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Depressive Symptoms in Epilepsy

Prevalence, Impact, Aetiology, Biological Correlates and Effect of Treatment with Antiepileptic Drugs

Drugs volume 68, pages 1493–1509 (2008)Cite this article

Abstract

Occurring in up to 80% of patients with epilepsy, depression in epilepsy may manifest as (i) major depressive disorder, meeting Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnostic criteria; (ii) atypical depression or dysthymia; or (iii) a dysthymic-like disorder with intermittent symptoms that can be milder than those of major depression. Depressive symptoms impair patients’ health-related quality of life and may affect the clinical course of epilepsy. Depressive symptoms in epilepsy have been attributed to several causes, including endocrine and/or metabolic effects of seizures; the psychological response to epilepsy and its associated mental, physical and social challenges; common pathogenic mechanisms between depression and epilepsy; and the adverse effects of certain antiepileptic drugs (AEDs), particularly GABAergic agents, such as vigabatrin, tiagabine, topiramate and phenobarbital. Whereas some AEDs impair mood, others appear to improve aspects of mood or are mood neutral. Demonstrable antidepressant efficacy of AEDs used to manage seizures could have a significant impact on the care of patients with epilepsy. The AED lamotrigine has been demonstrated to be effective in the treatment of depressive symptoms in patients with epilepsy. In randomized, double-blind, clinical trials in patients with epilepsy, depressive symptoms improved more with lamotrigine monotherapy than valproate monotherapy and more with lamotrigine adjunctive therapy than placebo. Results of open-label studies of lamotrigine monotherapy and adjunctive therapy are consistent with the results of double-blind clinical trials. Lamotrigine-associated improvement in depressive symptoms is independent of its anticonvulsant efficacy. In prospective assessments, gabapentin, levetiracetam and oxcarbazepine each exhibited potentially beneficial effects on depressive symptoms in patients with epilepsy. However, evidence for the efficacy of gabapentin, levetiracetam and oxcarbazepine in the treatment of depressive symptoms in epilepsy is inconclusive at present because the effects of each agent have only been reported in single studies of an open-label design and with small sample sizes.

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References

  1. Lambert MV, Robertson MM. Depression in epilepsy: etiology, phenomenology, and treatment. Epilepsia 1999; 40 Suppl. 10: S21–47

    Article  PubMed  CAS  Google Scholar 

  2. Kanner AM, Palac S. Depression in epilepsy: a common but often unrecognized comorbid malady. Epilepsy Behav 2000; 1: 37–51

    Article  PubMed  Google Scholar 

  3. Kanner AM. Depression in epilepsy: prevalence, clinical semiology, pathogenic mechanisms, and treatment. Biol Psychiatry 2003; 54: 388–98

    Article  PubMed  Google Scholar 

  4. Schmitz B. Depression and mania in patients with epilepsy. Epilepsia 2005; 46 Suppl. 4: 45–9

    Article  PubMed  Google Scholar 

  5. Besag FM. Behavioural effects of the newer antiepileptic drugs: an update. Expert Opin Drug Saf 2004; 3: 1–8

    Article  PubMed  CAS  Google Scholar 

  6. Smith D, Baker G, Davies G, et al. Outcomes of add-on treatment with lamotrigine in partial epilepsy. Epilepsia 1993; 34: 312–22

    Article  PubMed  CAS  Google Scholar 

  7. Steiner TJ, Dellaportas CI, Findley LJ, et al. Lamotrigine monotherapy in newly diagnosed untreated epilepsy: a double-blind comparison with valproate. Epilepsia 1999; 40: 601–7

    Article  PubMed  CAS  Google Scholar 

  8. Sackellares J, Kwong J, Vuong A, et al. Lamotrigine monotherapy improves health-related quality of life in epilepsy: a double-blind comparison with valproate. Epilepsy Behav 2002; 3: 376–82

    Article  Google Scholar 

  9. Kaminow L, Schimschock JR, Hammer AE, et al. Lamotrigine monotherapy compared with carbamazepine, phenytoin, or valproate monotherapy in patients with epilepsy. Epilepsy Behav 2003; 4: 659–66

