Abstracts

Rationale: Epilepsy and depression are both common in older adults. While the relationship of epilepsy with depression has been extensively researched in adolescents and younger adults, the prevalence of depression in older adults with epilepsy is not well known. To address this gap, we conducted a systematic literature review and meta-analysis of the prevalence of depression in older adults with epilepsy.


Methods: We searched PubMed, Web of Science, Google Scholar, and psychINFO to identify systematic reviews of epilepsy and depression that cited original studies. Then we reviewed the original studies to identify those that reported findings specifically for older adults. At least two reviewers assessed study titles and abstracts for inclusion. From the full text of included studies we extracted methodological characteristics (Table 1) and numerical results for older adults (Table 2). We pooled study-specific numerical measures using random-effects inverse-variance meta-analysis.


Results: We identified 13 systematic reviews covering the relationship of epilepsy with depression in adults of any age range, which together cited 251 unique original studies. However, most original studies either didn’t include older adults at all or didn’t report the prevalence of depression specifically in older adults. We identified seven original studies that reported prevalence of depression specifically in older adults, including four with non-epilepsy comparison groups (Table 1 and Table 2). Three studies were case-control and four were cross-sectional; five recruited in clinical settings and two in community settings; and methods for diagnosing epilepsy and depression varied (Table 1). In our meta-analysis of seven original studies, 2,647 people had epilepsy and 548 were also depressed. The pooled prevalence of depression in older adults with epilepsy was 21.4 cases per 100 older adults (95% CI: 12.1, 34.9). In our meta-analysis of four studies comparing older adults with epilepsy versus without, 1,415 had epilepsy and 210 were depressed, and 205,027 didn’t have epilepsy and 18,157 were depressed. The pooled prevalence difference of depression was 6.5 additional cases of depression per 100 older adults with epilepsy compared with 100 older adults without epilepsy (95% CI: 3.2, 9.8; P = 0.008). The pooled prevalence ratio showed that depression was 2.36 times as common in older adults with epilepsy than those without epilepsy (95% CI: 0.62, 9.01; P = 0.133). Two studies reported sex-specific results, one finding higher prevalence of depression in older women with epilepsy, the other finding higher prevalence of depression in older men; and one study reported higher prevalence of depression in older adults with late-onset epilepsy compared to those with lifelong epilepsy.


Conclusions: Based on limited studies, depression afflicts approximately 1 in 5 older adults with epilepsy. Published studies on epilepsy, depression and older adults are mostly small, some without comparison groups, and lacking longitudinal data, underscoring need for further investigation in this area. Future research should include larger samples, comparison groups, and longitudinal data to provide more comprehensive insights.


Funding: None