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DOI: 10.4103/jnrp.jnrp_21_17
High Frequency of Depressive Symptoms among Adults with Epilepsy: Results from a Hospital-based Study
Publication History
Publication Date:
03 September 2019 (online)

ABSTRACT
Context: Assessment of comorbid burden of depression and associated factors among adult people living with epilepsy (PWE) has the potential to inform clinical evaluation and management to improve outcomes. Aim: The aim of this study is to determine frequency of depressive symptoms and factors associated with it among PWE attending a tertiary care hospital. Setting and Design: This was a cross-sectional observational study conducted in the outpatient clinic of a tertiary care center. Subjects and Methods: One hundred and fifty patients with epilepsy were recruited between May 2016 and August 2016. For assessing depression, Tamil validated version of Patient Health Questionnaire-12 was used. Frequency of depression and its association with various sociodemographic and clinical factors were assessed. Statistical Analysis Used: Student t-test and Chi-square test for univariate analysis and logistic regression for multivariate analysis were used for statistical analysis. Results: Of the 150 subjects, 89 (59.3%) were males. Generalized tonic–clonic seizures were present in 131 people (87.3%). Genetic and unknown epilepsies contributed higher proportion (44.7%) as compared to structural epilepsies (37.3%). Majority (88%) were on one or two antiepileptic drugs. Thirty-one people (20.3%) had less than one seizure per year. Depressive symptoms were present in 95 patients (63.3%). In multivariate regression analysis, secondary generalized seizures and seizure frequency >1/month emerged as significant predictors of depression ([OR]: 5.48 [95% (CI): 1.35–22.28] and OR: 2.53 [95% CI: 1.11–5.75], respectively). Conclusion: Depression is prevalent in a majority of adult PWE. Hence, a routine screening for depression as part of comprehensive epilepsy care is advisable for PWE attending the outpatient clinic.
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REFERENCES
- 1 Sridharan R, Murthy BN. Prevalence and pattern of epilepsy in India. Epilepsia 1999; 40: 631-6
- 2 Murray CJ, Lopez AD, Jamison DT. The global burden of disease in 1990: Summary results, sensitivity analysis and future directions. Bull World Health Organ 1994; 72: 495-509
- 3 Cramer JA, Blum D, Fanning K, Reed M. Epilepsy Impact Project Group. The impact of comorbid depression on health resource utilization in a community sample of people with epilepsy. Epilepsy Behav 2004; 5: 337-42
- 4 Christensen J, Vestergaard M, Mortensen PB, Sidenius P, Agerbo E. Epilepsy and risk of suicide: A population-based case-control study. Lancet Neurol 2007; 6: 693-8
- 5 Hesdorffer DC, Hauser WA, Annegers JF, Cascino G. Major depression is a risk factor for seizures in older adults. Ann Neurol 2000; 47: 246-9
- 6 Alsaadi T, El Hammasi K, Shahrour TM, Shakra M, Turkawi L, Nasreddine W. et al. Depression and Anxiety among Patients with Epilepsy and Multiple Sclerosis: UAE Comparative Study. Behav Neurol 2015; 2015: 196373
- 7 Ettinger A, Reed M, Cramer J. Epilepsy Impact Project Group. Depression and comorbidity in community-based patients with epilepsy or asthma. Neurology 2004; 63: 1008-14
- 8 Onwuekwe I, Ekenze O, Bzeala-Adikaibe EjekwuJ. Depression in patients with epilepsy: A study from Enugu, South East Nigeria. Ann Med Health Sci Res 2012; 2: 10-3
- 9 Babu CS, Satishchandra P, Sinha S, Subbakrishna DK. Co-morbidities in people living with epilepsy: Hospital based case-control study from a resource-poor setting. Epilepsy Res 2009; 86: 146-52
- 10 Desai S, Shukla G, Goyal V, Srivastava A, Srivastava MV, Tripathi M. et al. Changes in psychiatric comorbidity during early postsurgical period in patients operated for medically refractory epilepsy – A MINI-based follow-up study. Epilepsy Behav 2014; 32: 29-33
- 11 Hesdorffer DC, Lee P. Health, wealth, and culture as predominant factors in psychosocial morbidity. Epilepsy Behav 2009; 15 Suppl (Suppl. 01) S36-40
- 12 Schmitz EB, Robertson MM, Trimble MR. Depression and schizophrenia in epilepsy: Social and biological risk factors. Epilepsy Res 1999; 35: 59-68
- 13 Friedman DE, Kung DH, Laowattana S, Kass JS, Hrachovy RA, Levin HS. Identifying depression in epilepsy in a busy clinical setting is enhanced with systematic screening. Seizure 2009; 18: 429-33
