Abstracts

The prevalence of depressive complaints in people with epilepsy (PWE) ranges from 20 to 55% with [sim]8% to 48% (mean of 29%) meeting criteria for a Major Depressive Disorder (MDD). Several authors have noted the importance of milder depressive, dysthymic-like complaints in PWE. In addition, the single most significant predictive factor in the quality of life of PWE appears to be depressive complaints. Antiepileptic drugs (AEDs) have both negative and positive psychotropic features. Lamotrigine (LTG) has recently been approved for the maintenance treatment of depression in patients with bipolar disorder. The purpose of this study is to further evaluate the antidepressant qualities of LTG in PWE. This is a multicenter open label study. Lamotrigine was added onto a stable AED regimen in the adjunctive and maintenance phases and became a single agent in the monotherapy phase. Patients were eligible for the study if they had refractory epilepsy, exhibited depressive symptoms (Center for Epidemiological Studies Depression Scale (CES-D) [ge] 12) but were excluded if they had a MDD as determined by a Mini International Neuropsychiatric Interview (M.I.N.I.) evaluation. One hundred fifty-nine patients with epilepsy have been entered into the study and results are available for 58 completing the adjunctive phase and 33 completing the monotherapy phase. Patients were evaluated using the Neurological Disorders Depression Inventory in Epilepsy (NDDI-E), Beck Depression Inventory (BDI-II), CES-D, Cornell Dysthymia Scale Self-Report (CDRS-SR) and the Profile of Mood States (POMS) at baseline, at the end of the adjunctive phase (Week 19) and the monotherapy phase (Week 36). Preliminary results are reported. Results of the depression psychometrics used are as follows: Mean baseline, end of adjunctive and monotherapy scores for weeks 19 and 36 for the NDDI-E were 14.0, 12.4 and 10.6; for the BDI-II, 20.2, 12.4, 8.8; for the CES-D, 26.7, 15.6, 12.6; for the CDRS-SR 62.1, 54.3, 49.6; and for the POMS were 63.0, 40.1, 25.8 respectively. All change scores were significant at p [le] 0.0001 except for the NDDI-E at the end of adjunctive therapy where p [le] 0.0014. Convergent validity appears to exist between all the measures. Seizure[ndash]free rates were 38% at baseline, 50% after adjunctive therapy and 69% after monotherapy. Changes in seizure frequency did not significantly correlate with changes in mood states. It appears from preliminary data that LTG has antidepressant activity for PWE with low to moderate levels of depression that do not meet criteria for a MDD as measured by the M.I.N.I. Since this is an open label study with no control group the extent of this effect is unclear, but does not appear to be due to changes in seizure frequency. (Supported by GlaxoSmithKline)