    Article  PubMed  Google Scholar 

  10. Cramer JA, Hammer AE, Kustra RP. Improved mood states with lamotrigine in patients with epilepsy. Epilepsy Behav 2004; 5: 702–7

    Article  PubMed  Google Scholar 

  11. Selai C, Bannister D, Trimble M. Antiepileptic drugs and the regulation of mood and quality of life (QOL): the evidence from epilepsy. Epilepsia 2005; 46 Suppl. 4: 50–7

    Article  PubMed  CAS  Google Scholar 

  12. Edwards KR, Sackellares JC, Vuong A, et al. Lamotrigine monotherapy improves depressive symptoms in epilepsy: a double-blind comparison with valproate. Epilepsy Behav 2001; 2: 28–36

    Article  PubMed  Google Scholar 

  13. Ettinger AB, Kustra RP, Hammer AE. Effect of lamotrigine on depressive symptoms in adult patients with epilepsy. Epilepsy Behav 2007; 10: 148–54

    Article  PubMed  Google Scholar 

  14. Mendez MF, Cummings JL, Benson DF. Depression in epilepsy: significance and phenomenology. Arch Neurol 1986; 43: 766–70

    Article  PubMed  CAS  Google Scholar 

  15. Wiegartz P, Seidenberg M, Woodard A, et al. Comorbid psychiatric disorder in chronic epilepsy: recognition and etiology of depression. Neurology 1999; 53 (5 Suppl. 2): S3–8

    PubMed  CAS  Google Scholar 

  16. Blumer D, Montouris G, Hermann B. Psychiatric morbidity in seizure patients on a neurodiagnostic monitoring unit. J Neuropsychiatry Clin Neurosci 1995; 7: 445–56

    PubMed  CAS  Google Scholar 

  17. Reilly RE, Bowden SC, Bardenhagen FJ, et al. Equality of the psychological model underlying depressive symptoms in patients with temporal lobe epilepsy versus heterogeneous neurological disorders. J Clin Exp Neuropsychol 2006; 28: 1257–71

    Article  PubMed  Google Scholar 

  18. Ettinger AB, Weisbrot DM, Nolan EE, et al. Symptoms of depression and anxiety in pediatric epilepsy patients. Epilepsia 1998; 39: 595–9

    Article  PubMed  CAS  Google Scholar 

  19. Plioplys S. Depression and children and adolescents with epilepsy. Epilepsy Behav 2003; 4 Suppl. 3: S39–45

    Article  PubMed  Google Scholar 

  20. Caplan R, Siddarth P, Gurbani S, et al. Depression and anxiety disorders in pediatric epilepsy. Epilepsia 2005; 46: 720–30

    Article  PubMed  Google Scholar 

  21. Baker GA. Depression and suicide in adolescents with epilepsy. Neurology 2006; 66 (6 Suppl. 3): S5–12

    Article  PubMed  Google Scholar 

  22. Tarsitani L, Bertolote JM. Major depressive comorbidity in epilepsy as a reactive process to a chronic condition. Epilepsy Behav 2006; 8: 343–4

    Article  PubMed  CAS  Google Scholar 

  23. Cramer JA, Blum D, Reed M, et al. The influence of comorbid depression on seizure severity. Epilepsia 2003; 44: 1578–84

    Article  PubMed  Google Scholar 

  24. Zeber JE, Copeland LA, Amuan M, et al. The role of comorbid psychiatric conditions in health status in epilepsy. Epilepsy Behav 2007; 10(4): 539–46

    Article  PubMed  Google Scholar 

  25. Devinsky O, Vickrey BG, Cramer J, et al. Development of the quality of life in epilepsy inventory. Epilepsia 1995; 36: 1089–104

    Article  PubMed  CAS  Google Scholar 

  26. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. J Applied Psychol Measurement 1977; 1: 385–401

