Abstracts

Major depression is a frequently unrecognized and untreated comorbidity in chronic epilepsy. In particular, the psychological status of patients undergoing epilepsy surgery is a critical issue in clinical management and a major factor in quality of life. Changes in mood both positive and negative and psychiatric status have been noted with surgery. Multiple factors have been implicated in mood changes after surgery including epilepsy-specific variables such as laterality, location of seizures, and seizure outcome as well as psychosocial variables including personality traits. The purpose of this study is to investigate the mental health of epilepsy patients prior to surgery in order to identify disorders and symptoms amenable to treatment., [underline][/underline]Participants are two hundred and twenty-five adults (44% male, 88% Caucasian, 44% married, 42.1% employed full or part-time) aged 18-75 with medically intractable epilepsy undergoing evaluation for surgery at the Cleveland Clinic. They participated in a Health Psychology evaluation that included chart review for demographic, disease, and health-related information; clinical interview concerning current and past psychological status; and self-report measures of mood, fatigue, and daytime sleepiness, Based on self-report, 65% reported a positive mental health history including depression in 50.2%, anxiety 15.6%, bipolar disorder 1.3% and psychosis 2.7%. Regarding treatment, 43.8% had previously seen a mental health professional and 41.8% had used psychotropic medication. Based on pre-operative Beck Depression Inventory responses, 16.9% were mildly depressed, 27.9% moderately depressed, and 11.5% severely depressed. In contrast, only 5.8% were taking psychotropic medication.
Pre-operatively, both employment (full or part-time) and marital status (married) were associated with lower depression scores. Although patients who had ever used psychotropic medication were more likely to have higher pre-operative depression scores, those currently taking psychotropic medication were not., Comparable to previous studies, we found high rates of depression including almost 40% of patients reporting moderate to severe depression. In spite of this, many patients had never seen a mental health professional and even fewer had taken psychotropic medication (only 5.8% at the time of the evaluation) both known to be effective treatments for depression. It is not clear why patients are not being identified and/or treated. One possibility is that both professionals and patients assume that depression is common with medically intractable epilepsy and consequently treatment is not recommended or sought. These findings support the routine assessment of all patients being considered for epilepsy surgery in order to identify and initiate treatment of depression regardless of whether or not patients have surgery.,