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Depression in epilepsy: a critical review from a clinical perspective

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.

References

  1. Marcus, S. C. & Olfson, M. National trends in the treatment for depression from 1998 to 2007. Arch. Gen. Psychiatry 67, 1265–1273 (2010).

    Article  PubMed  Google Scholar 

  2. Kanner, A. M., Barry, J. J., Gilliam, F., Hermann, B. & Meador, K. J. Anxiety disorders, subsyndromic depressive episodes, and major depressive episodes: do they differ on their impact on the quality of life of patients with epilepsy? Epilepsia 51, 1152–1158 (2010).

    Article  PubMed  Google Scholar 

  3. Global Parkinson's Disease Survey Steering Committee. Factors impacting on quality of life in Parkinson's disease: results from an international survey. Mov. Disord. 17, 60–67 (2002).

  4. Lule, D. et al. Life can be worth living in locked-in syndrome. Prog. Brain Res. 177, 339–351 (2009).

    Article  CAS  PubMed  Google Scholar 

  5. Pena, P., Sancho, J., Rufo, M., Martinez, S. & Rejas, J. Driving cost factors in adult outpatients with refractory epilepsy: a daily clinical practice in clinics of neurology in Spain. Epilepsy Res. 83, 133–143 (2009).

    Article  PubMed  Google Scholar 

  6. Reynolds, E. H. & Trimble, M. R. Epilepsy, psychiatry, and neurology. Epilepsia 50 (Suppl. 3), 50–55 (2009).

    Article  PubMed  Google Scholar 

  7. Barry, J. J. et al. Consensus statement: the evaluation and treatment of people with epilepsy and affective disorders. Epilepsy Behav. 13, S1–S29 (2008).

    Article  PubMed  Google Scholar 

  8. Hermann, B., Seidenberg, M. & Jones, J. The neurobehavioural comorbidities of epilepsy: can a natural history be developed? Lancet Neurol. 7, 151–160 (2008).

    Article  PubMed  Google Scholar 

  9. LaFrance, W. C. Jr, Kanner, A. M. & Hermann, B. Psychiatric comorbidities in epilepsy. Int. Rev. Neurobiol. 83, 347–383 (2008).

    Article  PubMed  Google Scholar 

  10. Mula, M., Schmitz, B. & Sander, J. W. The pharmacological treatment of depression in adults with epilepsy. Expert Opin. Pharmacother. 9, 3159–3168 (2008).

    Article  CAS  PubMed  Google Scholar 

  11. de Boer, H. M., Mula, M. & Sander, J. W. The global burden and stigma of epilepsy. Epilepsy Behav. 12, 540–546 (2008).

    Article  PubMed  Google Scholar 

  12. Verrotti, A. et al. Epilepsy and suicide: pathogenesis, risk factors, and prevention. Neuropsychiatr. Dis. Treat. 4, 365–370 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Meador, K. J. Suicide in patients with epilepsy. Epilepsy Curr. 8, 40–42 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kanner, A. M. Psychiatric issues in epilepsy: the complex relation of mood, anxiety disorders, and epilepsy. Epilepsy Behav. 15, 83–87 (2009).

    Article  PubMed  Google Scholar 

  15. Beyenburg, S., Mitchell, A. J., Schmidt, D., Elger, C. E. & Reuber, M. Anxiety in patients with epilepsy: systematic review and suggestions for clinical management. Epilepsy Behav. 7, 161–171 (2005).

    Article  PubMed  Google Scholar 

  16. Kanner, A. Depression and epilepsy: A bidirectional relation? Epilepsia 52 (Suppl. 1), 21–27 (2011).

    Article  PubMed  Google Scholar 

  17. Feinstein, A. R. The pre-therapeutic classification of co-morbidity in chronic disease. J. Chronic Dis. 23, 455–468 (1970).

    Article  CAS  PubMed  Google Scholar 

  18. Zimmermann, F. & Endermann, M. Self-proxy agreement and correlates of health-related quality of life in young adults with epilepsy and mild intellectual disabilities. Epilepsy Behav. 13, 202–211 (2008).

    Article  PubMed  Google Scholar 

  19. Canuet, L. et al. Factors associated with impaired quality of life in younger and older adults with epilepsy. Epilepsy Res. 83, 58–65 (2009).

    Article  PubMed  Google Scholar 

  20. Hall, K. E., Isaac, C. L. & Harris, P. Memory complaints in epilepsy: An accurate reflection of memory impairment or an indicator of poor adjustment? A review of the literature. Clin. Psychol. Rev. 29, 354–367 (2009).

    Article  PubMed  Google Scholar 

  21. Liik, M., Vahter, L., Gross-Paju, K. & Haldre, S. Subjective complaints compared to the results of neuropsychological assessment in patients with epilepsy: the influence of comorbid depression. Epilepsy Res. 84, 194–200 (2009).

    Article  PubMed  Google Scholar 

  22. Pompili, M. et al. Depression, hopelessness and suicide risk among patients suffering from epilepsy. Ann. Ist. Super. Sanita 43, 425–429 (2007).

    PubMed  Google Scholar 

  23. Beck, A. T., Brown, G., Berchick, R. J., Stewart, B. L. & Steer, R. A. Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Am. J. Psychiatry 147, 190–195 (1990).

    Article  CAS  PubMed  Google Scholar 

  24. Mula, M. et al. Interictal dysphoric disorder and periictal dysphoric symptoms in patients with epilepsy. Epilepsia 51, 1139–1145 (2010).

    Article  PubMed  Google Scholar 

  25. Krishnamoorthy, E. S., Trimble, M. R. & Blumer, D. The classification of neuropsychiatric disorders in epilepsy: a proposal by the ILAE Commission on Psychobiology of Epilepsy. Epilepsy Behav. 10, 349–353 (2007).

