TITLE:
Depressive disorders in patients with epilepsy: Why should neurologists care?
AUTHORS:
Taoufik Alsaadi, Khalid Zamel, Ahmed Sameer, Waseem Fathalla, Iyad Koudier
KEYWORDS:
Depression; Seizures; Temporal Lobe Epilepsy; Quality of Life; Serotonin Reuptake Inhibitors (SSRIs)
JOURNAL NAME:
Health,
Vol.5 No.6A,
June
17,
2013
ABSTRACT: Epilepsy is a complex disorder that
is commonly associated with brain dysfunction, social isolation, and
vocational difficulty. Each of these factors may contribute to the increased
prevalence of psychiatric illness in epilepsy, but emerging evidence is
providing a more complete and clearer elucidation of the problem. Clinical
investigations have consistently demonstrated that depression has a large
impact on subjective health status. In patients with recurrent seizures,
depression appears to have a stronger association with quality of life than
does the seizure rate. In fact, depression is second only to medication
toxicity as the clinical factor that explains the greatest variance in quality
of life. Only a small number of studies have investigated the plausible
neurobiological mechanisms of depression in epilepsy, but preliminary data
suggest that underlying brain dysfunction may be a more important predictor
than vocational or social disability. Furthermore, specific aspects of hippocampal
dysfunction may be a causal factor in the genesis and maintenance of depression
in temporal lobe epilepsy. Current treatment recommendations for depression
in epilepsy are similar to those for otherwise neurologically normal depressed
patients, emphasizing the role of serotonin reuptake inhibitors, but certain antidepressants should be used with caution. Ongoing studies are attempting to
define optimal treatment strategies, and more definitive data
to guide clinical management are expected to become available in the near future.