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Giuliano L, Durante V, Battaglia G, Gasparini S, Zambrelli E, Ermio C, La Neve A, Mostacci B. Sex Differences in Adverse Effects of Antiseizure Medications in Adults with Epilepsy: A Systematic Review. CNS Drugs 2024; 38:409-423. [PMID: 38691320 DOI: 10.1007/s40263-024-01088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Sex differences in epilepsy have been described in prevalence, seizure propensity and response to treatment. Therefore, taking into account sex-based differences in epilepsy is important for both diagnostic purposes and therapeutic considerations. However, little is known about sex differences in adverse effects of antiseizure medications (ASMs). OBJECTIVES We performed a systematic review searching for sex differences in adverse effects of ASMs in adult persons with epilepsy (PWE) as part of a wider project aimed to assess sex-based differences in efficacy and adverse effects of ASMs in PWE. METHODS We conducted a comprehensive literature search in the PubMed database. The search was conducted with no restriction on publication date, and all results up to April 2020 were included. We included articles written in English, Italian, Spanish, or French that evaluated adverse effects of one or more ASMs in PWE, with specific mention of the two sexes. When appropriate, Newcastle-Ottawa or Jadad scales were used to assess study quality. RESULTS Of 5164 identified studies, only 167 considered sex in the analysis and were therefore included. Significant sex-related differences were found in 58 of those studies. We found a consistently higher frequency of cutaneous adverse effects in females; higher risk of developing general adverse effects on different ASMs in females; stronger risk of adverse effects on bone metabolism in females, mainly on treatment with enzyme-inducing ASMs; a concordant higher risk of visual field loss was noted in males on vigabatrin; an overall worse lipid profile in males; as well as higher leptin levels and higher body mass index in females treated with various ASMs. CONCLUSIONS Our analysis has identified some important sex differences in the adverse effects of ASMs. Clinicians should be aware of these differences when informing patients about the risks associated with ASM treatment in PWE.
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Affiliation(s)
- Loretta Giuliano
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
| | - Vania Durante
- Neurology Unit, "A. Perrino" Hospital, Brindisi, Italy
| | - Giulia Battaglia
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
- Regional Epilepsy Center, "Great Metropolitan Hospital", Reggio Calabria, Italy
| | - Elena Zambrelli
- Epilepsy Center, Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Caterina Ermio
- Department of Neuroscience, "S. Giovanni Paolo II" Hospital, Lamezia Terme, Catanzaro, Italy
| | - Angela La Neve
- Department DiBrain, University of Bari "Aldo Moro", Bari, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the ERN EpiCARE, Bologna, Italy
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Shi W, Sun H, Peng W, Chen Z, Wang Q, Lin W, Ding M, Sun H, Wang X, Wang T, Wang X, Liu Y, Chen Y, Zhu G, Zhou D, Li J. Prevalence and risk factors of anxiety and depression in adult patients with epilepsy: a multicenter survey-based study. Ther Adv Neurol Disord 2023; 16:17562864231187194. [PMID: 37663409 PMCID: PMC10469248 DOI: 10.1177/17562864231187194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/22/2023] [Indexed: 09/05/2023] Open
Abstract
Background Depression and anxiety are the most common psychiatric comorbidities in patients with epilepsy (PWE). However, they are often unrecognized and consequently untreated. Objective The study was conducted to evaluate the prevalence and risk factors of anxiety and depression among Chinese adult PWE. Design Cross-sectional study. Methods Adult PWE were recruited from 13 tertiary epilepsy centers from February to September 2022. Generalized Anxiety Disorder-7 and Neurological Disorders Depression Inventory for Epilepsy were applied to evaluate anxiety and depression, respectively. Both univariate and multivariate logistic regression analyses models were performed to explore the risk factors of anxiety and depression. Results A total of 1326 PWE were enrolled in this study. The prevalence of anxiety and depression was 31.45% and 27.30%, respectively. Being female [odds ratio (OR) = 1.467, 95% CI: 1.134-1.899; p = 0.004], focal and focal to bilateral tonic-clonic seizures (TCSZ) (OR = 1.409, 95% CI: 1.021-1.939; p = 0.036), and seizure occurrence in the last 3 months (OR = 1.445, 95% CI: 1.026-2.044; p = 0.036) were the risk factors for anxiety. Focal and focal to bilateral TCSZ (OR = 1.531, 95% CI: 1.094-2.138; p = 0.013) and seizure occurrence in the last 3 months (OR = 1.644, 95% CI: 1.130-2.411; p = 0.010) were the risk factors for depression. In addition, for every 1-year increment of age, the odds of developing depression were decreased by 3.8% (p = 4.12e-5). Nevertheless, up to 70% of PWE did not receive any treatment for comorbidity. Conclusion There were approximately 30% of PWE screened positive for anxiety or depression. Both focal and focal to bilateral TCSZ and seizure occurrence in the last 3 months were estimated as risk factors for anxiety and depression. However, the current status of treatment was not optimal.
