Diagnosing and treating depression in epilepsy

Abstract

At least one third of patients with active epilepsy suffer from significant impairment of their emotional well-being. A targeted examination for possible depression (irrespective of any social, financial or personal burdens) can identify patients who may benefit from medical attention and therapeutic support. Reliable screening instruments such as the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) are suitable for the timely identification of patients needing help. Neurologists should be capable of managing mild to moderate comorbid depression but referral to mental health specialists is mandatory in severe and difficult-to-treat depression, or if the patient is acutely suicidal. In terms of the therapeutic approach, it is essential first to optimize seizure control and minimize unwanted antiepileptic drug-related side effects. Psychotherapy for depression in epilepsy (including online self-treatment programs) is underutilized although it has proven effective in ten well-controlled trials. In contrast, the effectiveness of antidepressant drugs for depression in epilepsy is unknown. However, if modern antidepressants are used (e.g. SSRI, SNRI, NaSSA), concerns about an aggravation of seizures and or problematic interactions with antiepileptic drugs seem unwarranted. Epilepsy-related stress ("burden of epilepsy") explains depression in many patients but acute and temporary seizure-related states of depression or suicidality have also been reported. Limbic encephalitits may cause isolated mood alteration without any recognizable psychoetiological background indicating a possible role of neuroinflammation. This review will argue that, overall, a bio-psycho-social model best captures the currently available evidence relating to the etiology and treatment of depression as a comorbidity of epilepsy.

Depression and quality of life in patients with epilepsy in Northwest Greece

“…These findings could potentially be explained by the financial crisis, if we accept that patients of chronic illnesses may be more vulnerable to socio-economic changes. In our series, depression was undiagnosed in 40% of patients with epilepsy and depression, while this proportion has been described in the literature to be higher than 60% [47,48].…”

The Gut-Brain-Axis on the Manifestation of Depressive Symptoms in Epilepsy: An Evidence-Driven Hypothesis

“…Frequently prescribed anti-depressants to epileptic patients are from classes such as the selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs). They act as primary drugs or treatment for depression due to greater tolerability and decreased adverse effects as compared to classic tricyclic antidepressants (TCAs) which have been known to worsen seizure activity and decreasing seizure threshold in a dose-dependent manner (Dailey and Naritoku, 1996;Elger et al, 2017). The mechanism of action for both inhibitors blocks different transporters at the presynaptic neuronal membrane and elevate serotonin and/or noradrenaline levels in the synapse (Cardamone et al, 2013).…”

Plötzlicher, unerwarteter Tod bei Epilepsie

“…Anhand tierexperimenteller Daten wurde gezeigt, dass der Einsatz von selektiven Serotonin-Wiederaufnahmehemmern (SSRI) bei Mäusen mit audiogenen Reflex-Epilepsien die SUDEP-Rate senken kann [53]. Bei Menschen mit Epilepsie können SSRI einen günstigen Effekt auf die häufigen, affektiven Begleitstörungen [84] sowie möglicherweise die Anfallsfrequenz [85] haben und zumindest auch die Phase der postiktualen Hypoxämie abmildern. Auch Modulationen des endogenen Opiatsystems oder Adenosinrezeptorsystems werden in der wissenschaftlichen Literatur diskutiert, praktisch relevante Empfehlungen können allerdings aufgrund mangelnder Daten nicht gegeben werden [86].…”