Abstract
A long-recognized association exists between epilepsy and affective disturbance, especially depression. People with complex partial seizures that result from temporal lobe seizure foci are highly vulnerable to psychiatric disorders. Accurate diagnosis of such disorders is an important key to treatment. Interictal depression or dysphoria is the most clinically significant problem of this type. Pharmacotherapeutic treatments that have positive effects in other types of depressive illness are also effective for depression associated with epilepsy. Electroconvulsive therapy is helpful to some patients with depression that is refractory to drug treatment or psychotherapy. Surgical resection of seizure foci may lead to psychiatric improvement for some individuals, but can also have psychiatric complications.
Keywords
Depressive Symptom Major Depressive Disorder Gabapentin Lamotrigine Temporal Lobe EpilepsyPreview
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 1.Barry JJ, Lembke A, Huynh N: Affective disorders in epilepsy. In Psychiatric Issues in Epilepsy. Edited by Ettinger A, Kanner M. Philadelphia: Lippincott Williams & Wilkins; 2001. Broadly covers current clinical strategies in psychopathology in the setting of epilepsy. It is well written, and its concise informative chapters make it a great read.Google Scholar
- 2.Hauser WA, Annegers JF, Kurland LT: Prevalence of epilepsy in Rochester, Minnesota: 1940–1980. Epilepsia 1991, 32:429–4.PubMedGoogle Scholar
- 3.Leung LS, Ma J, McLachlan RS: Behaviors induced or disrupted by complex partial seizures. Neurosci Biobehav Rev 2000, 24:763–75.PubMedCrossRefGoogle Scholar
- 4.Wieser H: Ictal manifestations of temporal lobe seizures. In Advances in Neurology. Edited by Smith D, Treiman D, Trimble M. New York: Raven Press; 1991:301–315.Google Scholar
- 5.American Psychiatric Association: Diagnostic and Statistical Manual, edn 4. Washington: American Psychiatric Association; 2000.Google Scholar
- 6.Murphy JM, Laird NM, Monson RR, et al.: A 40-year perspective on the prevalence of depression. Arch Gen Psychiatry 2000, 57:209–215.PubMedCrossRefGoogle Scholar
- 7.Robertson MM: Depression in patients with epilepsy: an overview. Semin Neurol 1991, 11:182–189.PubMedGoogle Scholar
- 8.Mendez MF, Doss RC, Taylor JL, et al.: Depression in epilepsy: relationship to seizures and anticonvulsant therapy. J Nerv Mental Dis 1993, 181:4–47.CrossRefGoogle Scholar
- 9.Altshuler L, Rausch R, Delrahim S, et al.: Temporal lobe epilepsy, temporal lobectomy, and major depression. J Neuropsychiatry Clin Neurosci 1999, 11:436–43.PubMedGoogle Scholar
- 10.Kraepelin E: Psychiatrie, edn 8. Leipzig: Barth; 1923.Google Scholar
- 11.Blumer D: Dysphoric disorders and paroxysmal affects. Harv Rev Psychiatry 2000, 8:8–17.PubMedCrossRefGoogle Scholar
- 12.Mendez MF, Cummings JL, Benson F: Depression in epilepsy. Arch Neurol 1986, 43:76–70.Google Scholar
- 13.Blanchet P, Frommer GP: Mood change preceding epileptic seizures. J Nerv Mental Dis 1986, 174:471–476.CrossRefGoogle Scholar
- 14.Cascino GD: Complex partial seizures. Psychiatr Clin North Am 1992, 15:373–382.PubMedGoogle Scholar
- 15.Williams D: The structure of emotions reflected in epileptic experiences. Brain 1956, 79:29–67.PubMedCrossRefGoogle Scholar
