Objective: To estimate the prevalence of depression in persons with epilepsy (PWE) and the strength of association between these 2 conditions.Methods: The MEDLINE (1948-2012, EMBASE (1980EMBASE ( -2012, and PsycINFO (1806PsycINFO ( -2012 databases, reference lists of retrieved articles, and conference abstracts were searched. Content experts were also consulted. Two independent reviewers screened abstracts and extracted data. For inclusion, studies were population-based, original research, and reported on epilepsy and depression. Estimates of depression prevalence among PWE and of the association between epilepsy and depression (estimated with reported odds ratios [ORs]) are provided.Results: Of 7,106 abstracts screened, 23 articles reported on 14 unique data sources. Nine studies reported on 29,891 PWE who had an overall prevalence of active (current or past-year) depression of 23.1% (95% confidence interval [CI] 20.6%-28.31%). Five of the 14 studies reported on 1,217,024 participants with an overall OR of active depression of 2.77 (95% CI 2.09-3.67) in PWE. For lifetime depression, 4 studies reported on 5,454 PWE, with an overall prevalence of 13.0% (95% CI 5.1-33.1), and 3 studies reported on 4,195 participants with an overall OR of 2.20 (95% CI 1.07-4.51) for PWE.Conclusions: Epilepsy was significantly associated with depression and depression was observed to be highly prevalent in PWE. These findings highlight the importance of proper identification and management of depression in PWE. Depression is the leading cause of years lived with disability and the fourth leading cause of disability-adjusted life-years worldwide.1 It is often under-recognized and improperly managed in persons with epilepsy (PWE), and can interfere with treatment outcomes and quality of life.
2Undermanaged depression in epilepsy is associated with work absenteeism, increased health care system utilization, and direct medical costs.3 The reported prevalence of depression in PWE varies between 12% and 37% in community settings. 4,5 This wide range of estimates may be attributed to heterogeneity in study design, population demographics, or the method of diagnosing depression or epilepsy. A systematic review and meta-analysis could help explain the variability in the existing literature and through pooling, produce more precise estimates.The purpose of this systematic review was to estimate the prevalence of depression in PWE and to determine the strength of the association between epilepsy and depression. The second objective was to assess the nature and importance of heterogeneity between estimates. We hypothesized that reported differences in estimates of depression in epilepsy would be largely attributable to variations in depression ascertainment methods (e.g., self-report vs screening questionnaire).