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Affiliation(s)
- Wenyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hanlin Sun
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ziyi Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Meiping Ding
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Hongbin Sun
- Department of Neurology, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Xiangqing Wang
- Department of Neurology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Tiancheng Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yonghong Liu
- Department of Neurology, Air Force Medical University Xijing Hospital, Xi’an, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoxing Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan, 610041, China
| | - Jinmei Li
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan, 610041, China
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Validation of the Generalized Anxiety Disorder-7 (GAD-7) in Russian people with epilepsy. Epilepsy Behav 2021; 123:108269. [PMID: 34500434 DOI: 10.1016/j.yebeh.2021.108269] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the capacity of Generalized Anxiety Disorder-7 (GAD-7) to detect anxiety disorders in a Russian sample of patients with epilepsy and to validate this instrument for rapid screening of anxiety in these patients. METHODS Study included 233 patients with epilepsy, both inpatients and outpatients. For all patients Mini-International Neuropsychiatric Interview was conducted as a gold standard for diagnosis of mental disorders. All patients also completed the questionnaires - the Russian version of GAD-7 and Hospital Anxiety and Depression Scale (HADS) to assess convergent validity. Chi-square and Fisher's exact tests were used to compare categorical variables, and the Mann-Whitney test was used for the quantitative ones. Internal consistency was assessed using Cronbach's alpha, Cronbach's alpha at point deletion, and corrected point-to-point correlation. ROC analysis was used to evaluate the properties of the GAD-7 to determine anxiety disorders. RESULTS Among 97 (41.6%) patients with epilepsy diagnosed with any anxiety disorders, 42 (18%) had panic disorder, 37 (15.9%) had agoraphobia, 17 (7.3%) had social anxiety disorder, and 64 (27.5%) had generalized anxiety disorder; 42 patients (18%) showed a combination of several anxiety disorders. The overall GAD-7 score was similar to other epilepsy studies, but higher cutoff scores characterize our sample. The scale performed well in detecting any anxiety disorder with the AUC of 0.866 and the optimal cutoff point > 8 points, and in detecting GAD with AUC = 0.922 and the optimal cutoff point > 9 points, showing overall acceptable sensitivity. CONCLUSION Russian version of the GAD-7 could be used as a screening tool for any anxiety disorders in PWE with the optimal cutoff score > 8 points.