    Article  CAS  PubMed  Google Scholar 

  26. Valderas, J. M., Starfield, B., Sibbald, B., Salisbury, C. & Roland, M. Defining comorbidity: implications for understanding health and health services. Ann. Fam. Med. 7, 357–363 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jensen, F. E. Epilepsy as a spectrum disorder: implications from novel clinical and basic neuroscience. Epilepsia 52 (Suppl. 1), 1–6 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fuller-Thomson, E. & Brennenstuhl, S. The association between depression and epilepsy in a nationally representative sample. Epilepsia 50, 1051–1058 (2009).

    Article  PubMed  Google Scholar 

  29. Villanueva, V. et al. Validation of the Spanish version of the Side Effect and Life Satisfaction Inventory in patients with epilepsy. Epilepsy Behav. 14, 96–101 (2009).

    Article  PubMed  Google Scholar 

  30. Mensah, S. A., Beavis, J. M., Thapar, A. K. & Kerr, M. P. A community study of the presence of anxiety disorder in people with epilepsy. Epilepsy Behav. 11, 118–124 (2007).

    Article  PubMed  Google Scholar 

  31. Mensah, S. A., Beavis, J. M., Thapar, A. K. & Kerr, M. The presence and clinical implications of depression in a community population of adults with epilepsy. Epilepsy Behav. 8, 213–219 (2006).

    Article  PubMed  Google Scholar 

  32. de Oliveira, G. N. et al. Brazilian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Epilepsy Behav. 19, 328–331 (2010).

    Article  PubMed  Google Scholar 

  33. Stefanello, S., Marin-Leon, L., Fernandes, P. T., Li, L. M. & Botega, N. J. Psychiatric comorbidity and suicidal behavior in epilepsy: a community-based case–control study. Epilepsia 51, 1120–1125 (2010).

    Article  PubMed  Google Scholar 

  34. Devinsky, O. et al. Changes in depression and anxiety after resective surgery for epilepsy. Neurology 65, 1744–1749 (2005).

    Article  CAS  PubMed  Google Scholar 

  35. Friedman, D. E. et al. Identifying depression in epilepsy in a busy clinical setting is enhanced with systematic screening. Seizure 18, 429–433 (2009).

    Article  PubMed  Google Scholar 

  36. Desai, S. D. et al. Study of DSM-IV Axis I psychiatric disorders in patients with refractory complex partial seizures using a short structured clinical interview. Epilepsy Behav. 19, 301–305 (2010).

    Article  PubMed  Google Scholar 

  37. Ekinci, O., Titus, J. B., Rodopman, A. A., Berkem, M. & Trevathan, E. Depression and anxiety in children and adolescents with epilepsy: prevalence, risk factors, and treatment. Epilepsy Behav. 14, 8–18 (2009).

    Article  PubMed  Google Scholar 

  38. Fortin, M., Hudon, C., Haggerty, J., Akker, M. & Almirall, J. Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Serv. Res. 10, 111 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  39. Mula, M. et al. On the prevalence of bipolar disorder in epilepsy. Epilepsy Behav. 13, 658–661 (2008).

    Article  PubMed  Google Scholar 

  40. Adams, S. J. et al. Neuropsychiatric morbidity in focal epilepsy. Br. J. Psychiatry 192, 464–469 (2008).

    Article  PubMed  Google Scholar 

  41. Baker, G. A. Depression and suicide in adolescents with epilepsy. Neurology 66, S5–S12 (2006).

    Article  PubMed  Google Scholar 

  42. Bell, G. S. & Sander, J. W. Suicide and epilepsy. Curr. Opin. Neurol. 22, 174–178 (2009).

    Article  PubMed  Google Scholar 

  43. Stefanello, S., Marin-Leon, L., Fernandes, P. T., Min, L. L. & Botega, N. J. Suicidal thoughts in epilepsy: a community-based study in Brazil. Epilepsy Behav. 17, 483–488 (2010).

    Article  PubMed  Google Scholar 

  44. Fu, C. W. et al. The prevalence of anxiety symptoms and depressive symptoms in patients with somatic disorders in urban China: a multi-center cross-sectional study. Int. J. Psychiatry Med. 37, 185–199 (2007).

    Article  PubMed  Google Scholar 

  45. Reijnders, J. S., Ehrt, U., Weber, W. E., Aarsland, D. & Leentjens, A. F. A systematic review of prevalence studies of depression in Parkinson's disease. Mov. Disord. 23, 183–189 (2008).

    Article  PubMed  Google Scholar 

  46. Blumer, D., Montouris, G. & Davies, K. The interictal dysphoric disorder: recognition, pathogenesis, and treatment of the major psychiatric disorder of epilepsy. Epilepsy Behav. 5, 826–840 (2004).

    Article  PubMed  Google Scholar 

  47. Mula, M. et al. Clinical and psychopathological definition of the interictal dysphoric disorder of epilepsy. Epilepsia 49, 650–656 (2008).

    Article  PubMed  Google Scholar 

  48. Ferguson, P. L. et al. A population-based study of risk of epilepsy after hospitalization for traumatic brain injury. Epilepsia 51, 891–898 (2010).

    Article  PubMed  Google Scholar 

  49. Kharatishvili, I. & Pitkanen, A. Posttraumatic epilepsy. Curr. Opin. Neurol. 23, 183–188 (2010).

    Article  PubMed  Google Scholar 

  50. Ettinger, A. B., Copeland, L. A., Zeber, J. E., Van Cott, A. C. & Pugh, M. J. V. Are psychiatric disorders independent risk factors for new-onset epilepsy in older individuals? Epilepsy Behav. 17, 70–74 (2010).

    Article  PubMed  Google Scholar 

  51. McLaughlin, D. P., Pachana, N. A. & McFarland, K. Depression in a community-dwelling sample of older adults with late-onset or lifetime epilepsy. Epilepsy Behav. 12, 281–285 (2008).

