Abstracts

Rationale: Psychiatric issues such as depression are extremely important in improving their quality of life in epilepsy patients. However, a treatment strategy for depression in such cases remains to be fully established. We investigated treatment outcome of depressive symptoms in patients with epilepsy in order to determine an effective care strategy. We also investigated the efficacy and safety of antidepressants in such patients. Methods: We retrospectively evaluated 30 epilepsy patients who sought treatment for depressive symptoms and met the criteria for mood disorders according to DSM-IV (American Psychiatric Association). Clinical factors related to both epilepsy and depressive symptoms were explored in each patient. The Hamilton Depression Rating Score (HDRS) was used to assess severity of depression. Treatment administered in each patient was investigated. Seizure frequencies at before and after medication were compared in patients treated with antidepressants. Treatment outcome was assessed according to the Global Assessment of Functioning (GAF) defined by DSM-IV. Results: Patients consisted of 13 men and 17 women aged 20-78 years (mean 40 years). Of these 30 patients, 19 had temporal lobe epilepsy and 6 had frontal lobe epilepsy, while the remaining 5 had the other types of epilepsy. Median seizure frequency was monthly. With regard to depressive symptoms, HDRS was 10-27(mean 17) indicating mild to moderate severity. On the other hand, 16 (53%) had ideated about suicide, and 14 (47%) needed to be admitted to psychiatric institutes. Four patients experienced irritability, and 3 had psychotic symptoms, including persecutory delusion. Two patients had manic episodes and were eventually diagnosed with bipolar disorder. Pharmacological treatment was given in 26: selective serotonin reuptake inhibitor in 6; serotonin noradrenalin reuptake inhibitor in 2; tricyclic antidepressant in 9; sulpiride in 4; and benzodiazepine in 3. The two patients with bipolar disorder were treated with valproate in addition to antiepileptic drugs (AEDs). Non-pharmacological treatment was conducted in 6 patients: psychotherapy in addition to pharmacotherapy in 4; and psychotherapy only in 2. In another 2 patients, the patients were given alternative AED due to side effects of earlier AED resulting in depression. Clinical improvement in depression, with a GAF>70, was observed in 23 (77%), while 7 patients showed no remarkable changes. No aggravation in seizure frequency was observed in any patient who was treated with antidepressants. Conclusions: Overall outcome of depressive symptoms in epilepsy patients was relatively good with adequate treatment, even though the severity of depression was severe in some patients, requiring admission to psychiatric institutes. Antidepressants were effective and safe, with no aggravation of seizures. Therefore, we recommend early and sufficient psychiatric intervention in such patients.