- 16.Barraclough B: Suicide and epilepsy. In Epilepsy and Psychiatry. Edited by Reynolds E, Trimble M. Edinburgh: Churchill Livingstone; 1981:72–76.Google Scholar
- 17.Schmitz B: Antidepressant drugs: indications and guidelines for use in epilepsy. Epilepsia 2002, 43:14–18.PubMedCrossRefGoogle Scholar
- 18.Quiske A, Helmstaedter C, Lux S, et al.: Depression in patients with temporal lobe epilepsy is related to mesial temporal sclerosis. Epilepsy Res 2000, 39:121–125.PubMedCrossRefGoogle Scholar
- 19.Landolt H: Serial EEG investigations during psychotic episodes in epileptic patients during psychotic episodes and during schizophrenic attacks. In Lectures in Epilepsy. Edited by de Haas L. Amsterdam: Elsevier; 1958:91–137.Google Scholar
- 20.Trimble MR: New antiepileptic drugs and psychopathology. Neuropsychobiology 1998, 38:149–151. Briefly discusses current topics covered under this rubric.PubMedCrossRefGoogle Scholar
- 21.Trimble MR: Psychosis in Epilepsy. New York: Raven Press; 1991.Google Scholar
- 22.Rayport M, Ferguson SM: Psychosis of epilepsy: an integrated approach. In Psychiatric Aspects of Epilepsy: A Practical Guide to Diagnosis and Treatment. Edited by Ettinger A, Kanner A. Baltimore: Lippincott, Williams and Wilkins; 2001:73–94.Google Scholar
- 23.Blumer D: Antidepressant and double antidepressant treatment for the affective disorder of epilepsy. J Clin Psychiatry 1997, 58:3–1.PubMedGoogle Scholar
- 24.Kanner AM, Palac S: Neuropsychiatric complications of epilepsy. Curr Neurol Neurosci Rep 2002, 2:365–372.PubMedCrossRefGoogle Scholar
- 25.Lambert MV, Robertson MM: Depression in epilepsy: etiology, phenomenology, and treatment. Epilepsia 1999, 40:S21-S47. This article contains a good review of depression in epilepsy including treatment concepts and suggestions for iatrogenic depression from AEDs, depression after epilepsy surgery, and the importance of psychosocial factors.PubMedCrossRefGoogle Scholar
- 26.Brent DA: Overrepresentation of epileptics in a consecutive series of suicide attempters seen at a children’s hospital, 1978–1983. J Am Acad Child Psychiatry 1986, 25:242–246.PubMedCrossRefGoogle Scholar
- 27.Brent DA, Crumrine PK, Varma RR, et al.: Phenobarbital: treatment and major depressive disorder in children with epilepsy. Pediatrics 1987, 80:909–917.PubMedGoogle Scholar
- 28.Barabas G, Matthews WS: Barbiturate anticonvulsants as a cause of severe depression. Pediatrics 1988, 82:284–285.PubMedGoogle Scholar
- 29.Ferrie CD, Robinson RO, Panayiotopoulos CP: Psychotic and severe behavioral reactions with vigabatrin: a review. Acta Neurol Scand 1996, 93:1–8.PubMedGoogle Scholar
- 30.Levison DF, Devinsky O: Psychiatric adverse events during vigabatrin therapy. Neurology 1999, 53:1503–1511.Google Scholar
- 31.Ben-Menachem E, French JA: Vigabatrin. In Epilepsy: A Comprehensive Textbook. Edited by Engel. JJ, Pedley TA. Philadelphia: Lippincott-Raven Publishers; 1997:1609–1618.Google Scholar
- 32.Crawford PM: An audit of topiramate use in a general neurology clinic. Seizure 1998, 7:207–211.PubMedCrossRefGoogle Scholar
- 33.Janssen-Cilag: Topamax: Product Monograph. 1996.Google Scholar