    Article  Google Scholar 

  27. Perrine K, Hermann BP, Meador KJ, et al. The relationship of neuropsychological functioning to quality of life in epilepsy. Arch Neurol 1995; 52: 997–1003

    Article  PubMed  CAS  Google Scholar 

  28. Gilliam F. Optimizing health outcomes in active epilepsy. Neurology 2002: 58 Suppl. 5: S9–19

    Article  PubMed  Google Scholar 

  29. Boylan LS, Flint LA, Labovitz DL, et al. Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy. Neurology 2004; 62: 258–61

    Article  PubMed  CAS  Google Scholar 

  30. Gilliam FG. Epilepsy: success in clinical practice. Translating trials to practice. Eur J Neurol 2005A; 12 Suppl. 4: 22–9

    Article  PubMed  Google Scholar 

  31. Johnson EK, Jones JE, Seidenberg M, et al. The relative impact of anxiety, depression, and clinical seizure features on healthrelated quality of life in epilepsy. Epilepsia 2004; 45: 544–50

    Article  PubMed  Google Scholar 

  32. Beck AT, Steer RA. Beck Depression Inventory manual. San Antonio (TX): Harcourt Brace & Company, 1987

    Google Scholar 

  33. Jones JE, Hermann BP, Barry JJ, et al. Rates and risk factors for suicide, suicidal ideation, and suicide attempts in chronic epilepsy. Epilepsy Behav 2003; 4 Suppl. 3: S31–8

    Article  PubMed  Google Scholar 

  34. Pompili M, Girardi P, Ruberto A, et al. Suicide in the epilepsies: a meta-analytic investigation of 29 cohorts. Epilepsy Behav 2005; 7: 305–10

    Article  PubMed  Google Scholar 

  35. Robertson MM. Suicide, parasuicide, and epilepsy. In: Engel Jr J, Pedley TA, editors. Epilepsy: a comprehensive textbook. Philadelphia (PA): Lippincott-Raven, 1997: 2071–81

    Google Scholar 

  36. Harris EC, Barraclough B. Suicide as an outcome for mental disorders: a meta-analysis. Br J Psychiatry 1997; 170: 205–28

    Article  PubMed  CAS  Google Scholar 

  37. Kalinin VV. Suicidality and antiepileptic drugs: is there a link? Drug Saf 2007; 30: 123–42

    Article  PubMed  CAS  Google Scholar 

  38. Katz R. FDA update. Epilepsy Res 2006; 68: 19–94

    Article  Google Scholar 

  39. FDA. Information for healthcare professionals suicidality and antiepileptic drugs [online]. Available from URL: http://www.fda.gov/cder/drug/InfoSheets/HCP/antiepilepticsHCP. htm [Accessed 2008 Jun 6]

  40. Seethalakshmi R, Krishnamoorthy ES. Depression in epilepsy: phenomenology, diagnosis and management. Epileptic Disord 2007; 9: 1–10

    PubMed  CAS  Google Scholar 

  41. Mensah SA, Beavis JM, Thapar AK, et al. The presence and clinical implications of depression in a community population of adults with epilepsy. Epilepsy Behav 2006; 8: 213–9

    Article  PubMed  Google Scholar 

  42. de Souza EA, Salgado PC. A psychosocial view of anxiety and depression in epilepsy. Epilepsy Behav 2006; 8: 232–8

    Article  PubMed  Google Scholar 

  43. Fattoye F, Mosaku KS, Komolafe M, et al. Interictal anxiety and depression symptoms in Nigerians with epilepsy: a controlled study. Epilepsy Behav 2006; 9: 312–6

    Article  Google Scholar 

  44. Grabowska-Grzyb A, Jedrzejczak J, Naganska E, et al. Risk factors for depression in patients with epilepsy. Epilepsy Behav 2006; 8: 411–7

    Article  PubMed  Google Scholar 

  45. Lehrner J, Kalchmayr R, Series W, et al. Health-related quality of life, activity of daily living, and depressive mood disorder in temporal lobe epilepsy patients. Seizure 1999; 8: 88–92

