Depression in adults with epilepsy: Relationship to psychobiological variables

AIM:To characterize the relationship between depression and epilepsy-related seizures, treatment, hormonal and biological variables.METHODS: Included were 200 Egyptian adults(male = 100, female = 100) with epilepsy(mean age: 30.87 ± 7.88 years; duration of illness: 13.89 ± 7.64 years) and 100 healthy matched subjects for comparison. Psychiatric interview, Beck Depression Inventory(BDIII) and Hamilton Anxiety Rating Scale(HAM-A) were used to assess depression and anxiety. Blood levels offree testosterone, sex hormone binding globulin, prolactin, free thyroxin and thyroid stimulating hormone, serotonin, noradrenaline and adrenaline neurotransmitters were measured to assess endocrine and biological states.RESULTS: Patients had higher rates of depressive disorder(25.5% or 51/200), mostly intermixed with anxiety(47.06%), psychotic features(19.61%), aggression(40%) and suicide(55%). Compared to controls, higher scores on the BDI-II were observed with right-sided epileptic foci(P = 0.011), polytherapy(P = 0.001) and lack of control on antiepileptic drugs(AEDs)(P = 0.0001). Patients had lower levels of serotonin(P = 0.001) [marked with depression(P = 0.012)] and adrenaline(P = 0.0001), while noradrenaline was lower with temporal lobe epilepsy(P = 0.039), left-sided foci(P = 0.047) and lack of control on AEDs(P = 0.017). Negative correlations were observed between levels of serotonin and BDI-II(P = 0.048) and HAM-A(P = 0.009) scores, but not with AEDs dose or drug level. CONCLUSION: Comorbid depressive disorder with epilepsy appears to be closely related to seizure type, focus, side, intractability to medications and neurotransmitter changes. Thus, optimizing seizure control and early recognition and management of depression is necessary to improve patients’ quality of life.