COMMENTARY

Epilepsy and Depression and Anxiety, Oh My!

Andrew N. Wilner, MD

Disclosures

July 01, 2014

Comorbid Conditions in Epilepsy

The proper treatment of epilepsy requires eliminating seizures as much as possible without incurring intolerable side effects. Furthermore, identifying and treating comorbid conditions, both psychiatric and somatic, has recently emerged as an important priority. In my team's recent research, we identified somatic and psychiatric comorbid conditions in 50% of women and 43% of men in a population of 6621 people with epilepsy.[1] The top comorbid conditions for women and men with epilepsy were a psychiatric diagnosis, hyperlipidemia, hypertension, asthma, diabetes, headache, and anemia.[1]

A spate of articles emphasizing the importance of epilepsy-related comorbid conditions recently appeared in Epilepsy and Behavior. Asato and colleagues[2] wrote, "Epilepsy increases the likelihood of depression, anxiety disorders, attention deficit hyperactivity disorder (ADHD), a schizophrenia-like interictal psychosis, autism, as well as suicidal behavior in patients with an unprovoked seizure, focal epilepsy, idiopathic cryptogenic epilepsy, and self-reported epilepsy...contemporary standards of practice fail to integrate screening and treatment of the comorbidities into routine care."

Andres M. Kanner, MD, an epileptologist and psychiatrist at the University of Miami in Florida, observed, "Depression and anxiety disorders are the most frequent psychiatric comorbidities in people with epilepsy (PWE), with lifetime prevalence rates estimated to range between 30%-35%. Yet, despite the wide recognition of the problems associated with these two conditions, they remain undiagnosed and untreated in a vast majority of these patients."[3]

Dr. Kanner recommended that neurologists should be trained to identify and manage common psychiatric disorders, but acknowledged that these efforts could be compromised by the limited time allowed for patient encounters; the meager psychiatric background of many neurologists; and the traditionally poor communication between neurologists and psychiatrists.[3]

Unfortunately, most neurologists do not have extensive psychiatric training and do not feel confident treating psychiatric disorders.[4] Jones[5] emphasized the importance of "innovative tools that are easily translated into clinical settings in order to begin to address the barriers that contribute to the underidentification of these co-occurring problems."

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