Neuropsychiatric Symptoms of Epilepsy

Chapter 2
Depression
Andres M. Kanner and Ramses Ribot
Abstract Depressive disorders are the most frequent psychiatric comorbidity in
people with epilepsy, with lifetime prevalence rates of 30–35 %. Their prevalence is
also higher than in the general population, and in particular, in people with poorly
controlled seizures. In addition, there is a complex relation between epilepsy and
depressive disorders, whereby not only are patients with epilepsy at greater risk of
developing depressive disorders, but patients with primary depressive disorders are
at greater risk of developing epilepsy. In this chapter, we review the salient aspects
of depressive disorders in epilepsy that any clinician treating people with epilepsy
must know.
Keywords Major Depressive Disorder • Postictal Depression • Ictal Depression •
Suicidality • Antidepressant Drugs
Introduction
Depressive disorders are the most frequent psychiatric comorbidity in people with
epilepsy (PWE), with lifetime prevalence rates ranging from 30 to 35 % [ 1 ]. Higher
prevalence rates (21–33 %) have been also found in patients with persistent seizures
when compared to seizure-free patients (4–6 %) in several cross-sectional studies
[ 2 – 4 ]. Furthermore, a population-based survey of 185,000 households, which
screened for lifetime symptoms of depression yielded higher rates in PWE than
those with other chronic conditions [ 5 ], with at least one episode of symptoms of
depression reported by 32 % of PWE, compared to 16 % of patients with asthma, 13
% with diabetes, and 8.6 % of healthy respondents. Similar prevalence rates have
been identified in children and adolescents with epilepsy [ 6 ].
A. M. Kanner , MD, FANA (*) • R. Ribot , MD
Epilepsy Section, Department of Neurology , Comprehensive Epilepsy Center,
University of Miami, Miller School of Medicine ,
1120 NW 14th Street, Room 1324 , Miami , FL , 33136 , USA
EEG Monitoring Unit , University of Miami Hospital,
University of Miami, Miller School of Medicine ,
1120 NW 14th Street, Room 1324 , Miami , FL , 33136 , USA
e-mail: a.kanner@med.miami.edu
© Springer International Publishing Switzerland 2016
M. Mula (ed.), Neuropsychiatric Symptoms of Epilepsy, Neuropsychiatric
Symptoms of Neurological Disease, DOI 10.1007/978-3-319-22159-5_2
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