Epilepsy and Depression: Commonly Comorbid, Often Undertreated

Jeannette Y. Wick, RPh, MBA, FASCP
Published Online: Friday, July 27, 2012
Follow Pharmacy_Times:
A number of recent studies have investigated the relationship between epilepsy and depression, providing insights into both conditions. 

Experts acknowledge that epilepsy and depression occur often as comorbidities, but it is unclear how the 2 conditions are related. The chronic stresses and limitations of epilepsy may cause depression. Or, the conditions may be related genetically, as animal models appear to indicate. At the American Academy of Neurology's April 2012 annual meeting in San Diego, 2 poster presentations underscored the difficulties of diagnosing and treating comorbid depression and epilepsy.
The first study from the poster presentation, carried out by researchers at the University of Calgary, looked at population-based studies that assessed the association between depression and epilepsy. The researchers used data from 11 studies, which were based on 7 unique samples including 11,716 participants with epilepsy and 1,397,354 participants without epilepsy. They determined that the pooled odds ratio of depression for participants with epilepsy was 2.43, higher than the odds ratio for depression associated with having a chronic illness. This seems to support the hypothesis that epilepsy and depression share a common genetic cause.
Untreated depression may also increase the likelihood of diminished epilepsy control. The second study from the poster presentation, carried out by researchers at Rush University Medical Center in Chicago, set out to determine whether selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) could improve seizure control in patients with poorly controlled epilepsy. This retrospective observational study found that seizure frequency improved in approximately a fourth of patients treated for depression with SSRIs or SNRIs. Equally as important, the results indicated that these drugs are safe treatment options for patients with epilepsy.
Some prescribers hesitate to prescribe antidepressants for people with epilepsy, however, based on fears of drug interactions. A study published in the June 2012 edition of Epilepsia is of particular interest to pharmacists. In it, the researchers find that patients who have depressive and anxiety disorders report more severe adverse reactions to antiepileptic drugs, even if their depression or anxiety is mild to moderate.
Clearly, clinicians need to screen patients who have epilepsy for comorbid mental illnesses, and treat them appropriately.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.

Related Articles
Women with a history of depression may have greater odds of developing gestational diabetes.
While pharmacists spend the majority of their time concentrating on patients’ well-being, a video from University of Alberta pharmacy students serves as a reminder for peers to look after their own mental health.
The FDA today expanded the indication of Allergan’s onabotulinumtoxinA (Botox), allowing the drug to be used for the treatment of upper limb spasticity in adults.
Over my past 3 decades of pharmacy practice, acetaminophen has been one of my most recommended OTC treatments.
Latest Issues
  • photo
    Pharmacy Times
    Health-System Edition
    Directions in Pharmacy
    OTC Guide
    Generic Supplements
  • photo
    Pharmacy Careers
    Specialty Pharmacy Times