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Nigussie K, Tesfaye B, Lemma A, Kerebih H. Magnitude and associated factors of suicidal ideation and attempt among people with epilepsy attending outpatient treatment at primary public hospitals in northwest Ethiopia: a multicentre cross-sectional study. BMJ Open 2021; 11:e043227. [PMID: 33397668 PMCID: PMC7783519 DOI: 10.1136/bmjopen-2020-043227] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/09/2020] [Accepted: 12/19/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to assess magnitude and associated factors of suicidal ideation and attempt among people with epilepsy attending outpatient treatment at primary public hospitals, northwest Ethiopia using suicide module of World Mental Health Survey initiative version of the WHO, composite international diagnostic interview. DESIGN Multicentre-based cross-sectional study was used. SETTING Data were collected using face to face interview from patients with epilepsy who attended outpatient treatment at primary public hospitals at northwest Ethiopia. PARTICIPANTS Adult patients with epilepsy (n=563) who came to attend outpatient treatment during the study period were included in the study using systematic random sampling technique. OUTCOME MEASURES Suicidal ideation, suicidal attempt and factors associated with suicidal ideation and attempt. RESULTS The overall magnitude of suicidal ideation and attempt was 26.5% and 12.6%, respectively. Being woman adjusted OR ((AOR)=1.68, 95% CI 1.09 to 3.23), living alone (AOR=2.4, 95% CI 1.47 to 3.92), divorced/widowed/(AOR=2.2, 95% CI 1.09 to 7.8), family history of suicidal attempt (AOR=2.53, 95% CI 1.34 to 4.79), depression (AOR=3.18, 95% CI 1.85 to 5.45), anxiety (AOR=2.92, 95% CI 1.68 to 5.09), comorbid medical illness (AOR=2.60, 95% CI 1.17 to 5.82) and poor social support (AOR=2.35, 95% CI 1.26 to 4.40) were statistically associated with suicidal ideation. Depression (AOR=4.87, 95% CI 2.56 to 9.28) living alone (AOR=2.66, 95% CI 1.62 to 5.41), family history of committed suicide (AOR=2.80, 95% CI 1.24 to 6.39), taking medication for mental illness (AOR=2.17, 95% CI 1.06 to 4.46), hazardous alcohol use (AOR=2.10, 95% CI 1.05 to 4.23) were statistically associated with suicidal attempts at a p value <0.05. CONCLUSION This study showed that the magnitude of suicidal ideation and attempt was high among people with epilepsy. Being woman, living alone, having depression and anxiety, single, divorced/widowed in marital status, family history of suicidal attempt and poor social support were statistically associated with suicidal ideation. Having depression, living alone, family history of suicide attempt, hazardous alcohol use and drug taking for mental illness were statistically associated with suicidal attempt. Based on the findings of this study early screening, detection and management of suicide were recommended in people with epilepsy.
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Affiliation(s)
- Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bizuneh Tesfaye
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemu Lemma
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Kerebih
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ciuffini R, Stratta P, Rossi R, Perilli E, Marrelli A. Hopelessness in persons with epilepsy: Relationship with demographic, clinical, and social variables. Epilepsy Behav 2019; 100:106383. [PMID: 31574427 DOI: 10.1016/j.yebeh.2019.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/05/2019] [Accepted: 06/13/2019] [Indexed: 10/25/2022]
Abstract
Persons with epilepsy show a higher risk of suicidal ideation and behavior than the general population. Hopelessness, as a feature of demoralization, is considered an emerging risk factor for suicidal ideation. Psychopathological comorbidity, mainly depression, has to be taken into account to predict suicidal attempts but the relationship between suicidality and epilepsy has been also reported independently from depressive disorders. The aim of the study was to investigate hopelessness in a sample of persons suffering from epilepsy without comorbidity with psychiatric disorders and its association with demographic, social, and clinical variables, putatively predictive of suicidal behaviors. Beck Hopelessness Scale (BHS) has been used as measure of suicidal ideation in 72 consecutive outpatients afferent to a third level epilepsy center. Exclusion criterion was psychiatric comorbidity evaluated by clinical approach and quantified by Clinical Global Impression (CGI) Scale. Clinical (focus localization, age at onset, number of drugs), demographic, social variables, and intellectual level were considered. Age, age at onset, gender, intellectual level, socioeconomic status, duration of illness and therapy, number of drugs, seizure frequency, and localization of the epileptic focus and side involved were found associated with BHS score increase. In a sample of persons with epilepsy, without psychiatric comorbidity, our data show an association between factors related to the biological pathophysiology and the clinical course of the disease with the sociodemographic status, as a risk factor for suicidal ideation.
