
  62. Trimble M.R. and Reynolds E.H. (1976). Anticonvulsant drugs and mental symptoms: A review. Psychological Medicine, 6: 169-178. DOI: 10.1017/S0033291700013726
  63. Velissaris S.L., Saling M.M., Newton M.R., Berkovic S.F. and Wilson S.J. (2012). Psychological trajectories in the year after a newly diagnosed seizure. Epilepsia, 53: 1774-81.
  64. Verrotti A., Carrozzino D., Milioni M., Minna M. and Fulcheri M. (2014). Epilepsy and its main psychiatric comorbidities in adults and children. Journal of Neurological Sciences, 343: 23-29.
  65. Walker E.R., Obolensky N., Dinis S. and Thompson N.I. (2010). Formative and process evaluations of a cognitive-behavioral therapy and mindfulness intervention for people with epilepsy and depression. Epilepsy & Behavior, 19: 239-246.
  66. Wilson S., Bladin P. and Saling M. (2001). The “burden of normality”: Concepts of adjustment after surgery for seizures. Journal of Neurology, Neurosurgery & Psychiatry, 70: 649-656.
  67. Wrench J.M., Rayner G. and Wilson S.J. (2011). Profiling the evolution of depression after epilepsy surgery. Epilepsia, 52(5): 900-908.
  68. Yuen E.K., Goetter E.M., Herbert J.D. and Forman E.M. (2012). Challenges and opportunities in internet-mediated telemental health. Professional Psychology: Research and Practice, 43: 1-8.

Rita D’Amico, La depressione nell’epilessia. Cause, diagnosi e trattamento in "PSICOLOGIA DELLA SALUTE" 3/2018, pp 24-43, DOI: 10.3280/PDS2018-003002