- 14 Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League against Epilepsy. Epilepsia 1981; 22: 489-501
- 15 Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W. et al. Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia 2010; 51: 676-85
- 16 Poongothai S, Pradeepa R, Ganesan A, Mohan V. Reliability and validity of a modified PHQ-9 item inventory (PHQ-12) as a screening instrument for assessing depression in Asian Indians (CURES-65). J Assoc Physicians India 2009; 57: 147-52
- 17 Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56-62
- 18 Mainio A, Alamäki K, Karvonen K, Hakko H, Särkioja T, Räsänen P. Depression and suicide in epileptic victims: A population-based study of suicide victims during the years 1988-2002 in Northern Finland. Epilepsy Behav 2007; 11: 389-93
- 19 Mehta S, Tyagi A, Tripathi R, Kumar M. Study of inter-relationship of depression, seizure frequency and quality of life of people with epilepsy in India. Ment Illn 2014; 6: 5169
- 20 Seshadri V, Thomas J, Murthy J, Raju C. Prevalence of depression and its effect on quality of life in patients with epilepsy: A community based study and a comprehensive rural epilepsy study in South India (CRESSI). Neurol Asia 2004; 9: 139
- 21 Pandian GB, Mohan A. Study on prevalence of depression and adverse drug reactions among South Indian epileptic patients. Asian J Pharm Clin Res 2015; 8: 73-6
- 22 Lee SA, Lee SM, No YJ. Factors contributing to depression in patients with epilepsy. Epilepsia 2010; 51: 1305-8
- 23 Yousafzai AU, Yousafzai AW, Taj R. Frequency of depression in epilepsy: A hospital based study. J Ayub Med Coll Abbottabad 2009; 21: 73-5
- 24 Kanner AM, Balabanov A. Depression and epilepsy: How closely related are they? Neurology. 2002; 58 (08) Suppl (Suppl. 01) S27-39
- 25 Kanner AM. Depression in epilepsy: A neurobiologic perspective. Epilepsy Curr 2005; 5: 21-7
- 26 Mazarati A, Shin D, Auvin S, Caplan R, Sankar R. Kindling epileptogenesis in immature rats leads to persistent depressive behavior. Epilepsy Behav 2007; 10: 377-83
- 27 Chen SD, Wang YL, Liang SF, Shaw FZ. Rapid amygdala kindling causes motor seizure and comorbidity of anxiety- and depression-like behaviors in rats. Front Behav Neurosci 2016; 10: 129
- 28 Amir M, Roziner I, Knoll A, Neufeld MY. Self-efficacy and social support as mediators in the relation between disease severity and quality of life in patients with epilepsy. Epilepsia 1999; 40: 216-24
- 29 Tegegne MT, Mossie TB, Awoke AA, Assaye AM, Gebrie BT, Eshetu DA. Depression and anxiety disorder among epileptic people at Amanuel Specialized Mental Hospital, Addis Ababa, Ethiopia. BMC Psychiatry 2015; 15: 210
- 30 Ogunrin OA, Obiabo YO. Depressive symptoms in patients with epilepsy: Analysis of self-rating and physician’s assessment. Neurol India 2010; 58: 565-70
- 31 Dias R, Bateman LM, Farias ST, Li CS, Lin TC, Jorgensen J. et al. Depression in epilepsy is associated with lack of seizure control. Epilepsy Behav 2010; 19: 445-7
- 32 Jacoby A, Baker GA, Steen N, Potts P, Chadwick DW. The clinical course of epilepsy and its psychosocial correlates: Findings from a U.K. Community study. Epilepsia 1996; 37: 148-61
- 33 Thapar A, Roland M, Harold G. Do depression symptoms predict seizure frequency – Or vice versa?. J Psychosom Res 2005; 59: 269-74
- 34 Ojemann LM, Friel PN, Trejo WJ, Dudley DL. Effect of doxepin on seizure frequency in depressed epileptic patients. Neurology 1983; 33: 646-8
- 35 Mula M, Sander JW. Negative effects of antiepileptic drugs on mood in patients with epilepsy. Drug Saf 2007; 30: 555-67
- 36 Trimble MR, Rüsch N, Betts T, Crawford PM. Psychiatric symptoms after therapy with new antiepileptic drugs: Psychopathological and seizure related variables. Seizure 2000; 9: 249-54
- 37 Bifftu BB, Dachew BA, Tiruneh BT, Birhan Tebeje N. Depression among people with epilepsy in Northwest Ethiopia: A cross-sectional institution based study. BMC Res Notes 2015; 8: 585
- 38 Kerr MP, Mensah S, Besag F, de Toffol B, Ettinger A, Kanemoto K. et al. International consensus clinical practice statements for the treatment of neuropsychiatric conditions associated with epilepsy. Epilepsia 2011; 52: 2133-8
- 39 Meyer B, Weiss M, Holtkamp M, Arnold S, Brückner K, Schröder J. et al. Protocol for the ENCODE trial: Evaluating a novel online depression intervention for persons with epilepsy. BMC Psychiatry 2017; 17: 55