    Article  PubMed  CAS  Google Scholar 

  46. Mendez MF, Doss RC, Taylor JL, et al. Depression in epilepsy: relationship to seizures and anticonvulsant therapy. J Nerv Ment Dis 1993; 181: 444–7

    Article  PubMed  CAS  Google Scholar 

  47. Kogeorgos J, Fonagy P, Scott DR. Psychiatric symptom patterns of chronic epileptics attending a neurological clinic: a controlled investigation. Br J Psychiatry 1982; 140: 236–43

    Article  PubMed  CAS  Google Scholar 

  48. Ettinger A, Reed M, Cramer J, et al. Depression and comorbidity in community-based patients with epilepsy or asthma. Neurology 2004; 63: 1008–14

    Article  PubMed  Google Scholar 

  49. Forsgren L, Nystrom L. An incident case-referent study of epileptic seizures in adults. Epilepsy Res 1990; 6: 66–81

    Article  PubMed  CAS  Google Scholar 

  50. Nilsson FM, Kessing LV, Bolwig TG. On the increased risk of developing late-onset epilepsy for patients with major affective disorder. J Affect Disord 2003; 76: 39–48

    Article  PubMed  Google Scholar 

  51. Attarian H, Vahle V, Carter J, et al. Relation between depression and intractability of seizures. Epilepsy Behav 2003; 4: 298–301

    Article  PubMed  CAS  Google Scholar 

  52. Bymaster FP, McNamara RK, Tran PV. New approaches to developing antidepressants by enhancing monoaminergic neurotransmission. Expert Opin Investig Drugs 2003; 12: 531–43

    Article  PubMed  CAS  Google Scholar 

  53. Jobe PC, Dailey JW, Wernicke JF. A noradrenergic and serotonergic hypothesis of the linkage between epilepsy and affective disorders. Crit Rev Neurobiol 1999; 13: 317–56

    PubMed  CAS  Google Scholar 

  54. Kanner AM. Depression in epilepsy: a neurobiologic perspective. Epilepsy Curr 2005; 5: 21–7

    Article  PubMed  Google Scholar 

  55. Phillips ML, Drevets WC, Rauch SL, et al. Neurobiology of emotion perception II: implications for major psychiatric disorders. Biol Psychiatry 2003; 54: 515–28

    Article  PubMed  Google Scholar 

  56. Hajszan T, MacLusky NJ. Neurologic links between epilepsy and depression in women: is hippocampal neuroplasticity the key? Neurology 2006; 66 (6 Suppl. 3): S13–22

    Article  PubMed  Google Scholar 

  57. Harden CL. The comorbidity of depression and epilepsy: epidemiology, etiology, and treatment. Neurology 2002; 59 (6 Suppl. 4): S48–55

    Article  PubMed  CAS  Google Scholar 

  58. Gilliam FG, Maton BM, Martin RC, et al. Hippocampal 1HMRSI correlates with severity of depression symptoms in temporal lobe epilepsy. Neurology 2007; 68: 364–8

    Article  PubMed  CAS  Google Scholar 

  59. 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: 121–5

    Article  PubMed  CAS  Google Scholar 

  60. Richardson EJ, Griffith HR, Martin RC, et al. Structural and functional neuroimaging correlates of depression in temporal lobe epilepsy. Epilepsy Behav 2007; 10: 242–9

    Article  PubMed  Google Scholar 

  61. Briellmann RS, Hopwood MJ, Jackson GD. Major depression in temporal lobe epilepsy with hippocampal sclerosis: clinical and imaging correlates. J Neurol Neurosurg Psychiatry 2007; 78(11): 1226–30

    Article  PubMed  Google Scholar 

  62. Hermann BP, Wyler AR, Richey ET. Wisconsin Card Sorting Test performance in patients with complex partial seizures of temporal-lobe origin. J Clin Exp Neuropsychol 1988; 10: 467–76

