Abstracts

Rationale: Epilepsy clinics serve the needs of individuals with complex medical and mental health challenges who may require more frequent and focused intervention. The monitoring of depression (DEP) and suicidal symptoms in these patients allows for broadening our understanding of the relationship between mood and epilepsy. The purpose of the current project is to explore self-reported DEP symptoms in epilepsy clinic patients evaluated over consecutive appointments. Methods: The DEP screening questionnaires of adult patients seen at the Minnesota Epilepsy Group outpatient clinic over a 20 month period were reviewed. The questionnaire included the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the suicide question from the Beck Depression Inventory-II (BDI-SUI). In addition, data was collected regarding demographics, current anti-epileptic drugs (AEDs), other psychotropic medications, and current involvement in mental health services. Those individuals who were identified as depressed at their first appointment were given a DEP information and resource packet. Results: 1997 screening questionnaires were completed by 1226 patients over a 20 month time period. 155 (13%) patients were identified as having at least 3 clinic appointments during this same time period. The mean NDDI-E total scores for appt1, appt2, and appt3 were 12.1, 11.7, and 10.8, respectively. Paired t-tests between appt1 and appt3 revealed a significant difference (p < .001) with the trend towards progressive symptom reduction. Additionally, 23% of this patient sub-group scored in the clinically depressed range (>15) on the NDDI-E at appt1 and 6% indicated suicidal ideation on the BDI-SUI. Further review of this DEP sub-group showed a similar trend in symptom reduction over time with mean NDDI-E scores for appt1, appt2, and appt3 of 18.1, 15.3, and 14.4, respectively. Paired t-tests between appt1 and appt3 revealed a significant reduction in depressive symptoms (p < .001). The improved NDDI-E scores between appt1 and appt3 coincided with increased utilization of psychiatry (9% vs. 21%) and counseling (17% vs. 21%) while psychotropic medication management remained stable at 50%. There was little change in mean number of AEDs prescribed between appt1 and appt3 (1.9 vs. 2.1). Conclusions: Approximately 16% of adult patients presenting to an epilepsy clinic report significant DEP per the NDDI-E. This study has established that depressive symptoms improve over time in a subgroup of regularly seen patients. There was no clear relationship between the reduction in depressive symptoms and psychological or psychiatric treatment, although these services were accessed slightly more frequently over time. The number of AEDs and psychotropic medications remained constant. We suggest that the DEP screening process, minimal intervention (i.e., info about DEP), and/or regular return-to-clinic appointments likely offer therapeutic benefit through symptom acknowledgment and educational/resource support. With close monitoring and modest intervention, patients presenting with DEP are apt to experience improved quality of life.