Depression and suicide attempt as risk factors for incident unprovoked seizures

Abstract

Major depression has been shown to increase the risk for development of epilepsy, but prior studies have not evaluated whether this is due to specific symptoms of depression. We conducted a population-based case-control study of all newly diagnosed unprovoked seizures among Icelandic children and adults aged 10 years and older to test the hypothesis that major depression is a risk factor for developing unprovoked seizure and epilepsy, and to address whether specific symptoms of depression account for this increased risk. Cases were matched to the next two same sex births from the population registry. Using standardized interviews, we ascertained symptoms of major depression to make a Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) diagnosis. A history of major depression was 1.7-fold more common among cases than among controls (95% confidence interval, 1.1-2.7). A history of attempted suicide was 5.1-fold more common among cases than among controls (95% confidence interval, 2.2-11.5). Attempted suicide increased seizure risk even after adjusting for age, sex, cumulative alcohol intake, and major depression or number of symptoms of depression. Major depression and attempted suicide independently increase the risk for unprovoked seizure. These data suggest that depression and suicide attempt may be due to different underlying neurochemical pathways, each of which is important in the development of epilepsy.

Diagnoses and referral pattern at a first seizure clinic in London

“…In this regard, it is important to note that data on psychiatric comorbidities of epilepsy usually comes from drug-refractory patients with limited information about patients with first unprovoked seizures or new onset epilepsies (Pohlmann-Eden et al, 2015). However, it is now becoming evident that psychiatric conditions often precede the onset of epilepsy (Hesdorffer et al, 2006) and our data further support this view.…”

Anxiety disorders in people with epilepsy

“…This strict association seems to be further supported by the existence of a bidirectional relationship between epilepsy and anxiety meaning that anxiety does not only follow epilepsy but that it may precede the onset of epilepsy by years (Hesdorffer et al, 2006), which is, by the way, also true for psychosis, depression and suicidality. One explanation for the bidirectional relationship between anxiety disorders and epilepsy may be in the role that serotonin plays for both diseases (Kanner, 2009).…”

The interictal dysphoric disorder of epilepsy: Legend or reality?

“…In his famous quotation, Hippocrates report that "melancholics ordinarily become epileptics, and epileptics, melancholics: what determines the preference is the direction the malady takes; if it bears upon the body, epilepsy, if upon the intelligence, melancholy" [1]. This ancient observation has been recently revitalized by modern epidemiological data suggesting a bidirectional relationship between epilepsy and mood disorders and between epilepsy and suicide [2][3][4]. Although such a bidirectional link seems to be present in several chronic conditions, for example Parkinson's disease [5], stroke [6], dementia [7], diabetes [8] and cardiovascular diseases [9], the case of epilepsy is definitely intriguing given the neurobiological underpinning shared by the two conditions [10][11][12].…”