    Article  PubMed  Google Scholar 

  52. Dickens, C. et al. New onset depression following myocardial infarction predicts cardiac mortality. Psychosom. Med. 70, 450–455 (2008).

    Article  PubMed  Google Scholar 

  53. Pan, A. et al. Bidirectional association between depression and type 2 diabetes mellitus in women. Arch. Intern. Med. 170, 1884–1891 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  54. Menza, M. et al. A controlled trial of antidepressants in patients with Parkinson disease and depression. Neurology 72, 886–892 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Strodl, E. & Kenardy, J. The 5-item mental health index predicts the initial diagnosis of nonfatal stroke in older women. J. Womens Health (Larchmt) 17, 979–986 (2008).

    Article  Google Scholar 

  56. Devanand, D. P. et al. Depressed mood and the incidence of Alzheimer's disease in the elderly living in the community. Arch. Gen. Psychiatry 53, 175–182 (1996).

    Article  CAS  PubMed  Google Scholar 

  57. Hermann, B. P., Trenerry, M. R. & Colligan, R. C. Learned helplessness, attributional style, and depression in epilepsy. Bozeman Epilepsy Surgery Consortium. Epilepsia 37, 680–686 (1996).

    Article  CAS  PubMed  Google Scholar 

  58. Wagner, J. L., Smith, G., Ferguson, P. L., Horton, S. & Wilson, E. A hopelessness model of depressive symptoms in youth with epilepsy. J. Pediatr. Psychol. 34, 89–96 (2009).

    Article  PubMed  Google Scholar 

  59. McLaughlin, D. P., Pachana, N. A. & McFarland, K. The impact of depression, seizure variables and locus of control on health related quality of life in a community dwelling sample of older adults. Seizure 19, 232–236 (2010).

    Article  PubMed  Google Scholar 

  60. Asadi-Pooya, A. A., Schilling, C. A., Glosser, D., Tracy, J. I. & Sperling, M. R. Health locus of control in patients with epilepsy and its relationship to anxiety, depression, and seizure control. Epilepsy Behav. 11, 347–350 (2007).

    Article  PubMed  Google Scholar 

  61. McEwen, B. S. & Stellar, E. Stress and the individual. Mechanisms leading to disease. Arch. Intern. Med. 153, 2093–2101 (1993).

    Article  CAS  PubMed  Google Scholar 

  62. McEwen, B. S. Stress, adaptation, and disease. Allostasis and allostatic load. Ann. NY Acad. Sci. 840, 33–44 (1998).

    Article  CAS  PubMed  Google Scholar 

  63. Friedman, D. E. & Gilliam, F. G. Seizure-related injuries are underreported in pharmacoresistant localization-related epilepsy. Epilepsia 51, 43–47 (2010).

    Article  PubMed  Google Scholar 

  64. Hamelin, S., Kahane, P. & Vercueil, L. Fatigue in epilepsy: a prospective inter-ictal and post-ictal survey. Epilepsy Res. 91, 153–160 (2010).

    Article  PubMed  Google Scholar 

  65. Hesdorffer, D. C. & Lee, P. Health, wealth, and culture as predominant factors in psychosocial morbidity. Epilepsy Behav. 15, S36–S40 (2009).

    Article  PubMed  Google Scholar 

  66. Thompson, A. W., Miller, J. W., Katon, W., Chaytor, N. & Ciechanowski, P. Sociodemographic and clinical factors associated with depression in epilepsy. Epilepsy Behav. 14, 655–660 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  67. Whatley, A. D., DiIorio, C. K. & Yeager, K. Examining the relationships of depressive symptoms, stigma, social support and regimen-specific support on quality of life in adult patients with epilepsy. Health Educ. Res. 25, 575–584 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Lee, S. A., Lee, S. M. & No, Y. J. Factors contributing to depression in patients with epilepsy. Epilepsia 51, 1305–1308 (2010).

    Article  PubMed  Google Scholar 

  69. Kwan, P., Yu, E., Leung, H., Leon, T. & Mychaskiw, M. A. Association of subjective anxiety, depression, and sleep disturbance with quality-of-life ratings in adults with epilepsy. Epilepsia 50, 1059–1066 (2009).

    Article  PubMed  Google Scholar 

  70. Lacey, C. J., Salzberg, M. R., Roberts, H., Trauer, T. & D'Souza, W. J. Psychiatric comorbidity and impact on health service utilization in a community sample of patients with epilepsy. Epilepsia 50, 1991–1994 (2009).

    Article  PubMed  Google Scholar 

  71. Winkler, A. S. et al. Belief systems of epilepsy and attitudes toward people living with epilepsy in a rural community of northern Tanzania. Epilepsy Behav. 19, 596–601 (2010).

    Article  PubMed  Google Scholar 

  72. Mecarelli, O. et al. Past and present public knowledge and attitudes toward epilepsy in Italy. Epilepsy Behav. 18, 110–115 (2010).

    Article  PubMed  Google Scholar 

  73. Danielsson, S. et al. Psychopathology, psychosocial functioning, and IQ before and after epilepsy surgery in children with drug-resistant epilepsy. Epilepsy Behav. 14, 330–337 (2009).

    Article  PubMed  Google Scholar 

  74. Siegel, A. M., Cascino, G. D., Fessler, A. J., So, E. L. & Meyer, F. B. Psychiatric co-morbidity in 75 patients undergoing epilepsy surgery: lack of correlation with pathological findings. Epilepsy Res. 80, 158–162 (2008).

    Article  CAS  PubMed  Google Scholar 

  75. Wilson, S. J., Wrench, J. M., McIntosh, A. M., Bladin, P. F. & Berkovic, S. F. Profiles of psychosocial outcome after epilepsy surgery: the role of personality. Epilepsia 51, 1133–1138 (2010).

