Depression and Mania in Patients with Epilepsy

Abstract

Depression has a major impact on quality of life in patients with epilepsy and is also the main risk factor for the increased suicide rate in epilepsy. The frequency of depressive disorders depends on the severity of epilepsy and the localization of the epileptogenic focus, with a prevalence of <or=50% in patients with intractable temporal lobe epilepsy. The diagnosis of depression in epilepsy may be difficult because symptoms of depression may be fluctuating, and some symptoms, such as memory complaints, may be misinterpreted as being a consequence of drug treatment or the epilepsy per se. Affective disorders in epilepsy may differ from those seen in patients without epilepsy. A possibility exists that patients with epilepsy will develop a specific interictal dysphoric syndrome related to limbic system dysfunction. Recent epidemiologic studies suggest a bidirectional relation between depression and epilepsy. Depression does not necessarily occur after the onset of epilepsy; the sequence may as well be the other way round, suggesting a common underlying mechanism for both disorders. Classic bipolar disorder type I is rarely seen in epilepsy, and manic episodes occur almost exclusively in the setting of postictal psychosis or after epilepsy surgery. This article explores the clinical manifestations of depressive and manic disorders in epilepsy and the differences from bipolar disorder.

Anger Is a Distinctive Feature of Epilepsy Patients with Depression

“…It has been consistently noted that depressive disorders in epilepsy are under-recognized and, consequently, undertreated (Lambert and Robertson 1999;Kanner and Palac 2000;Schmitz 2005). Certainly, the frequent presence of depressive symptoms in epilepsy, which may be milder and more intermittent than those in patients with idiopathic major depression, may contribute to this under-recognition (Lambert and Robertson 1999;Kanner and Palac 2000;Schmitz 2005).…”

“…Certainly, the frequent presence of depressive symptoms in epilepsy, which may be milder and more intermittent than those in patients with idiopathic major depression, may contribute to this under-recognition (Lambert and Robertson 1999;Kanner and Palac 2000;Schmitz 2005). However, even moderate or severe depressive states in patients with epilepsy that might lead to suicide attempts have apparently escaped medical attention.…”

Screening of anxiety and quality of life in people with epilepsy

“…These factors in this relatively young patient group can themselves contribute to psychiatric disturbances, as well as biological factors. Numerous studies show that the incidence of psychiatric disorders in PwE is significantly higher than in the general population [2][3][4][5][6][7] . Up to 50 or 60% of patients with chronic epilepsy have at least one mood disorder including depression and anxiety 8 .…”

5-HT1A Receptor Binding in Temporal Lobe Epilepsy Patients With and Without Major Depression

“…One study of 174 patients with epilepsy, using standardized assessment methods based on DSM-IV, found current Axis I disorders in 49%, with anxiety (30.4%) and mood (21.8%) disorders being the most common categories; major depressive episode were the most common individual diagnosis (17.2%) (24). Of depressed patients with epilepsy, the majority suffer from unipolar depression (48). Longitudinal studies in epilepsy and depression reported a bidirectional temporal association between the two conditions: epilepsy was frequently followed by depression, and a history of depression was a considerable risk factor for subsequent epilepsy onset (17,22).…”