Abstracts

Rationale: The 2008 FDA alert concerning suicidality and antiepileptic drugs has prompted epilepsy care centers to assess related clinical practices. Although the results of the FDA study are controversial, given the prevalence of comorbid psychiatric illness in the epilepsy patient population, routine screening for depression and suicidality has been recommended by experts and legal advisors in the field. The purpose of the current project is to describe the results of a process for screening all appropriate adult epilepsy patients for depression and suicidality, in an outpatient epilepsy clinic setting. Methods: Adults patients seen at the Minnesota Epilepsy Group clinic for first-time or routine clinic visits were administered a brief self-report questionnaire. Patients were included if they were over the age of 18, their own legal guardian, and able to read and understand the questionnaire. The questionnaire included the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the suicide question from the Beck Depression Inventory-II (BDI-II). Patients were also asked if they were being treated by a psychiatrist, psychologist, or counselor. Clinic nursing staff scored the screening measure and took one of the following actions based on depression symptoms: 1) no response, 2) depression information packet given, or 3) suicide risk assessment administered by psychology staff. Current AED data was collected from each patient. Results: Since project onset 104 patients have completed questionnaires. The mean score on the NDDI-E was 11.42 (>15 is suggestive of depressive disorder). On the BDI-II suicide question, 95 % responded I don t have any thoughts of killing myself and the remaining 5% responded I have thoughts of killing myself, but I would not carry them out . Approximately 1/4 of patients met established criteria to receive a depression information packet, and 72 % had no action taken. No patients required immediate mental health assessment due to indicated suicidal risk. There were no differences in the number of AEDs prescribed to patients scoring >15 or <15 on the NDDI-E. The possible relationship between specific AEDs and depressive/suicidal symptoms will be explored. Conclusions: A new process for monitoring depression and suicidal symptoms was instituted in a busy epilepsy clinic with minimal disruption to clinic procedures. These findings support existing literature on prevalence of depression in the epilepsy patient population. Based on this limited sample, no clear relationship between AED use and suicidal thinking was observed. Although this project addresses the FDA warning concerns, a more comprehensive assessment of all factors that may contribute to compromised life satisfaction is in the best interest of this patient population