Around 400 BC, Hippocrates wrote: "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".The relationship between depression and epilepsy has been known since ancient times, however, to date, it is not fully understood.The prevalence of psychiatric disorders (PD) in persons with epilepsy is high compared to general population. Mood disorders occur in 11 to 62%, psychosis in 7 to 10% and personality disorders in 5 to 33% [1][2][3][4][5][6][7][8] . Depression is the most frequent PD in persons with epilepsy [9][10][11] . It is assumed that the rate of depression ranges from 20 to 55% in patients with refractory epilepsy, especially considering those with temporal lobe epilepsy caused by mesial temporal sclerosis (TLE-MTS). Furthermore, people with epilepsy have a lifetime prevalence of any type of mood disorder higher than that observed in general population or people with other chronic medical disorders. Despite its high prevalence, depression remains underdiagnosed and undertreated in persons with epilepsy, with relevant personal and social costs. The impact of depression in morbidity can be
ABSTRACTThe relationship between depression and epilepsy has been known since ancient times, however, to date, it is not fully understood. The prevalence of psychiatric disorders in persons with epilepsy is high compared to general population. It is assumed that the rate of depression ranges from 20 to 55% in patients with refractory epilepsy, especially considering those with temporal lobe epilepsy caused by mesial temporal sclerosis. Temporal lobe epilepsy is a good biological model to understand the common structural basis between depression and epilepsy. Interestingly, mesial temporal lobe epilepsy and depression share a similar neurocircuitry involving: temporal lobes with hippocampus, amygdala and entorhinal and neocortical cortex; the frontal lobes with cingulate gyrus; subcortical structures, such as basal ganglia and thalamus; and the connecting pathways. We provide clinical and brain structural evidences that depression and epilepsy represent an epiphenomenon sharing similar neural networks.Key words: epilepsy, depression, neuroimaging, temporal lobe.
RESUMOA relação entre depressão e epilepsia é conhecida desde a antiguidade; entretanto, até o momento, não é completamente compreendida. A prevalência de transtornos psiquiátricos nas pessoas com epilepsia é elevada quando comparada à população em geral. A taxa de depressão varia de 20 a 55% nos pacientes com epilepsia refratária, especialmente considerando-se aqueles com epilepsia do lobo temporal causada por esclerose mesial temporal. A epilepsia do lobo temporal é um bom modelo biológico para compreender as bases estruturais comuns entre a epilepsia e a depressão. É relevante ressaltar que a epilepsia do lobo mesial e a depressão apresentam circuitos similares envolvendo: os lobos temporais com o hipocampo...