Abstracts

Rationale: Depression and its assessment in epilepsy remains poorly understood. Assessment of depression in the medically-ill, in general, is plagued by the overlap of medical and somatic complaints of depression. Self-report depression measures such as the Beck Depression Inventory-II (BDI-II) were designed for the general population based on diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). DSM-IV criteria places an emphasis on cardinal symptoms of depression including depressed mood, loss of interest, feelings of worthlessness/guilt, indecisiveness, suicidal thoughts, weight and appetite changes, sleep disturbance, agitation/retardation, fatigue, and concentration difficulties. Patients with epilepsy may readily endorse the latter six of these symptoms by virtue of their disorder and antiepileptic medication side effects. The present study sought to explore the endorsement of symptoms on the BDI-II among patients with epilepsy. Moreover, the endorsement patterns of depressed epilepsy (DE) and non-depressed epilepsy patients (NDE) was examined to determine which symptoms may be more common to epilepsy and which were more common among depressed patients. Methods: A consecutive sample of 100 patients with epilepsy were administered the BDI-II as part of a neuropsychological evaluation for surgery candidacy. Frequency analyses were conducted to determine the endorsement patterns of depressive symptoms among this sample. A subsequent group (N = 71) underwent both neuropsychological and psychiatric evaluations to assess comorbid depression. Chi-square analyses and logistic regressions were conducted between the identified DE and NDE patients. Results: Over 50% of 100 patients with epilepsy reported experiencing difficulty with changes in appetite, sleep disturbance, concentration difficulties, fatigue, and loss of energy. Subsequent comparisons between the DE and NDE patients found that DE patients more frequently endorsed all symptoms of the BDI-II, excluding feelings of punishment, agitation, loss of energy, fatigue, and appetite changes. Furthermore, both DE and NDE patients endorsed these symptoms at strikingly high rates (agitation [DE=83%, NDE=62%], appetite changes [DE=79%, NDE=60%], and fatigue [DE=55%, NDE = 45%]). Similarly, although significantly different, both DE and NDE patients frequently endorsed irritability (DE=90%, NDE=64%)and sexual dysfunction (DE=86%, NDE = 60%). Final logistic regression analyses indicated that reports of “loss of pleasure” were most indicative of depression. Conclusions: Findings suggest that reports of appetite changes, sleep disturbance, concentration difficulties, fatigue, loss of energy, agitation, irritability, and sexual dysfunction are common in epilepsy. Endorsement of these symptoms may not always be most indicative of depression among patients with epilepsy given the high base rate of these symptoms. Consideration should be given to their severity and frequency and their presence in conjunction with other symptoms more indicative of depression, such as “loss of pleasure.”