    Article  PubMed  Google Scholar 

  76. Reisinger, E. L. & Dilorio, C. Individual, seizure-related, and psychosocial predictors of depressive symptoms among people with epilepsy over six months. Epilepsy Behav. 15, 196–201 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  77. Austin, J. K. et al. Self-esteem and symptoms of depression in children with seizures: relationships with neuropsychological functioning and family variables over time. Epilepsia 51, 2074–2083 (2010).

    Article  PubMed  Google Scholar 

  78. Taylor, J. et al. Factors predictive of resilience and vulnerability in new-onset epilepsy. Epilepsia 52, 610–618 (2010).

    Article  PubMed  Google Scholar 

  79. Kopp, C. M. C., Muzykewicz, D. D. A., Staley, B. A., Thiele, E. A. & Pulsifer, M. B. Behavior problems in children with tuberous sclerosis complex and parental stress. Epilepsy Behav. 13, 505–510 (2008).

    Article  PubMed  Google Scholar 

  80. Wood, L. J., Sherman, E. M. S., Hamiwka, L. D., Blackman, M. A. & Wirrell, E. C. Maternal depression: the cost of caring for a child with intractable epilepsy. Pediatr. Neurol. 39, 418–422 (2008).

    Article  PubMed  Google Scholar 

  81. Ferro, M. A. & Speechley, K. N. Depressive symptoms among mothers of children with epilepsy: a review of prevalence, associated factors, and impact on children. Epilepsia 50, 2344–2354 (2009).

    Article  PubMed  Google Scholar 

  82. Ferro, M. A., Avison, W. R., Campbell, M. K. & Speechley, K. N. Prevalence and trajectories of depressive symptoms in mothers of children with newly diagnosed epilepsy. Epilepsia 52, 326–336 (2011).

    PubMed  Google Scholar 

  83. Chiou, H. H. & Hsieh, L. P. Parenting stress in parents of children with epilepsy and asthma. J. Child Neurol. 23, 301–306 (2008).

    Article  PubMed  Google Scholar 

  84. Cushner-Weinstein, S. et al. Parenting stress and childhood epilepsy: the impact of depression, learning, and seizure-related factors. Epilepsy Behav. 13, 109–114 (2008).

    Article  PubMed  Google Scholar 

  85. Shore, C. P., Austin, J. K. & Dunn, D. W. Maternal adaptation to a child's epilepsy. Epilepsy Behav. 5, 557–568 (2004).

    Article  PubMed  Google Scholar 

  86. Marchetti, R. L. et al. Psychiatric diagnoses of patients with psychogenic non-epileptic seizures. Seizure 17, 247–253 (2008).

    Article  PubMed  Google Scholar 

  87. Schramke, C. J., Kay, K. A., Valeriano, J. P. & Kelly, K. M. Using patient history to distinguish between patients with non-epileptic and patients with epileptic events. Epilepsy Behav. 19, 478–482 (2010).

    Article  PubMed  Google Scholar 

  88. Koby, D. G. et al. Questioning the role of abuse in behavioral spells and epilepsy. Epilepsy Behav. 19, 584–590 (2010).

    Article  PubMed  Google Scholar 

  89. Sperling, M. R., Schilling, C. A., Glosser, D., Tracy, J. I. & Asadi-Pooya, A. A. Self-perception of seizure precipitants and their relation to anxiety level, depression, and health locus of control in epilepsy. Seizure 17, 302–307 (2008).

    Article  PubMed  Google Scholar 

  90. Kanner, A. M., Trimble, M. & Schmitz, B. Postictal affective episodes. Epilepsy Behav. 19, 156–158 (2010).

    Article  PubMed  Google Scholar 

  91. Nishida, T. et al. Postictal mania versus postictal psychosis: differences in clinical features, epileptogenic zone, and brain functional changes during postictal period. Epilepsia 47, 2104–2114 (2006).

    Article  PubMed  Google Scholar 

  92. Fincham, R. & Anderson, S. Postictal depression following subtle seizures. Epilepsy Behav. 1, 278–280 (2000).

    Article  PubMed  Google Scholar 

  93. Hoppe, C., Poepel, A. & Elger, C. E. Epilepsy: accuracy of patient seizure counts. Arch. Neurol. 64, 1595–1599 (2007).

    Article  PubMed  Google Scholar 

  94. Blumer, D. Postictal depression: significance for the treatment of the neurobehavioral disorder of epilepsy. J. Epilepsy 5, 214–219 (1992).

    Article  Google Scholar 

  95. Garcia-Morales, I., Mayor, P. D. & Kanner, A. M. Psychiatric comorbidities in epilepsy: identification and treatment. Neurologist 14, S15–S25 (2008).

    Article  PubMed  Google Scholar 

  96. Volkl-Kernstock, S., Bauch-Prater, S., Ponocny-Seliger, E. & Feucht, M. Speech and school performance in children with benign partial epilepsy with centro-temporal spikes (BCECTS). Seizure 18, 320–326 (2009).

    Article  PubMed  Google Scholar 

  97. Hessen, E., Lossius, M. I. & Gjerstad, L. Behavioural adjustment in seizure-free epilepsy patients on monotherapy. Seizure 17, 422–430 (2008).

    Article  PubMed  Google Scholar 

  98. Micallef, S., Spooner, C. G., Harvey, A. S., Wrennall, J. A. & Wilson, S. J. Psychological outcome profiles in childhood-onset temporal lobe epilepsy. Epilepsia 51, 2066–2073 (2010).

    Article  PubMed  Google Scholar 

  99. Witt, J. A., Hollmann, K. & Helmstaedter, C. The impact of lesions and epilepsy on personality and mood in patients with symptomatic epilepsy: a pre- to postoperative follow-up study. Epilepsy Res. 82, 139–146 (2008).

