Depression and Epilepsy: A New Perspective on Two Closely Related Disorders

Depression is the most frequent psychiatric comorbidity in epilepsy. Yet, it remains under-recognized and untreated in a significant number of patients. It may mimic primary depressive disorders, but in a significant percentage of patients, depression presents with atypical pleomorphic characteristics. The use of screening self-rating scales may help to identify depressive episodes in patients with epilepsy, but a diagnosis cannot be established by the sole use of these instruments without an additional, in-depth evaluation. Timely recognition and treatment of depression is of the essence in epilepsy patients, as its persistence is an independent predictor of poor quality of life, increased suicidal risk, greater use of health services, and higher medical costs not related to the psychiatric treatment. Neurologists will often find themselves in the position of being the only health care provider available to initiate treatment. Accordingly, they should be well trained to provide psychopharmacologic treatment for major depressive episodes, dysthymic disorders, and minor depression. However, patients with suicidal ideation, psychotic symptoms, or bipolar disorders should be referred immediately to the care of a psychiatrist

Depression in Epilepsy: A Neurobiologic Perspective

Depression is the most frequent psychiatric comorbidity in patients with epilepsy. By the same token, patients with depression are at higher risk of developing epilepsy than are controls. Such bidirectional relations raise the question of whether both disorders share common pathogenic mechanisms, presenting with common neurotransmitter abnormalities and involvement of the same neuroanatomic structures. In this article, some of the available data in support of this hypothesis are reviewed

The impact of depression, seizure variables and locus of control on health related quality of life in a community dwelling sample of older adults

Few studies have examined the impact of epilepsy on the quality of life of older people, although epilepsy is one of the most common neurological disorders of old age. This study investigated the association of depression, seizure type and frequency and locus of control on health related quality of life in community dwelling adults aged over 60 years. Sixty-four participants were administered a clinical diagnostic interview to assess depression and dysthymia, and completed measures of HRQOL (QOLIE-31), locus of control and provided information on seizure variables. Depression, dysthymia and more frequent seizures were important predictors of HRQOL, accounting for 63% of the variance, with dysthymia the strongest individual predictor of impaired HRQOL. This study has highlighted the negative consequences of depression, dysthymia and seizure frequency on HRQOL for older people with epilepsy. Importantly, these results indicate that rather than major depression, it is the more chronic symptoms of dysthymia that are most disruptive of HRQOL. Seizure frequency, but not seizure type, was also associated with reduced HRQOL. The results of this study suggest that clinical treatment in late adulthood should address seizure control while concurrently focusing on the management of depressive symptomatology to improve overall HRQOL. (C) 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved