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Pharmacotherapy of mood disorders in epilepsy: The role of newer psychotropic drugs

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Depression in patients with epilepsy (PWE) is a relatively common comorbidity that has a significant negative impact on their quality of life. Therefore, recognition and management of a comorbid depressive disorder is paramount to achieve successful comprehensive treatment in PWE. Depression in epilepsy may mimic primary depres-sive disorders, but in a significant percentage of depressed PWE, the clinical semiol-ogy has an atypical presentation and fails to meed any of the diagnostic criteria established in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Despite the relatively high prevalence of depression in epilepsy and its frequent atyp-ical presentation, there has been only one controlled study (in 1979) to establish the safety and efficacy of antidepressant drugs in PWE. Accordingly, clinicians must rely on data from studies of pharmacotherapy of primary depression. These data are ade-quate to guide the clinician in the basic principles of pharmacotherapy of depression in PWE. Many questions are yet to be answered, including: 1) are the expectations of symptom remission to pharmacotherapy in PWE different in typical and atypical forms of depression, and do they differ from those of patients with primary depression? and 2) are the doses of antidepressant drugs necessary to yield symptom remission differ-ent between PWE and those patients with primary mood disorders?

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References and Recommended Reading

  1. Jacoby A, Baker GA, Steen N, et al.: The clinical course of epilepsy and its psychosocial correlates: Findings from a UK community study. Epilepsia 1996, 37: 148–161.

    Article  PubMed  CAS  Google Scholar 

  2. Anthony JC, Eaton WW, Henderson AS: Psychiatric epi-demiology. Epidemiol Rev 1995, 17: 240–242.

    PubMed  CAS  Google Scholar 

  3. Kogeorgos J, Fonagy P, Scott D, et al.: Psychiatric symp-tom patterns of chronic epileptics attending a neuro-logic clinic: a controlled investigation. Br J Psychiatry 1982, 140: 236–244.

    Article  PubMed  CAS  Google Scholar 

  4. Mendez MF, Cummings J, Benson D, et al.: Depression in epilepsy: significance and phenomenology. Arch Neurol 1986, 43: 766–770.

    PubMed  CAS  Google Scholar 

  5. Regier DA, Farmer ME, Rae DS, et al.: One-month prevalence of mental disorders in the United States and socio-demographic characteristics: the Epidemiologic Catchment Area Study. Acta Psychiatr Scan 1993, 88: 35–47.

    CAS  Google Scholar 

  6. Kessler RC, McGonagle KA, Zhao S, et al.: Lifetime and 12-month prevalence of DSM-III-R psychiatric disor-ders in the United States: results from the national comorbidity study. Arch Gen Psychiatr 1994, 51: 8–19.

    PubMed  CAS  Google Scholar 

  7. Anthony JC, Eaton WW, Henderson AS: Looking to the future in psychiatric epidemiology. Epidemiol Rev 1995, 17: 240–242.

    PubMed  CAS  Google Scholar 

  8. Blumer D, Zielinski J: Pharmacologic treatment of psy-chiatric disorders associated with epilepsy. J Epilepsy 1988, 1: 135–150.

    Article  Google Scholar 

  9. Barraclough B: The suicide rate of epilepsy. Acta Psych Scand 1987, 76: 339–345.

    CAS  Google Scholar 

  10. Gilliam F: Optimizing health outcomes in active epi-lepsy. Neurology 2002, 58(Suppl 5): S9-S19.

    PubMed  Google Scholar 

  11. Cramer JA, Blum D, Fanning K, Reed M: Epilepsy Impact Project Group. The impact of comorbid depression on health resource utilization in a com-munity sample of people with epilepsy. Epilepsy Behav 2004, 5: 337–342.

    Article  PubMed  Google Scholar 

  12. Rafnsson V, Olafsson E, Hauser WA, et al.: Cause-spe-cific mortality in adults with unprovoked seizures. A population-based incidence cohort study. Neuroepide-miology 2001, 20: 232–236.

    Article  CAS  Google Scholar 

  13. Nilsson L, Tomson T, Farahmand BY, et al.: Cause-spe-cific mortality in epilepsy: a cohort study of more than 9,000 patients once hospitalized for epilepsy. Epilepsia 1997, 38: 1062–1068.

    Article  PubMed  CAS  Google Scholar 

  14. Hauser WA, Annegers JF, Elveback IR: Mortality in patients with epilepsy. Epilepsia 1980, 21: 399–412.

    PubMed  CAS  Google Scholar 

  15. Indaco A, Carrieri PB, Nappi C, et al.: Interictal depres-sion in epilepsy. Epilpesy Res 1992, 12: 45–50.

    Article  CAS  Google Scholar 

  16. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (Text Revision), Fourth Edition. Washington, DC: American Psychiatric Association, 2000.

    Google Scholar 

  17. Stahl SM, ed: Depression and bipolar disorders. In Essential Pharmacology: Neuroscientific Basis and Practical Applications. Second Edition. New York: Cambridge Uni-versity Press; 2000: 135–197.

    Google Scholar 

  18. Hirschfield RMA, Bowden CL, Gitlin MJ, et al.: Practice guideline for the treatment of patients with bipolar disorder. Am J Psychiatry 2002, 159(Suppl 4): 1–15.

    Google Scholar 

  19. Elkin T, Shea MT, Watkins JT, et al.: National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatment. Arch Gen Psychiatry 1989, 46: 971–982.

    PubMed  CAS  Google Scholar 

  20. Charney DS, Berman RM, Miller HL: Treatment of depression. In Textbook of Psychopharmacology, Second Edi-tion. Edited by Schatzberg AF and Nemeroff CB. Wash-ington, DC: American Psychiatric Association Press; 1998: 705–732.

    Google Scholar 

  21. Paykel ES, Ramana R, Cooper Z, et al.: Residual symp-toms after partial remission; an important outcome in depression. Psychol Med 1995, 25: 1171–1180.

    Article  PubMed  CAS  Google Scholar 

  22. Blanchet P, Frommer GP: Mood change preceding epi-leptic seizures. J Nerv Ment Dis 1986, 174: 471–476.

    Article  PubMed  CAS  Google Scholar 

  23. Kanner AM, Soto A, Gross-Kanner H: Prevalence and clinical characteristics of postictal psychiatric symp-toms in partial epilepsy. Neurology 2004, 62: 708–713.

    PubMed  Google Scholar 

  24. Hancock J, Bevilacqua A: Temporal lobe dysrhythmia and impulsive and suicide behavior. South Med J 1971, 64: 1189–1193.

    PubMed  CAS  Google Scholar 

  25. Tollefson GD, Rosenbaum JF: Selective serotonin reuptake inhibitors. In Textbook of Psychopharmacology, Second Edition. Edited by Schatzberg AF and Nemeroff CB. Washington, DC: American Psychiatric Association Press; 1998: 219–237.

    Google Scholar 

  26. Kent JM, Gorman JM: Venlafaxine. In Textbook of Psychop-harmacology, Second Edition. Schatzberg AF and Nemeroff CB. Washington, DC: American Psychiatric Association Press; 1998: 301–306.

    Google Scholar 

  27. Kanner AM, Balabanov A: Depression in epilepsy: How closely related are these two disorders?. Neurology 2002, 58(Suppl 5): S27–39.

    PubMed  Google Scholar 

  28. Rosenstein D, Nelson J, Jacobs S: Seizures associated with antidepressants: a review. J Clin Psych 1993, 54: 289–299.

    CAS  Google Scholar 

  29. Preskorn S, Fast G: Tricyclic antidepressant induced seizures and plasma drug concentration. J Clin Psych 1992, 53: 160–162.

    CAS  Google Scholar 

  30. Curran S, DePauw: Selecting an antidepressant for use in a patient with epilepsy. Safety considerations. Drug Safety 1998, 18: 125–133.

    Article  PubMed  CAS  Google Scholar 

  31. Swinkels J, Jonghe F: Safety of antidepressants. Int Clin Psychopharmacol 1995, 9(Supp 4): 19–25.

    Article  PubMed  Google Scholar 

  32. Kanner AM, Kozak AM, Frey M: The use of sertraline in patients with epilepsy: is it safe? Epilepsy Behav 2000, 1: 100–105.

    Article  PubMed  Google Scholar 

  33. Grimsley S, Jann M, Carter J, et al.: Increased carbam-azepine plasma concentrations after fluoxetine coad-ministration. Clin Pharmacol Ther 1991, 50: 10–15.

    Article  PubMed  CAS  Google Scholar 

  34. Pearson H: Interaction of fluoxetine and carbam-azepine. J of Clin Psychiatry 1990, 51: 126.

    CAS  Google Scholar 

  35. Fritze J, Unsorg B, Lanczik M: Interaction between car-bamazepine and fluvoxamine. Acta Psych Scand 1991, 84: 583–584.

    CAS  Google Scholar 

  36. Post R, Putnam F, Uhde T: Electroconvulsive therapy as an anticonvulsant: implications for its mechanisms of action in affective illness. Electroconvulsive Therapy: Clinical and Basic Research Issues. Edited by Malitz S, Sackeim H. New York: New York Academy of Sciences; 1986.

    Google Scholar 

  37. Blackwood DHR, Cull RE, Freeman CP, et al.: A study of the incidence of epilepsy following ECT. J Neurol Neu-rosurg Psychiatry 1980, 43: 1098–1102.

    Article  CAS  Google Scholar 

  38. Abrams R: Electroconvulsive therapy in the high-risk patient. In: In Electroconvulsive therapy. New York: Oxford University Press; 1997: 81–113.

    Google Scholar 

  39. Sackeim HA: The anticonvulsant hypothesis of the mechanisms of action of ECT: current status. J ECT 1999, 15: 5–26.

    PubMed  CAS  Google Scholar 

  40. Viparelli U, Viparelli G: ECT and grand mal epilepsy. Convuls Ther 1992, 8: 39–42.

    PubMed  Google Scholar 

  41. Coffey CE, Lucke J, Weiner RD, et al.: Seizure threshold in electroconvulsive therapy (ECT) II. The anticonvul-sant effect of ECT. Biol Psychiatry 1995, 37: 777–788.

    Article  PubMed  CAS  Google Scholar 

  42. Sackeim HA, Decina P, Prohovnik I, et al.: Anticonvul-sant and antidepressant properties of electroconvul-sive therapy: a proposed mechanism of action. Biol Psychiatry 1983, 18: 1301–1310.

    PubMed  CAS  Google Scholar 

  43. Regenold WT, Weintraub D, Taller A: Electroconvulsive therapy for epilepsy and major depression. Am J Geri-atr Psychiatry 1998, 6: 180–183.

    CAS  Google Scholar 

  44. Fink M, Kellner C, Sackheim HA: Intractable seizures, status epilepticus and ECT. JECT Lett 1999, 15: 282–284.

    CAS  Google Scholar 

  45. Blum D, Reed M, Metz A: Prevalence of major affective disorders and manic/hypomanic symptoms in per-sons with epilepsy: A community survey. Neurology 2002, (Suppl 3): A–175.

  46. Delucchi GA, Calabrese JR: Anticonvulsants for the treatment of manic depression. Cleveland Clin J Med 1989, 56: 756–761.

    CAS  Google Scholar 

  47. Barry JJ, Lembke A, Huynh N: Affective disorders in epi-lepsy. In Psychiatric Issues in Epilepsy: A Practical Guide to Diagnosis and Treatment. Edited by Ettinger AB and Kan-ner AM. Philadelphia: Lippincott Williams & Wilkins; 2001: 45–72.

    Google Scholar 

  48. Lithium neuroleptic interactions: electroencephalo-graphic studies. Res Commun Psychology Psychiatry Behav 1991, 16:35–40.

  49. Bell AJ, Cole A, Eccleston D, et al.: Lithium neurotoxic-ity at normal therapeutic levels. Br J Psychiatry 1993, 162: 688–692.

    Google Scholar 

  50. Whitworth AB, Fleischhacker WW: Adverse effects of antipsychotic drugs. Int Clin Psychopharmacol 1995, 9(Suppl 5): 21–27.

    Article  PubMed  Google Scholar 

  51. Stahl SM, ed: Depression and bipolar disorders. In Essential Pharmacology: Neuroscientific Basis and Practical Applications. Second Edition. New York: Cambridge Uni-versity Press; 2000: 135–197.

    Google Scholar 

  52. Logothetis J: Spontaneous epileptic seizures and EEG changes in the course of phenothiazine therapy. Neu-rology 1967, 17: 869–877.

    CAS  Google Scholar 

  53. Toth P, Frankenburg FR: Clozapine and seizures: a review. Can J Psychiatry 1994, 39: 236–238.

    PubMed  CAS  Google Scholar 

  54. Pacia DV, Devinsky O: Clozapine related seizures. Neu-rology 1994, 44: 2247–2249.

    CAS  Google Scholar 

  55. Tiihonen J, Nousiainen U, Hakola P, et al.: EEG abnor-malities associated with clozapine treatment [letter]. Am J Psychiatry 1991, 148: 1406.

    PubMed  CAS  Google Scholar 

  56. Fatemi SH, Rapport DJ, Calabrese JR, Thuras P: Lamot-rigine in rapid-cycling bipolar disorder. J Clin Psychiatry 1997, 58: 522–527.

    PubMed  CAS  Google Scholar 

  57. Fogelson DL, Sternbach H: Lamotrigine treatment of refractory bipolar disorder. J Clin Psych 1997, 58: 271–273.

    CAS  Google Scholar 

  58. Sporn J, Sachs G: The anticonvulsant lamotrigine in treatment-resistant manic-depressive illness. J Clin Psychopharmacol 1997, 17: 185–189.

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Neurological Sciences, Rush University Medical Center, 1653 West Congress Parkway, 60612, Chicago, IL, USA

    Andres M. Kanner MD

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  2. Antoaneta J. Balabanov MD
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Kanner, A.M., Balabanov, A.J. Pharmacotherapy of mood disorders in epilepsy: The role of newer psychotropic drugs. Curr Treat Options Neurol 7, 281–290 (2005). https://doi.org/10.1007/s11940-005-0038-7

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