- 34.McElroy SL, Suppes T, Keck PE, et al.: Open-label adjunctive topiramate in the treatment of bipolar disorders. Biol Psychiatry 2000, 47:1025–1033.PubMedCrossRefGoogle Scholar
- 35.Leppik IE, Gram L, Deaton R, et al.: Safety of tiagabine: summary of 53 trials. Epilepsy Res 1999, 33:235–246.PubMedCrossRefGoogle Scholar
- 36.McConnell H, Duffy J, Cress K: Behavioral effects of felbamate. J Neuropsych Clin Neurosci 1994, 6:323.Google Scholar
- 37.Dodrill CB: Behavioral effects of antiepileptic drugs. Adv Neurol 1991, 55:213–24.PubMedGoogle Scholar
- 38.Shorvon S, Reynolds EH: Reduction in polypharmacy for epilepsy. BMJ 1979, 2:1023–1025.PubMedGoogle Scholar
- 39.Calabrese JR, Suppes T, Bowden CL, et al.: A double-blind, placebo-controlled, prophylaxis study of lamotrigine in rapidcycling bipolar disorder: Lamictal 614 Study Group. J Clin Psychiatry 2000, 61:841–850.PubMedCrossRefGoogle Scholar
- 40.Calabrese JR, Bowden CL, Sachs GS, et al.: A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression: Lamictal 602 Study Group. J Clin Psychiatry 1999, 60:79–8.PubMedCrossRefGoogle Scholar
- 41.McElroy SL, Soutullo CA, Kech PEJ, et al.: A pilot trial of adjunctive gabapentin in the treatment of bipolar disorder. Clin Psychiatry 1997, 9:9–103.Google Scholar
- 42.Harden CL, Lazar LM, Pick LH, et al.: A beneficial effect on mood in partial epilepsy patients treated with gabapentin. Epilepsia 1999, 40:1129–1134.PubMedCrossRefGoogle Scholar
- 43.Pande AC, Crockatt JG, Janney CA, et al.: Gabapentin in bipolar disorder: a placebo-controlled trial of adjunctive therapy: Gabapentin Bipolar Disorder Study Group. Bipolar Disord 2000, 2:249–255.PubMedCrossRefGoogle Scholar
- 44.Harden CL, Goldstein MA: Mood disorders in patients with epilepsy. CNS Drugs 2002, 16:291–302.PubMedCrossRefGoogle Scholar
- 45.Ketter TA, Post RM, Theodore WH: Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders. Neurology 1999, 2(suppl):53–67.Google Scholar
- 46.Pratt JA, Jenner P, Johnson AL, et al.: Anticonvulsant drugs alter plasma tryptophan concentrations in epileptic patients: implications for antiepileptic action and mental function. J Neurol Neurosurg Psychiatry 1984, 47:1131–133.PubMedCrossRefGoogle Scholar
- 47.Edeh J, Toone BK: Antiepileptic therapy, folate deficiency and psychiatric morbidity: a general practice survey. Epilepsia 1985, 26:434–40.PubMedGoogle Scholar
- 48.Fröscher W, Maier V, Laage M, et al.: Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995, 18:165–182.PubMedCrossRefGoogle Scholar
- 49.Carney MWP, Chary TKN, Laundy M, et al.: Red cell folate concentrations in psychiatric patients. J Affect Disord 1990, 19:207–213.PubMedCrossRefGoogle Scholar
- 50.Blumer D: Dysphoric disorders and paroxysmal affects: recognition and treatment of epilepsy-related psychiatric disorders. Harv Rev Psychiatry 2000, 8:8–17. This article gives an overview of psychiatric symptoms and disorders associated with epilepsy, and integrates historical and current thinking about such disorders.PubMedCrossRefGoogle Scholar
- 51.DeVane CL, Nemeroff CB: Psychotropic drug interactions 2000. Pharm Prac 2000, 2:5–75.Google Scholar
