Abstracts

Rationale: Treatment for depression in children with epilepsy is often neglected, partly because of concerns related to the use of antidepressive drugs, especially in patients with refractory epilepsy. The aims of the following study were: to evaluate the safety and efficacy of the use of selective serotonin reuptake inhibitors (SSRI) in the treatment of depressive symptoms in children and adolescents with epilepsy. Methods: A retrospective study was carried out by revision of a database and systematic analysis of medical records of 53 children and adolescents with a diagnosis of epilepsy and depression. We excluded from the study patients with other psychiatric disorders, with poor treatment adherence and those with problems in quantifying frequency of epileptic seizures. Worsening of seizure frequency was related to use of SSRI when occurring in up to three months after either its introduction or titration. We evaluated the effectiveness of SSRI treatment according to psychiatric assessments of the patient and judgments made by close family members. Results: Out of 53 children and adolescents included in the study 69,8% either presented incomplete seizure control or were on antiepileptic drug (AED) polytherapy. Seizure frequency worsening occurred in 2 patients (3.8%), one of which seizure remission was obtained after increase in AED dosage. Improvement of depressive symptoms with SSRI use was observed in 96% of all patients (52/53) and a total remission of depression in 62,3% (33/53).Adverse effects occurred in 09 patients (17%), of which some with more than one adverse effect. Adverse effects were: skin rash in 3,8%, gastrointestinal discomfort in 3,8%, weight loss in 3,8%, drowsiness in 3,8%, nocturnal enuresis in 1,9%, hematological disorders in 1,9%, and irritability in 1,9%. Treatment was discontinued in 12 patients due to adverse effects (11, 3%), partial or total inefficacy (7.5%), poor treatment adherence (1.9%) and worsening of epileptic seizures (1.9%). In seven out of these patients, the change for other SSRI lead to remission of adverse-effects or efficacy improvement. Conclusions: In our group of children and adolescents with epilepsy and depression, SSRI were considered as a satisfactory therapeutic option, when considering its efficacy in the remission of depressive symptoms, relatively few adverse effects and very rarely seizure worsening. Therefore, when taking into account the greater incidence of symptomatic epilepsy in children, with frequent seizures, when compared to the adult population, SSRI may be considered as a safe and effective therapeutic option.