    Article  PubMed  CAS  Google Scholar 

  63. Bromfield EB, Altshuler L, Leiderman DB, et al. Cerebral metabolism and depression in patients with complex partial seizures. Arch Neurol 1992; 49: 617–23

    Article  PubMed  CAS  Google Scholar 

  64. Horner MD, Flashman LA, Freides D, et al. Temporal lobe epilepsy and performance on the Wisconsin Card Sorting Test. J Clin Exp Neuropsychol 1996; 18: 310–3

    Article  PubMed  CAS  Google Scholar 

  65. Jokeit H, Seitz RJ, Markowitsch JH, et al. Prefrontal asymmetric interictal glucose hypometabolism and cognitive impairment in patients with temporal lobe epilepsy. Brain 1997; 120: 2283–94

    Article  PubMed  Google Scholar 

  66. Salzberg M, Taher T, Davie M, et al. Depression in temporal lobe epilepsy surgery patients: an FDG-PET study. Epilepsia 2006; 47: 2125–30

    Article  PubMed  Google Scholar 

  67. Baxter Jr LR, Schwartz JM, Phelps ME, et al. Reduction of prefrontal cortex glucose metabolism common to three types of depression. Arch Gen Psychiatry 1989; 46: 243–50

    Article  PubMed  CAS  Google Scholar 

  68. Paradiso S, Hermann BP, Blumer D, et al. Impact of depressed mood on neuropsychological status in temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2001; 70: 180–5

    Article  PubMed  CAS  Google Scholar 

  69. Kanner AM, Balabanov A. Depression and epilepsy: how closely related are they? Neurology 2002; 58 (8 Suppl. 5): S27–39

    Article  PubMed  Google Scholar 

  70. Ojemann LM, Baugh-Bookman C, Dudley DL. Effect of psychotropic medications on seizure control in patients with epilepsy. Neurology 1987; 37: 1525–7

    Article  PubMed  CAS  Google Scholar 

  71. Gilliam FG, Santos J, Vable V, et al. Depression in epilepsy: ignoring clinical expression of neuronal network dysfunction? Epilepsia 2004; 45 Suppl. 2: 28–33

    Article  PubMed  Google Scholar 

  72. Robertson MM, Trimble MR. The treatment of depression in patients with epilepsy: a double-blind trial. J Affect Disord 1985; 9: 127–36

    Article  PubMed  CAS  Google Scholar 

  73. Hovorka J, Herman E, Nemcova II. Treatment of interictal depression with citalopram in patients with epilepsy. Epilepsy Behav 2000; 1: 444–7

    Article  PubMed  Google Scholar 

  74. Kuhn KU, Quednow BB, Thiel M, et al. Antidepressive treatment in patients with temporal lobe epilepsy and major depression: a prospective study with three different antidepressants. Epilepsy Behav 2003; 4: 674–9

    Article  PubMed  Google Scholar 

  75. Thomé-Souza MS, Kuczynski E, Valente KD. Sertraline and fluoxetine: safe and effective treatments for children and adolescents with epilepsy and depression. Epilepsy Behav 2007; 10: 417–25

    Article  PubMed  Google Scholar 

  76. Mula M, Monaco F, Trimble MR. Use of psychotropic drugs in patients with epilepsy: interactions and seizure risk. Expert Rev Neurother 2004; 4: 953–64

    Article  PubMed  CAS  Google Scholar 

  77. Gilliam FG. Diagnosis and treatment of mood disorders in persons with epilepsy. Curr Opin Neurol 2005; 18: 129–33

    Article  PubMed  Google Scholar 

  78. Harden CL, Lazar RM, Pick LH, et al. A beneficial effect on mood in partial epilepsy patients treated with gabapentin. Epilepsia 1999; 40: 1129–34

    Article  PubMed  CAS  Google Scholar 

  79. Martinovic Z, Buder N, Milovanovic M, et al. Antiepileptic, behavioral, and antidepressant effects of adjuvant lamotrigine therapy in drug-resistant epilepsy. Vojnosanit Pregl 2004; 61: 485–90

