Depression Severity Tied to Increased Seizure Frequency

Pauline Anderson

December 04, 2018

NEW ORLEANS — Depression severity is tied to increased seizure frequency and to a greater risk of other psychiatric comorbidities, including panic disorder, obsessive compulsive disorder, and bipolar disorder, new research shows.

Management of patients with epilepsy should include early identification of psychiatric comorbidities and targeted treatments that improve care and outcomes, study investigator Martha Sajatovic, MD, Professor of Neurology and Psychiatry, Case Western Reserve University School of Medicine in Cleveland, told Medscape Medical News.

"Not everything that looks like depression is major depressive disorder; people can have depressive symptoms that are part of a different mental health condition," said Sajatovic.

The study was presented here at the American Epilepsy Society (AES) 2018 Annual Meeting.

Depression Common

Depression is a common comorbidity in epilepsy, affecting between 9% to 37% of patients. It increases suicide risk and decreases quality of life.

Furthermore, pharmacologic treatments and epilepsy surgery are less likely to be effective in patients with epilepsy who also have depression.

Identifying relationships between depression severity and clinical factors may help clinicians recognize and manage neuropsychiatric conditions in this patient population.

Using baseline data from a larger, randomized controlled trial on epilepsy self-management that was funded by the Centers for Disease Control and Prevention, the investigators assessed the relationship between depression severity and demographic and clinical variables.

The study sample included 120 patients with epilepsy who had been evaluated for depression severity using the self-rated 9-item Patient Health Questionnaire.

This scale helps identify and screen for depression and is widely used in primary care, said Sajatovic. It’s used somewhat less in epilepsy patients, but they chose to use it here "because it's so generalizable," and is a simple tool to use.

Using this scale, the researchers stratified subjects into those with no depression, mild depression, and moderate to severe depression and examined clinical variables in each of these categories.

Researchers assessed quality of life with the 10-item Quality of Life in Epilepsy questionnaire and used the Rapid Estimate of Adult Literacy in Medicine tool to assess health literacy and the Charlson Comorbidity Index to gather information on medical comorbidities.

About half of the sample (n = 62) had at least moderate depression severity.

Among demographic characteristics, only inability to work was significantly associated with depression severity (P = .05). Higher 30-day seizure frequency (P < .01) and lower quality of life (P < .0001) were associated with greater depression severity.

Researchers also looked at various mental health diagnoses. They found that some were associated with worse depressive symptoms, including bipolar disorder (P = .02), panic disorder (P < .01), and obsessive-compulsive disorder (P < .01).

This is in line with a body of literature suggesting that a variety of mental health conditions are more common in people with epilepsy compared with the general population, said Sajatovic.

"That’s probably not surprising when you consider the diverse causes of epilepsy, and what we know about mental health conditions. Those two tend to be bi-directional."

The literature supports the findings of correlations between worse depression, greater seizure frequency, and lower quality of life. But the finding of a link between greater depression severity and some psychiatric comorbidities is less known, said Sajatovic.

Managing patients with epilepsy should include early identification of psychiatric comorbidities and targeted treatments that could improve care and outcomes, said Sajatovic.

Interesting Ideas

Commenting on the study for Medscape Medical News, Daniel M. Goldenholz, MD, PhD, Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, said it "brings some very interesting ideas to the forefront that until recently haven't really been explored."

He's looking forward to the full publication of the results to get a closer look at "how these associations were evaluated. We probably have a lot more to learn about how robust these associations are over time."

If these associations prove true, "this could open up a whole other area that we should be exploring with our patients," he said.

Goldenholz offered the following example: For patients who experience high or medium seizure, are there specific screening questions to determine whether a psychiatric referral is warranted?

This study was supported by a grant from the Centers for Disease Control and Prevention.

Dr Sajatovic has research grants from Alkermes, Pfizer, Merck, Janssen, Reuter Foundation, Woodruff Foundation, Reinberger Foundation, National Institutes of Health, and the Centers for Disease Control and Prevention. She is a consultant to Bracket, Otsuka, Supernus, Neurocrine Biosciences, Health Analytics, and Sunovion and has received royalties from Springer Press, Johns Hopkins University Press, Oxford Press, and UpToDate. Dr Goldenholz has disclosed no relevant financial relationships.

American Epilepsy Society (AES) 2018 Annual Meeting: Abstract 1.371. Presented December 1, 2018.

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