Abstracts

Depression in epilepsy is common and a powerful indicator of the quality of life. Yet neurologists do not routinely screen epilepsy patients for depression in the clinic setting. In a busy neurology practice, where the major focus is seizure control, it is likely that symptoms of depression may be missed.
The PHQ-9 is a brief, self-administered questionnaire based on current DSM-IV criteria that has been validated in several patient populations. PHQ-9 scores of 10 or higher have high sensitivity and specificity for diagnosing major depression. Utilizing the PHQ-9, we sought to determine the frequency of depression in patients with epilepsy and to correlate patient characteristics with the degree of depression., 263 patients seen in a tertiary referral epilepsy clinic over a 6-month period were asked to complete the questionnaire. Depression scores were assessed in relation to seizure frequency; epilepsy diagnosis; antidepressant and antiepileptic drug usage. Differences across patients were compared using ANOVA., Nearly one-third of patients (29.3%) had scores consistent with major depression. Seizure-free patients had lower depression scores (mean score 5.1, s.d. 5.4; median score 3) than those with persistent seizures (mean score 8.1, s.d. 6.2; median score 7) (p=0.003).
Patients with non-epileptic psychogenic seizures had higher scores than those with localization related epilepsy, idiopathic generalized epilepsy or with symptomatic generalized epilepsy (Difference across groups significant p=0.044).
Depression scores were not related to the number or type of anti-epileptic drugs used. Patients currently taking antidepressant drugs had higher scores than those not on antidepressant drugs (p[lt]0.001). Just over one-half of patients with major depression were not on antidepressant medication., In patients with epilepsy, major depression was detected at a rate similar to that reported previously using [ldquo]gold-standard[rdquo] instruments.
The PHQ-9 is a sensitive measure of depression in this population. The brevity of this instrument is conducive to routine screening of patients with epilepsy.
Depression is under-recognized in this group of patients. Over half the patients with major depression were not on antidepressant drugs.
Depression is associated with persistent seizures rather than the type of epilepsy or antiepileptic drugs.[figure1], (Supported by Department of Neurology, University of California, Davis.)