    Article  PubMed  Google Scholar 

  80. Kalogjera-Sackellares D, Sackellares JC. Improvement in depression associated with partial epilepsy in patients treated with lamotrigine. Epilepsy Behav 2002; 3: 510–6

    Article  PubMed  Google Scholar 

  81. Fakhoury TA, Barry JJ, Miller JM, et al. Lamotrigine in patients with epilepsy and comorbid depressive symptoms. Epilepsy Behav 2007; 10: 155–62

    Article  PubMed  Google Scholar 

  82. Kustra RP, Meador KJ, Evans BK, et al. Lamotrigine therapy in patients requiring a change in antiepileptic drug regimen. Seizure 2005; 14: 254–61

    Article  PubMed  Google Scholar 

  83. Beck AT, Brown G, Steer RA. Beck Depression Inventory II manual. San Antonio (TX): The Psychological Corporation, 1996

    Google Scholar 

  84. McNair DM, Lorr M, Droppleman LF. EITS manual for the Profile of Mood States. San Diego (CA): Educational and Industrial Testing Service, 1971

    Google Scholar 

  85. Mason BJ, Kocsis JH, Leon AC, et al. Measurement of severity and treatment response in dysthymia. Psychiatr Ann 1993; 23: 625–31

    Google Scholar 

  86. Mason BJ, Kocsis JH, Leon AC, et al. Assessment of symptoms and change in dysthymic disorder. In: Kocsis JH, Klein DN, editors. Diagnosis and treatment of chronic depression. New York: Guildford Press, 1995: 73–88

    Google Scholar 

  87. Commission on classification and terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 1989; 30: 389–99

    Article  Google Scholar 

  88. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382–9

    Article  PubMed  CAS  Google Scholar 

  89. Hathaway SR, McKinley JC. Minnesota multiphasic personality inventory manual. New York: The Psychological Corporation, 1967

    Google Scholar 

  90. Mazza M, Martini A, Scoppetta M, et al. Effect of levetiracetam on depression and anxiety in adult epileptic patients. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32(2): 539–43

    Article  PubMed  CAS  Google Scholar 

  91. Mazza M, Delia Marca G, Di Nicola M, et al. Oxcarbazepine improves mood in patients with epilepsy. Epilepsy Behav 2007; 10: 397–401

    Article  PubMed  Google Scholar 

  92. Mula M, Sander JW. Negative effects of antiepileptic drugs on mood in patients with epilepsy. Drug Saf 2007; 30: 555–67

    Article  PubMed  CAS  Google Scholar 

  93. Brent DA, Crumrine PK, Varma RR, et al. Phenobarbital treatment and major depressive disorder in children with epilepsy. Pediatrics 1987; 80: 909–17

    PubMed  CAS  Google Scholar 

  94. Lopez-Gomez M, Ramirez-Bermudez J, Campillo C, et al. Primidone is associated with interictal depression in patients with epilepsy. Epilepsy Behav 2005; 6: 413–6

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

The authors acknowledge Jane Saiers, PhD, The WriteMedicine Inc., Chapel Hill, NC, USA, for assistance with writing the manuscript. GlaxoSmithKline funded Dr Saiers’ work. The authors are all full-time employees of GlaxoSmithKline. Drs Miller, Kustra, Vuong and Messenheimer hold equity in GlaxoSmithKline.

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  1. Neurosciences Medicines Development Centre, GlaxoSmithKline, 5 Moore Drive, Research Triangle Park, North Carolina, 27709, USA

    J. Mitchell Miller, Robert P. Kustra, Alain Vuong, Anne E. Hammer & John A. Messenheimer

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  1. J. Mitchell Miller
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Miller, J.M., Kustra, R.P., Vuong, A. et al. Depressive Symptoms in Epilepsy. Drugs 68, 1493–1509 (2008). https://doi.org/10.2165/00003495-200868110-00003

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Keywords

  • Depressive Symptom
  • Gabapentin
  • Lamotrigine
  • Temporal Lobe Epilepsy
  • Levetiracetam