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Depression in epilepsy: a critical review from a clinical perspective

Nature Reviews Neurology volume 7, pages 462–472 (2011)Cite this article

Subjects

Abstract

Depression is a serious and frequent comorbidity of epilepsy and other neurological conditions. Here, we review recent studies on the relationship between epilepsy and depression with regard to diagnostic criteria, epidemiology, etiology and treatment. Depression in epilepsy can be described in the general framework of the diathesis–stress model: chronic stress exposure owing to the 'burden of epilepsy' and learned helplessness due to the threat of recurrent seizures as unpredictable aversive events represent psychological risk factors for the development of depression. Epilepsy-related factors (for example, focus site or side) have shown little effect on mood. Nonepileptic individuals who are adversely affected by seizures (for example, parents of pediatric patients with epilepsy, and patients with psychogenic nonepileptic seizures) show increased levels of depression, similar to patients with epilepsy. However, seizures, subclinical hypersynchronous neural discharges and some antiepileptic drugs may cause acute states of depressive mood or depression on a purely neurobiological basis. Antidepressant drugs and psychotherapy have shown moderate efficacy in the treatment of depression comorbidity, but randomized controlled trials in patients with epilepsy are lacking, especially for drugs.

Key Points

  • Depression is a frequent comorbidity of epilepsy

  • Depression comorbidity in epilepsy can be explained in the framework of the diathesis–stress model

  • Seizures, subclinical hypersynchronous neural discharges and some antiepileptic drugs may cause acute states of depressive mood on a purely neurobiological basis

  • Nonepileptic individuals who are adversely affected by seizures (for example, parents of pediatric patients, and patients with psychogenic seizures) show elevated levels of depression, similar to patients with epilepsy

  • Antidepressants and psychotherapy seem to have a comparable, moderate antidepressant effect, but randomized controlled trials are lacking, particularly for drugs

  • More-comprehensive approaches to the understanding and treatment of depression and suicidality in epilepsy, which combine drug treatment with psychotherapy and rehabilitative care, need to be developed

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Figure 1: Patient complexity.

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  1. Department of Epileptology, University of Bonn Medical Centre, Sigmund-Freud-Straße 25, Bonn, 53105, Germany

    Christian Hoppe & Christian E. Elger

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C. Hoppe researched the data for and wrote the article. C. Hoppe and C. E. Elger contributed equally to discussions of the content and to review and/or editing of the manuscript before submission.

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Hoppe, C., Elger, C. Depression in epilepsy: a critical review from a clinical perspective. Nat Rev Neurol 7, 462–472 (2011). https://doi.org/10.1038/nrneurol.2011.104

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