    Article  PubMed  Google Scholar 

  100. Dias, R. et al. Depression in epilepsy is associated with lack of seizure control. Epilepsy Behav. 19, 445–447 (2010).

    Article  PubMed  Google Scholar 

  101. Seminario, N. A., Farias, S. T., Jorgensen, J., Bourgeois, J. A. & Seyal, M. Determination of prevalence of depression in an epilepsy clinic using a brief DSM-IV-based self-report questionnaire. Epilepsy Behav. 15, 362–366 (2009).

    Article  PubMed  Google Scholar 

  102. Bell, G. S., Gaitatzis, A., Bell, C. L., Johnson, A. L. & Sander, J. W. Suicide in people with epilepsy: how great is the risk? Epilepsia 50, 1933–1942 (2009).

    Article  PubMed  Google Scholar 

  103. Kanner, A. M., Byrne, R., Chicharro, A., Wuu, J. & Frey, M. A lifetime psychiatric history predicts a worse seizure outcome following temporal lobectomy. Neurology 72, 793–799 (2009).

    Article  CAS  PubMed  Google Scholar 

  104. Metternich, B. et al. Preoperative depressive symptoms predict postoperative seizure outcome in temporal and frontal lobe epilepsy. Epilepsy Behav. 16, 622–628 (2009).

    Article  PubMed  Google Scholar 

  105. Thapar, A., Kerr, M. & Harold, G. Stress, anxiety, depression, and epilepsy: investigating the relationship between psychological factors and seizures. Epilepsy Behav. 14, 134–140 (2009).

    Article  PubMed  Google Scholar 

  106. Guarnieri, R. et al. Do psychiatric comorbidities predict postoperative seizure outcome in temporal lobe epilepsy surgery? Epilepsy Behav. 14, 529–534 (2009).

    Article  PubMed  Google Scholar 

  107. Hughes, J. R. Periodic lateralized epileptiform discharges: do they represent an ictal pattern requiring treatment? Epilepsy Behav. 18, 162–165 (2010).

    Article  PubMed  Google Scholar 

  108. Shelley, B. P., Trimble, M. R. & Boutros, N. N. Electroencephalographic cerebral dysrhythmic abnormalities in the trinity of nonepileptic general population, neuropsychiatric, and neurobehavioral disorders. J. Neuropsychiatry Clin. Neurosci. 20, 7–22 (2008).

    Article  PubMed  Google Scholar 

  109. Vaaler, A. E. et al. Symptoms of epilepsy and organic brain dysfunctions in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department. BMC Psychiatry 9, 63 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  110. Vaaler, A. E., Morken, G., Iversen, V. C., Kondziella, D. & Linaker, O. M. Acute unstable depressive syndrome (AUDS) is associated more frequently with epilepsy than major depression. BMC Neurol. 10, 67 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  111. Mula, M. & Monaco, F. Antiepileptic drugs and psychopathology of epilepsy: an update. Epilept. Disord. 11, 1–9 (2009).

    Article  Google Scholar 

  112. Miller, J. M., Kustra, R. P., Vuong, A., Hammer, A. E. & Messenheimer, J. A. Depressive symptoms in epilepsy: prevalence, impact, aetiology, biological correlates and effect of treatment with antiepileptic drugs. Drugs 68, 1493–1509 (2008).

    Article  CAS  PubMed  Google Scholar 

  113. Arana, A., Wentworth, C. E., Ayuso-Mateos, J. L. & Arellano, F. M. Suicide-related events in patients treated with antiepileptic drugs. N. Engl. J. Med. 363, 542–551 (2010).

    Article  CAS  PubMed  Google Scholar 

  114. VanCott, A. C. et al. Suicide-related behaviors in older patients with new anti-epileptic drug use: data from the VA hospital system. BMC Med. 8, 4 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  115. Olesen, J. B. et al. Antiepileptic drugs and risk of suicide: a nationwide study. Pharmacoepidemiol. Drug Saf. 19, 518–524 (2010).

    Article  PubMed  Google Scholar 

  116. Hesdorffer, D. C. & Kanner, A. M. The FDA alert on suicidality and antiepileptic drugs: fire or false alarm? Epilepsia 50, 978–986 (2009).

    Article  PubMed  Google Scholar 

  117. Shneker, B. F., Cios, J. S. & Elliott, J. O. Suicidality, depression screening, and antiepileptic drugs: reaction to the FDA alert. Neurology 72, 987–991 (2009).

    Article  PubMed  Google Scholar 

  118. Ketter, T. A., Post, R. M. & Theodore, W. H. Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders. Neurology 53, S53–S67 (1999).

    CAS  PubMed  Google Scholar 

  119. Elger, C. E. & Schmidt, D. Modern management of epilepsy: a practical approach. Epilepsy Behav. 12, 501–539 (2008).

    Article  PubMed  Google Scholar 

  120. Brent, D. A., Crumrine, P. K., Varma, R. R., Allan, M. & Allman, C. Phenobarbital treatment and major depressive disorder in children with epilepsy. Pediatrics 80, 909–917 (1987).

    CAS  PubMed  Google Scholar 

  121. Brent, D. A., Crumrine, P. K., Varma, R., Brown, R. V. & Allan, M. J. Phenobarbital treatment and major depressive disorder in children with epilepsy: a naturalistic follow-up. Pediatrics 85, 1086–1091 (1990).

    Article  CAS  PubMed  Google Scholar 

  122. Lopez-Gomez, M. et al. Primidone is associated with interictal depression in patients with epilepsy. Epilepsy Behav. 6, 413–416 (2005).

    Article  CAS  PubMed  Google Scholar 

  123. Fakhoury, T. A., Miller, J. M., Hammer, A. E. & Vuong, A. Effects of lamotrigine on mood in older adults with epilepsy and co-morbid depressive symptoms: an open-label, multicentre, prospective study. Drugs Aging 25, 955–962 (2008).

