Abstracts

RATIONALE: The prevalence and implications of depression in epilepsy is not well known. Problems with some earlier studies include selection bias (tertiary centers), ascertainment method concerns, and lack of control groups. Large community-based studies are needed.
Objective: To better understand the prevalence and implications of depression in epilepsy.
METHODS: We mailed a survey to persons with epilepsy (PWE) and to persons with asthma, depression, and no chronic ailments (NoProb). Subjects had been identified from a prior survey of 180,997 individuals from the National Family Opinion (NFO) database. The survey included demographic factors, questions about seizures and functional status and the Center for Epidemiological Studies [ndash] Depression (CESD) inventory. Results were balanced to the US Census.
RESULTS: We identified 775 persons with epilepsy, 395 with asthma and 341 with NoProb. A diagnosis of depression was reported by 30.3% of PWE, 21% of persons with asthma, and 0% of NoProb. Diagnostic threshold on the CESD for major depression was reached in 24.9% of PWE, 18.4% of asthma and 2.7% of NoProb. Of the PWE who had been diagnosed with depression, 73.1% showed CESD scores consistent with ongoing moderate or major depressive symptomatology. Of the PWE who had not been diagnosed with depression, 13.3% showed CESD scores consistent with ongoing moderate or major depression. PWE had worse scores on all of the sub-items on the CESD questionnaire compared to asthma sufferers, except for sleep disturbance. The most recent seizure occurred more than a year ago in 28.6% of PWE with depression compared to 41.0% of PWE without depression. Visits to psychiatrists and/or psychologists were reported in the past 12 months by 6.3% of asthma, 10.1% of PWE, and 2.3% of NoProb. Psychotherapeutic drug use was 6.9% for asthma and 10.6% for PWE. Delays in taking medication for their major health problem due to concerns about side effects was reported by 30.0% of asthma, 19.2% of PWE without depression, and 43.6% of PWE with depression. At least partial employment status was seen in 46.7% of PWE, 38.4% of PWE with depression, 60% of depression alone, 68% of asthma, and 76.4% of the NoProb population.
CONCLUSIONS: In this large, population-based survey, depression is more frequent in persons with epilepsy than in persons with asthma or than in persons with no chronic ailments. Epilepsy patients were more likely to take antidepressant medications and to visit a psychiatrist/psychologist. Epilepsy with depression, compared to epilepsy without depression, was associated with poor seizure control, increased health care utilization, non-compliance and unemployment. A significant number of patients who had not been diagnosed with depression showed CESD scores suggestive of significant depressive symptomatology.
[Supported by: GlaxoSmithKline Pharmaceuticals]; (Disclosure: Grant - Approximately $70,000 total research grant funding to Long Island Jewish Medical Center for a study on Lamotrigine. Funded by GlaxoSmithKline, Honoraria - Occasional lecture sponsorship from companies such as GlaxoSmithKline, Elan. Total in range of $15,000 per year.)