Occurrence and treatment of depression symptoms and anxiety in patients with epilepsy: Findings from a German multicentre cross-sectional study

Background: People with epilepsy (PWE) bear a 3-5-fold higher risk of developing psychiatric illnesses such as depression or anxiety disorders. Our study aimed to quantify the prevalence of depression and anxiety symptoms in PWE and characterise the treatment received to improve medical therapy. Materials and methods: The analysis was based on data from the multicentre cross-sectional Epi2020 study. The Hospital Anxiety and Depression Scale (HADS) was used to self-assess depression and anxiety symptoms. A score of >= 8 points in the respective subscale was considered an indicator of depression or anxiety symptoms. Further, possible risk factors, medical care and therapy were analysed by comparing patients with depression or anxiety symptoms to unaffected patients. Results: We analysed data from 471 adults (58.4 % female) with a mean age of 40.4 years (SD 15.5). Self-assessment using the HADS revealed depression symptoms in 34 % and anxiety symptoms in 31.8 %. The use of multiple anti-seizure medications (ASMs) and ongoing seizures were associated with depression and anxiety symptoms. These patients had often received psychiatric treatment or mood-stabilising ASMs. However, a substantial proportion had not received either; these "untreated" patients were frequently given levetiracetam monotherapy. Additionally, at least one negative psychotropic ASM was given to those on multiple ASMs. An increased frequency of seizures was associated with a reduced likelihood of receiving treatment for symptoms of depression or anxiety. Conclusion: Our analysis confirms that a significant proportion of PWE report depression and anxiety symptoms. However, these symptoms frequently go unrecognised in routine clinical practice. In the majority of cases within the study cohort, ASM therapy did not appear to be adapted to these symptoms, suggesting that a transition to mood-stabilising ASMs and the avoidance of negative psychotropic medications should be feasible.