    Article  CAS  PubMed  Google Scholar 

  124. Labiner, D. M. et al. Effects of lamotrigine compared with levetiracetam on anger, hostility, and total mood in patients with partial epilepsy. Epilepsia 50, 434–442 (2009).

    Article  CAS  PubMed  Google Scholar 

  125. Mazza, M., Martini, A., Scoppetta, M. & Mazza, S. Effect of levetiracetam on depression and anxiety in adult epileptic patients. Prog. Neuropsychopharmacol. Biol. Psychiatry 32, 539–543 (2008).

    Article  CAS  PubMed  Google Scholar 

  126. Helmstaedter, C., Fritz, N., Kockelmann, E., Kosanetzky, N. & Elger, C. Positive and negative psychotropic effects of levetiracetam. Epilepsy Behav. 13, 535–541 (2008).

    Article  CAS  PubMed  Google Scholar 

  127. Mula, M., Trimble, M. R., Yuen, A., Liu, R. S. & Sander, J. W. Psychiatric adverse events during levetiracetam therapy. Neurology 61, 704–706 (2003).

    Article  CAS  PubMed  Google Scholar 

  128. Mula, M., Hesdorffer, D. C., Trimble, M. & Sander, J. W. The role of titration schedule of topiramate for the development of depression in patients with epilepsy. Epilepsia 50, 1072–1076 (2009).

    Article  PubMed  Google Scholar 

  129. Richy, F. F., Banerjee, S., Brabant, Y. & Helmers, S. Levetiracetam extended release and levetiracetam immediate release as adjunctive treatment for partial-onset seizures: an indirect comparison of treatment-emergent adverse events using meta-analytic techniques. Epilepsy Behav. 16, 240–245 (2009).

    Article  PubMed  Google Scholar 

  130. Wrench, J. M., Wilson, S. J., Bladin, P. F. & Reutens, D. C. Hippocampal volume and depression: insights from epilepsy surgery. J. Neurol. Neurosurg. Psychiatry 80, 539–544 (2009).

    Article  CAS  PubMed  Google Scholar 

  131. Salgado, P. C., Yasuda, C. L. & Cendes, F. Neuroimaging changes in mesial temporal lobe epilepsy are magnified in the presence of depression. Epilepsy Behav. 19, 422–427 (2010).

    Article  PubMed  Google Scholar 

  132. Shamim, S., Hasler, G., Liew, C., Sato, S. & Theodore, W. H. Temporal lobe epilepsy, depression, and hippocampal volume. Epilepsia 50, 1067–1071 (2009).

    Article  PubMed  Google Scholar 

  133. van Elst, L. T., Groffmann, M., Ebert, D. & Schulze-Bonhage, A. Amygdala volume loss in patients with dysphoric disorder of epilepsy. Epilepsy Behav. 16, 105–112 (2009).

    Article  Google Scholar 

  134. Caplan, R. et al. Suicidality and brain volumes in pediatric epilepsy. Epilepsy Behav. 18, 286–290 (2010).

    Article  PubMed  Google Scholar 

  135. Assem-Hilger, E. et al. Central serotonin 1A receptor binding in temporal lobe epilepsy: a [carbonyl-11C]WAY-100635 PET study. Epilepsy Behav. 19, 467–473 (2010).

    Article  PubMed  Google Scholar 

  136. Lothe, A. et al. Comorbidity between temporal lobe epilepsy and depression: a [18F]MPPF PET study. Brain 131, 2765–2782 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  137. Bonelli, S. B. et al. Preoperative amygdala fMRI in temporal lobe epilepsy. Epilepsia 50, 217–227 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  138. Gilliam, F. G. et al. Hippocampal 1H-MRSI correlates with severity of depression symptoms in temporal lobe epilepsy. Neurology 68, 364–368 (2007).

    Article  CAS  PubMed  Google Scholar 

  139. Babu, C. S., Satishchandra, P., Sinha, S. & Subbakrishna, D. K. Co-morbidities in people living with epilepsy: hospital based case-control study from a resource-poor setting. Epilepsy Res. 86, 146–152 (2009).

    Article  PubMed  Google Scholar 

  140. de Araujo, G. M. et al. Psychiatric comorbidity in epilepsy: a study comparing patients with mesial temporal sclerosis and juvenile myoclonic epilepsy. Epilepsy Behav. 13, 196–201 (2008).

    Article  Google Scholar 

  141. Asmussen, S. B., Kirlin, K. A., Gale, S. D. & Chung, S. S. Differences in self-reported depressive symptoms between patients with epileptic and psychogenic nonepileptic seizures. Seizure 18, 564–566 (2009).

    Article  PubMed  Google Scholar 

  142. Rayner, G., Wrench, J. M. & Wilson, S. J. Differential contributions of objective memory and mood to subjective memory complaints in refractory focal epilepsy. Epilepsy Behav. 19, 359–364 (2010).

    Article  PubMed  Google Scholar 

  143. Ertekin, B. A. et al. A comparative study of obsessive-compulsive disorder and other psychiatric comorbidities in patients with temporal lobe epilepsy and idiopathic generalized epilepsy. Epilepsy Behav. 14, 634–639 (2009).

    Article  PubMed  Google Scholar 

  144. Sanchez-Gistau, V. et al. Prevalence of interictal psychiatric disorders in patients with refractory temporal and extratemporal lobe epilepsy in Spain. A comparative study. Epilepsia 51, 1309–1313 (2010).

    Article  PubMed  Google Scholar 

  145. Bragatti, J. A. et al. Left-sided EEG focus and positive psychiatric family history are independent risk factors for affective disorders in temporal lobe epilepsy. Epilepsy Res. 87, 169–176 (2009).