- 52.Andersen BB, Mikkelson M, Vesterager A, et al.: No influence of the antidepressant paroxetine on carbamazepine, valproate and phenytoin. Epilepsy Res 1991, 10:201–204.PubMedCrossRefGoogle Scholar
- 53.Schmitz B: Antidepressant drugs: indications and guidelines for use in epilepsy. Epilepsia 2002, 43(suppl):14–18.PubMedCrossRefGoogle Scholar
- 54.Koutroumanidis M, Binnie CD, Hennessy MJ, et al.: VNS in patients with previous unsuccessful resective epilepsy surgery: antiepileptic and psychotropic effects. Acta Neurol Scand 2003, 107:117–121.PubMedCrossRefGoogle Scholar
- 55.Boon P, Vonck K, De Reuck J, et al.: Vagus nerve stimulation for refractory epilepsy. Seizure 2001, 10:448–455.PubMedGoogle Scholar
- 56.Topfer L, Hailey D: Vagus nerve stimulation (VNS) for treatment-resistant depression. Issues Emerg Health Technol 2001, 25:1–4.PubMedGoogle Scholar
- 57.Marangell LB, Rush AJ, George MS, et al.: Vagus nerve stimulation (VNS) for major depressive episodes: one year outcomes. Biol Psychiatry 2002, 51:280–287.PubMedCrossRefGoogle Scholar
- 58.George MS, Nahas Z, Bohning DE, et al.: Vagus nerve stimulation therapy: a research update. Neurology. 2002, 59:S56-S61.PubMedGoogle Scholar
- 59.Goodnick PJ, Rush AJ, George MS, et al.: Vagus nerve stimulation in depression. Expert Opin Pharmacother 2001, 2:1061–1063.PubMedCrossRefGoogle Scholar
- 60.Elger G, Hoppe C, Falkai P, et al.: Vagus nerve stimulation is associated with mood improvements in epilepsy patients. Epilepsy Res 2000, 42:203–210.PubMedCrossRefGoogle Scholar
- 61.Zwil AS, Pelchat RJ: ECT in the treatment of patients with neurological and somatic disease. Int J Psychiatry Med 1994, 24:1–29.PubMedCrossRefGoogle Scholar
- 62.Harden CL: The comorbidity of depression and epilepsy: epidemiology, etiology, and treatment. Neurology 2002, 59:S48-S55.PubMedCrossRefGoogle Scholar
- 63.Weiner RD, Coffey CE: Electroconvulsive therapy in the medical and neurologic patient. In Psychiatric Care of the Medical Patient. Edited by Stoudamire A, Fogel BS. New York: Oxford University Press; 1993:207–24.Google Scholar
- 64.Blumer D, Wakhlu S, Davies K, et al.: Psychiatric outcome of temporal lobectomy for epilepsy: incidence and treatment of psychiatric complications. Epilepsia. 1998, 39:478–486.PubMedCrossRefGoogle Scholar
- 65.Glosser G, Zwil AS, Glosser DS, et al.: Psychiatric aspects of temporal lobe epilepsy before and after anterior temporal lobectomy. J Neuro Neurosurg Psychiatry 2000, 68:53–58.CrossRefGoogle Scholar
- 66.Suchy Y, Chelune G: Postsurgical changes in self-reported mood and composite IQ in a matched sample of patients with frontal and temporal lobe epilepsy. J Clin Exp Neuropsychol 2001, 23:413–423.PubMedCrossRefGoogle Scholar
- 67.Quigg M, Broshek DK, Heidal-Schiltz S, et al.: Depression in intractable partial epilepsy varies by laterality of focus and surgery. Epilepsia 2003, 44:419–424.PubMedCrossRefGoogle Scholar
- 68.Anhoury S, Brown RJ, Krishnamoorthy ES, et al.: Psychiatric outcome after temporal lobectomy: a predictive study. Epilepsia 2000, 41:1608–1615.PubMedCrossRefGoogle Scholar
- 69.Marchetti RL, Fiore LA, Valente KD, et al.: Surgical treatment of temporal lobe epilepsy with interictal psychosis: results of six cases. Epilepsy Behav 2003, 4:146–152.PubMedCrossRefGoogle Scholar