NEW ORLEANS – Teens and adults with epilepsy are at higher risk for depression than the general population and should be screened regularly and provided therapy if needed, suggests research being presented at the American Epilepsy Society Annual Meeting.
A study of teens with epilepsy found that 8 percent had moderate or severe depression and another 5 percent had attempted suicide or thought about it. In other research, more than half of adults with epilepsy who had suffered a negative health event (such as an emergency room visit or accident) suffered from moderate or severe depression. Findings from that study also suggest that people with epilepsy who have depressive symptoms may suffer from other mental health issues, such as bipolar disorder, obsessive-compulsive disorder, and panic disorder, and should be screened.
"People with epilepsy who have depression are more likely to have seizures, so treating the depression doesn't just help with depression, but also with the epilepsy," said Martha Sajatovic, M.D., lead author of the study of adults with epilepsy and director of the Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine, Cleveland. "Identifying people with epilepsy who have depression or other mental health issues is half of the battle, and following up to ensure they receive treatment is vital, because it can truly change patient outcomes and help them achieve their best quality of life."
About 7.6 percent of people in the general population have depression at any given time, according to the Centers for Disease Control and Prevention (CDC).
Teens with Epilepsy and Depression
Results of research at UT Southwestern Medical Center, Dallas, suggest depression screening and psychological services should be part of comprehensive care provided to teens with epilepsy. In the study, researchers screened 394 teens (ages 15 to 18) with epilepsy for depression using the Patient Health Questionnaire (PHQ-9) and determined 13 percent required a behavioral health referral or intervention such as immediately seeing a social worker or psychologist. Another 22 percent of teens scored high enough to suggest a risk for depressive symptoms.
The PHQ-9 is a simple survey filled out by patients to assess if they are depressed and if so, determine their level of depression. They answer questions (such as whether they have little interest in doing things, trouble concentrating and sleep difficulties) on a scale from 0 (not at all) to 3 (every day). The higher the score, the higher the depression severity.
"We know that depression is more common in people with epilepsy compared to the general population, but there is less information about depression in children and teens than adults, and little is known about the factors that increase the likelihood of depressive symptoms," said Hillary Thomas, Ph.D., lead author of the study and a psychologist specializing in pediatric epilepsy at the Children's Health System of Texas. "Depression screening should be routine at epilepsy treatment centers and can identify children and teens who would benefit from intervention."
"Our results don't mean that only 13 percent of the teens with epilepsy had depressive symptoms," said Susan Arnold, M.D., senior author of the study and director of the Comprehensive Epilepsy Center at Children's Health System of Dallas. "They indicate the significant percentage of teens whose level of depressive symptoms warranted behavioral health referrals or further evaluation or even intervention during a clinic visit. Health care providers need to be vigilant about continually screening children and teens for depression."
Researchers note epilepsy treatment centers should include a psychosocial team such as a social worker or psychologist as part of each patient's comprehensive care.
They plan to continue to analyze the data to look for specific depression symptoms that are most common in teens and use them to develop additional resources for families, such as warning signs and symptom management, as well as group therapy and support groups.
Depression and Other Mental Health Issues in Adults with Epilepsy
In the second study, researchers determined 62 (52 percent) of 120 people with epilepsy who had a negative health event had a least moderate depression, based on the PHQ-9. The study was a secondary analysis of a prospective randomized controlled trial looking at a new epilepsy intervention to help people who had suffered from a negative health event.
The findings confirm previous research showing that people with depressive symptoms are more likely to have more frequent seizures and lower quality of life. New findings from the study suggest that people with epilepsy who have depressive symptoms may be suffering from other mental health disorders, and should be assessed for those issues. The researchers also found that those with severe depression were more likely to be unable to work.
"Health care providers should screen their epilepsy patients for depression but they shouldn't stop there," said Dr. Sajatovic. "A person may have depressive symptoms that don't reach the level of depression, but should be assessed for other types of mental health issues that could easily be overlooked."
She suggests health care providers have their patients with epilepsy fill out the PHQ-9 every year, or more frequently if their situation warrants it, since depression also can develop at any time.
"It's important that people with epilepsy who have depression or other mental health issues get treatment such as cognitive behavioral therapy and medication," said Dr. Sajatovic.
"Even being in a self-management program helps because the better they are at self-management, the less likely they are to suffer negative health effects."