    Article  PubMed  Google Scholar 

  146. de Oliveira, G. N. M. et al. Psychiatric disorders in temporal lobe epilepsy: an overview from a tertiary service in Brazil. Seizure 19, 479–484 (2010).

    Article  PubMed  Google Scholar 

  147. Pizzi, A. M., Chapin, J. S., Tesar, G. E. & Busch, R. M. Comparison of personality traits in patients with frontal and temporal lobe epilepsies. Epilepsy Behav. 15, 225–229 (2009).

    Article  PubMed  Google Scholar 

  148. DeRubeis, R. J., Siegle, G. J. & Hollon, S. D. Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms. Nat. Rev. Neurosci. 9, 788–796 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  149. Mor, N. & Haran, D. Cognitivebehavioral therapy for depression. Isr. J. Psychiatry Relat. Sci. 46, 269–273 (2009).

    PubMed  Google Scholar 

  150. Beltman, M. W., Voshaar, R. C. & Speckens, A. E. Cognitive-behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials. Br. J. Psychiatry 197, 11–19 (2010).

    Article  PubMed  Google Scholar 

  151. Cuijpers, P., Smit, F., Bohlmeijer, E., Hollon, S. D. & Andersson, G. Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. Br. J. Psychiatry 196, 173–178 (2010).

    Article  PubMed  Google Scholar 

  152. Pull, C. B. Current empirical status of acceptance and commitment therapy. Curr. Opin. Psychiatry 22, 55–60 (2009).

    Article  PubMed  Google Scholar 

  153. Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D. & Geller, P. A. A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behav. Modif. 31, 772–799 (2007).

    Article  PubMed  Google Scholar 

  154. Sturmey, P. Behavioral activation is an evidence-based treatment for depression. Behav. Modif. 33, 818–829 (2009).

    Article  PubMed  Google Scholar 

  155. Thompson, N. J. et al. Distance delivery of mindfulness-based cognitive therapy for depression: project UPLIFT. Epilepsy Behav. 19, 247–254 (2010).

    Article  PubMed  Google Scholar 

  156. Walker, E. R., Obolensky, N., Dini, S. & Thompson, N. J. Formative and process evaluations of a cognitive-behavioral therapy and mindfulness intervention for people with epilepsy and depression. Epilepsy Behav. 19, 239–246 (2010).

    Article  PubMed  Google Scholar 

  157. Ciechanowski, P. et al. PEARLS depression treatment for individuals with epilepsy: a randomized controlled trial. Epilepsy Behav. 19, 225–231 (2010).

    Article  PubMed  Google Scholar 

  158. Wagner, J. L., Smith, G., Ferguson, P., van Bakergem, K. & Hrisko, S. Pilot study of an integrated cognitive-behavioral and self-management intervention for youth with epilepsy and caregivers: Coping Openly and Personally with Epilepsy (COPE). Epilepsy Behav. 18, 280–285 (2010).

    Article  PubMed  Google Scholar 

  159. DiIorio, C. et al. Project EASE: a study to test a psychosocial model of epilepsy medication managment. Epilepsy Behav. 5, 926–936 (2004).

    Article  PubMed  Google Scholar 

  160. Lundgren, T., Dahl, J., Yardi, N. & Melin, L. Acceptance and commitment therapy and yoga for drug-refractory epilepsy: a randomized controlled trial. Epilepsy Behav. 13, 102–108 (2008).

    Article  PubMed  Google Scholar 

  161. Lundgren, T., Dahl, J. & Hayes, S. C. Evaluation of mediators of change in the treatment of epilepsy with acceptance and commitment therapy. J. Behav. Med. 31, 225–235 (2008).

    Article  PubMed  Google Scholar 

  162. Martinovic, Z., Simonovic, P. & Djokic, R. Preventing depression in adolescents with epilepsy. Epilepsy Behav. 9, 619–624 (2006).

    Article  PubMed  Google Scholar 

  163. Kuyk, J., Siffels, M. C., Bakvis, P. & Swinkels, W. A. Psychological treatment of patients with psychogenic non-epileptic seizures: an outcome study. Seizure 17, 595–603 (2008).

    Article  PubMed  Google Scholar 

  164. LaFrance, W. C. Jr et al. Cognitive behavioral therapy for psychogenic nonepileptic seizures. Epilepsy Behav. 14, 591–596 (2009).

    Article  PubMed  Google Scholar 

  165. Arida, R. M., Scorza, F. A. & Cavalheiro, E. A. Favorable effects of physical activity for recovery in temporal lobe epilepsy. Epilepsia 51, 76–79 (2010).

    Article  PubMed  Google Scholar 

  166. Arida, R. M., Scorza, F. A., da Silva, S. G., Schachter, S. C. & Cavalheiro, E. A. The potential role of physical exercise in the treatment of epilepsy. Epilepsy Behav. 17, 432–435 (2010).

    Article  PubMed  Google Scholar 

  167. Charyton, C., Elliott, J. O., Moore, J. L. & Klatte, E. T. Is it time to consider cognitive behavioral therapy for persons with epilepsy? Clues from pathophysiology, treatment and functional neuroimaging. Expert Rev. Neurother. 10, 1911–1927 (2010).

    Article  PubMed  Google Scholar 

  168. Ioannidis, J. P. Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials? Philos. Ethics Humanit. Med. 3, 14 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  169. Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A. & Rosenthal, R. Selective publication of antidepressant trials and its influence on apparent efficacy. N. Engl. J. Med. 358, 252–260 (2008).

    Article  CAS  PubMed  Google Scholar 

  170. Kirsch, I. et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 5, e45 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  171. Fournier, J. C. et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA 303, 47–53 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  172. Khan, A., Leventhal, R. M., Khan, S. R. & Brown, W. A. Severity of depression and response to antidepressants and placebo: an analysis of the Food and Drug Administration database. J. Clin. Psychopharmacol. 22, 40–45 (2002).

