NEW ORLEANS -- Teenagers and adults with epilepsy showed an increased risk for depression and should undergo regular screening, according to two studies presented here at the annual .
About 13% of teens with epilepsy reported serious depression symptoms, reported Hillary Thomas, PhD, of UT Southwestern Medical Center in Dallas, and colleagues. An additional 22% of teens with epilepsy scored high enough results to suggest a risk for depressive symptoms.
And in a separate study of adults with epilepsy who had experienced a negative health event like an emergency room visit or accident, 52% had moderate to severe depression, according to Martha Sajatovic, MD, of Case Western Reserve University School of Medicine in Cleveland and co-authors.
By contrast, depression affects 7.6% of persons over age 12 in the general population, .
"These studies highlight the elevated rates of depressive symptoms in people with epilepsy," said Page Pennell, MD, of Brigham and Women's Hospital in Boston, who was not involved with either study. "They strongly support the notion that screening tools for depression, such as the PHQ-9, should be implemented into the routine clinical care of people with epilepsy," Pennell told 51˶.
The Patient Health Questionnaire () is a survey completed by patients, who answer questions about whether they have little interest in doing things, trouble concentrating, difficulty sleeping, and other depressive symptoms.
Depression in Teens with Epilepsy
Little is known about the factors that increase the likelihood of depressive symptoms in teens with epilepsy, Thomas said.
"Our results don't mean that only 13% of the teens with epilepsy had depressive symptoms," co-author Susan Arnold, MD, also of UT Southwestern Medical Center, said in a statement.
"They indicate the significant percentage of teens whose level of depressive symptoms warranted behavioral health referrals or further evaluation, or even intervention during a clinic visit," she emphasized.
In their study, researchers screened 394 teenagers with epilepsy (age range 15 to 18; 50% female) for depression using the PHQ-9 Adolescent Version, from June 2017 to May 2018. The teens had a range of depressive symptoms: 8% had moderate/moderately severe depressive symptoms and 5% reported suicidal ideation or previous suicide attempts. About 64% of teen patients with epilepsy fell in the minimal range of depressive symptoms.
"Health care providers need to be vigilant about continually screening children and teens for depression," Arnold said. "Epilepsy treatment centers should include a psychosocial team such as a social worker or psychologist as part of each patient's comprehensive care."
Mood Disorders in Adult Patients
In the adult study, Sajatovic and co-authors used baseline data from a randomized controlled trial about epilepsy self-management, examining the relationship between depression severity and clinical and other variables. This analysis focused depression was measured by the PHQ-9 in adult epilepsy patients who had experienced a negative health event like an emergency room visit or accident.
Of 120 adult patients in this study, 52% reported moderate or severe depression; some also reported bipolar disorder, obsessive compulsive disorder, or panic disorder. Inability to work was significantly associated with depression severity (P=0.05), as was 30-day seizure frequency (P<0.01) and lower quality of life (P<0.0001).
"People with epilepsy who have depression are more likely to have seizures, so treating the depression doesn't just help with depression, but also with the epilepsy," Sajatovic said in a statement,
"Identifying people with epilepsy who have depression or other mental health issues is half of the battle," Sajatovic pointed out."It's important that people with epilepsy who have depression or other mental health issues get treatment, such as cognitive behavioral therapy and medication."
"Even being in a self-management program helps because the better they are at self-management, the less likely they are to suffer negative health effects," Sajatovic said.
Disclosures
The study of teenagers with epilepsy received no funding. The study of adults was supported by a grant from the CDC.
Primary Source
American Epilepsy Society
Thomas H, et al "Depression screening in pediatric epilepsy" AES 2018; Abstract 1.388.
Secondary Source
American Epilepsy Society
Kumar N, et al "Depressive symptom severity in individuals with epilepsy and recent health complications" AES 2018; Abstract 1.371.