Risk factors for postoperative depression: A retrospective analysis of 248 subjects operated on for drug‐resistant epilepsy

Abstract

SUMMARYThe aim of this retrospective case series analysis was to identify the predictors of postoperative depression (PostOp-D) in a sample of 248 subjects with focal drug-resistant focal epilepsy. The presence or absence of PostOp-D during a 12-month follow-up period was the outcome variable. Demographic, neurologic, psychiatric characteristics, and antiepileptic therapy were the explanatory variables. After preliminary bivariate analysis, a multivariate logistic regression model was fitted to identify variables associated with PostOp-D. Sixty-seven patients (27%) experienced PostOp-D. At multivariate analysis, lifetime depression, age at surgery, and levetiracetam (LEV) are positive predictors of PostOp-D; carbamazepine (CBZ) and anxiety disorders are protective factors. LEV increases the risk for PostOp-D by about half; the relative risk (RR) is 1.48. Conversely, CBZ decreases the risk for PostOp-D by about half (RR 0.59). Our results suggest that careful psychiatric evaluation and follow-up should be recommended for subjects at risk. It is advisable to treat patients with depression before surgery. Antiepileptic drugs should be selected carefully when patients present with not modifiable risk factors, such as positive personal history for depression.

Brain tumor location influences the onset of acute psychiatric adverse events of levetiracetam therapy: an observational study

“…Self-reported aggressiveness, for example, is reported as "always" a problem by 9.8% of the patients on LEV treatment and is not an isolated symptom but associated to depressed mood [26]. In another recent study, LEV has been reported to be an independent risk factor for the development of postoperative depression in patients with drug-resistant focal epilepsy; the use of carbamazepine reduced this risk [27]. The observations deriving from the present investigation give an additional knowledge on LEV-related PAEs.…”

Post–epilepsy surgery psychogenic nonepileptic seizures

“…There may be several explanations for this phenomenon. Neurosurgical interventions, including epilepsy surgery, can precipitate psychiatric disorders . Psychiatric comorbidity is observed in nearly half of patients with drug‐resistant temporal lobe epilepsy, and perhaps one fifth of patients develop de novo psychiatric morbidity after surgery .…”

“…Neurosurgical interventions, including epilepsy surgery, can precipitate psychiatric disorders. 10,11 Psychiatric comorbidity is observed in nearly half of patients with drug-resistant temporal lobe epilepsy, and perhaps one fifth of patients develop de novo psychiatric morbidity after surgery. 12 PNES may also develop after brain surgery undertaken for indications other than the control of drug-resistant epileptic seizures.…”

The comorbidity of epilepsy and depression: diagnosis and treatment

“…In 2011, Wrench et al [46] followed 60 epileptics for 12 months after surgery and found that the prevalence of postoperative major depression (MD) was increased with time, but was still lower than the preoperative prevalence (30% vs 43%). In 2015, Barbieri et al [47] followed 248 PWE for 12 months after epilepsy surgery and found that 27% of patients experienced postoperative depression, 3 patients committed suicide after the end of the study, and one was diagnosed with de novo depression within 6 months after surgery. Although the prevalence of postoperative depression is lower than the preoperative prevalence, it is still as high as 27%-30% and may even lead to suicide.…”