    Article  PubMed  Google Scholar 

  173. Bernardo, C. G., Singh, V. & Thompson, P. M. Safety and efficacy of psychopharmacological agents used to treat the psychiatric sequelae of common neurological disorders. Expert Opin. Drug Saf. 7, 435–445 (2008).

    Article  CAS  PubMed  Google Scholar 

  174. Cotterman-Hart, S. Depression in epilepsy: why aren't we treating? Epilepsy Behav. 19, 419 (2010).

    Article  PubMed  Google Scholar 

  175. Robertson, M. M. & Trimble, M. R. The treatment of depression in patients with epilepsy. A double-blind trial. J. Affect Disord. 9, 127–136 (1985).

    Article  CAS  PubMed  Google Scholar 

  176. Specchio, L. M. et al. Citalopram as treatment of depression in patients with epilepsy. Clin. Neuropharmacol. 27, 133–136 (2004).

    Article  CAS  PubMed  Google Scholar 

  177. Kanner, A. M., Kozak, A. M. & Frey, M. The use of sertraline in patients with epilepsy: is it safe? Epilepsy Behav. 1, 100–105 (2000).

    Article  PubMed  Google Scholar 

  178. Kuhn, K. U. et al. Antidepressive treatment in patients with temporal lobe epilepsy and major depression: a prospective study with three different antidepressants. Epilepsy Behav. 4, 674–679 (2003).

    Article  PubMed  Google Scholar 

  179. Thome-Souza, M. S., Kuczynski, E. & Valente, K. D. Sertraline and fluoxetine: safe treatments for children and adolescents with epilepsy and depression. Epilepsy Behav. 10, 417–425 (2007).

    Article  CAS  PubMed  Google Scholar 

  180. Tosun, A. et al. The effect of depression on academic achievement in children with epilepsy. Epilepsy Behav. 13, 494–498 (2008).

    Article  PubMed  Google Scholar 

  181. Kondziella, D. & Asztely, F. Don't be afraid to treat depression in patients with epilepsy! Acta Neurol. Scand. 119, 75–80 (2009).

    Article  CAS  PubMed  Google Scholar 

  182. Sandstrom, S. A., Bowman, E. S., Johnson, C. S. & Salanova, V. Interictal mood disorder and quality of life in active epilepsy. Epilepsy Behav. 17, 199–204 (2010).

    Article  PubMed  Google Scholar 

  183. Gibbons, R. D., Hur, K., Bhaumik, D. K. & Mann, J. J. The relationship between antidepressant prescription rates and rate of early adolescent suicide. Am. J. Psychiatry 163, 1898–1904 (2006).

    Article  PubMed  Google Scholar 

  184. Gibbons, R. D. et al. Relationship between antidepressants and suicide attempts: an analysis of the Veterans Health Administration data sets. Am. J. Psychiatry 164, 1044–1049 (2007).

    Article  PubMed  Google Scholar 

  185. Libby, A. M., Orton, H. D. & Valuck, R. J. Persisting decline in depression treatment after FDA warnings. Arch. Gen. Psychiatry 66, 633–639 (2009).

    Article  PubMed  Google Scholar 

  186. Olfson, M. & Marcus, S. C. National patterns in antidepressant medication treatment. Arch. Gen. Psychiatry 66, 848–856 (2009).

    Article  PubMed  Google Scholar 

  187. Hu, G., Wilcox, H. C., Wissow, L. & Baker, S. P. Mid-life suicide: an increasing problem in US Whites, 1999–2005. Am. J. Prev. Med. 35, 589–593 (2008).

    Article  PubMed  Google Scholar 

  188. McGlone, J. et al. Quality of life and memory after vagus nerve stimulator implantation for epilepsy. Can. J. Neurol. Sci. 35, 287–296 (2008).

    Article  PubMed  Google Scholar 

  189. Dodrill, C. B. & Morris, G. L. Effects of vagal nerve stimulation on cognition and quality of life in epilepsy. Epilepsy Behav. 2, 46–53 (2001).

    Article  PubMed  Google Scholar 

  190. Ridsdale, L. The social causes of inequality in epilepsy and developing a rehabilitation strategy: a UK-based analysis. Epilepsia 50, 2175–2179 (2009).

    Article  PubMed  Google Scholar 

  191. Brodtkorb, E. & Mula, M. Optimizing therapy of seizures in adult patients with psychiatric comorbidity. Neurology 67, S39–S44 (2006).

    Article  PubMed  Google Scholar 

  192. Nardi, R. et al. Co-morbidity does not reflect complexity in internal medicine patients. Eur. J. Intern. Med. 18, 359–368 (2007).

    Article  PubMed  Google Scholar 

  193. Safford, M. M., Allison, J. J. & Kiefe, C. I. Patient complexity: more than comorbidity. The vector model of complexity. J. Gen. Intern. Med. 22 (Suppl. 3), 382–390 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  194. Wrench, J. M., Wilson, S. J., O'Shea, M. F. & Reutens, D. C. Characterising de novo depression after epilepsy surgery. Epilepsy Res. 83, 81–88 (2009).

    Article  PubMed  Google Scholar 

  195. Kanner, A. M. Depression in epilepsy: prevalence, clinical semiology, pathogenic mechanisms, and treatment. Biol. Psychiatry 54, 388–398 (2003).

    Article  PubMed  Google Scholar 

  196. Monroe, S. M. & Simons, A. D. Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Psychol. Bull. 110, 406–425 (1991).

    Article  CAS  PubMed  Google Scholar 

  197. Diener, H. C. & Putzki, N. Leitlinien für Diagnostik und Therapie in der Neurologie (Georg Thieme Verlag, Stuttgart, 2008).

    Book  Google Scholar 

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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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