Depression in Persons with Epilepsy: A Comparative Study of Different Screening Tools in Indian Population

Objectives: Depression is a major comorbidity in persons with epilepsy (pWE) and its timely identification is essential. In this study, depression in PWE was assessed and potential screening tools were compared head-to-head.

Methods: After ethical clearance, 217 PWE above 18 years of age, on antiepileptic drugs (AEDs), attending neurology outpatient department (OPD) at All India Institute of Medical Sciences (AIIMS), New Delhi, were evaluated for depression using four different screening tools head-to- head: MINI, NDDI-E, PHQ 9, and HAM-D scale. Informed consent was taken before recruitment.

Results: Of the 217 PWE (112 male/105 female) with a mean age of 28.6 years, 69.1% had a diagnosis of generalized and 30.9% focal seizures, majority (59%) were on monotherapy, levetiracetam (n = 58), sodium valproate (n = 28), carbamazepine (n = 26), phenytoin (n = 9), clobazam (n = 4), clonazepam (n = 1), oxcarbazepine (n = 1), and lamotrigine (n = 1), while those on polytherapy (41%) received a combination of two to five of these AEDs. Using different scales, a variable percentage of PWE were screened positive for depression—41.5% with MINI, 24% with NDDI-E, 47.2% with HAM-D, and 48.3% with PHQ 9. When MINI scale was taken as reference standard, variable sensitivity and specificity of scales was found. At the recommended cut-off scores, HAM-D had 98% sensitivity and 91% specificity, PHQ-9 showed 100% sensitivity and 89% specificity, and the NDDI-E showed sensitivity of 55.6% and specificity of 98.4%.

Conclusion: A periodic assessment of PWE for depression is highly desirable. All the scales used in this study were found to be appropriate for use in PWE providing the cutoff points are properly validated as variation is possible.