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Affiliation(s)
- Roberta Ciuffini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy; Clinical Neurophysiology Unit, San Salvatore Hospital, L'Aquila, Italy.
| | | | - Rodolfo Rossi
- PhD program Psychiatry, Tor Vergata University, Roma, Italy
| | - Enrico Perilli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - Alfonso Marrelli
- Clinical Neurophysiology Unit, San Salvatore Hospital, L'Aquila, Italy
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6
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Raju Sagiraju HK, Wang CP, Amuan ME, Van Cott AC, Altalib HH, Pugh MJV. Antiepileptic drugs and suicide-related behavior: Is it the drug or comorbidity? Neurol Clin Pract 2018; 8:331-339. [PMID: 30140585 DOI: 10.1212/cpj.0000000000000489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/11/2018] [Indexed: 11/15/2022]
Abstract
Background We sought to compare trends of suicide-related behavior (SRB) before and after initiation of antiepileptic drug (AED) therapy among AED users (with and without epilepsy) to that of individuals without AED use controlling for sociodemographic characteristics and mental health comorbidity. Methods We used national Veterans Health Administration (VHA) data for post-9/11 veterans who received VHA care (2013-2014) without prior AED use. We conducted generalized estimation equation (GEE) analyses, stratified by epilepsy status and type of AED received, to assess the trend of SRB prevalence the year prior to and after the index date (date of first AED prescription/date of first health care encounter for non-AED users) controlling for sociodemographic factors and mental health comorbidity. Results The GEE analysis showed significant curvilinear trends of SRB prevalence over the 24-month study period among the AED users, indicating that the probability of SRB diagnoses increased over time with a peak before the index month and decreased thereafter. Similar patterns were observed among non-AED users, but significantly lower odds for SRB. Among AED users, there were no significant differences by epilepsy status; however, higher SRB prevalence and differential SRB trajectory measures were observed among those who received AEDs with mood-stabilizing action. Conclusions The peak of SRB prior to and rapid reduction in SRB after initiation of AED, and the finding that individuals eventually prescribed a mood-stabilizing AED (vs other AED or levetiracetam) had higher odds of SRB, suggests a strong possibility that the relationship of AED and SRB is one of residual confounding.
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Affiliation(s)
- Hari K Raju Sagiraju
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Chen-Pin Wang
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Megan E Amuan
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Anne C Van Cott
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Hamada H Altalib
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Mary Jo V Pugh
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
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Depression and Epilepsy: Comorbidity, Pathogenetic Similarity, and Principles of Treatment. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s11055-017-0534-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Scott AJ, Sharpe L, Hunt C, Gandy M. Anxiety and depressive disorders in people with epilepsy: A meta-analysis. Epilepsia 2017; 58:973-982. [PMID: 28470748 DOI: 10.1111/epi.13769] [Citation(s) in RCA: 229] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Comorbid anxiety and depressive disorders in people with epilepsy (PWE) are highly prevalent and associated with various adverse outcomes. However, the prevalence of anxiety disorders in PWE across studies is highly variable. Our aim was to estimate the prevalence and moderating factors of anxiety and depressive disorders in PWE. METHODS Following prospective registration (PROSPERO; CRD42015027101), electronic databases were searched for studies that reported the prevalence of both anxiety and depressive disorders in samples of PWE up until July 2016. Data extracted included the prevalence of anxiety and depressive disorders, and moderators of interest (e.g., method of diagnosis, prevalence of drug-resistant epilepsy). Meta-analysis of the overall pooled prevalence of anxiety and depressive disorders was conducted. RESULTS The search yielded 8,636 unique articles, with 27 studies meeting final inclusion criteria (3,221 PWE). The pooled prevalence of anxiety and depressive disorders was 20.2% (95% confidence interval [CI] 15.3-26.0%) and 22.9% (95% CI 18.2-28.4%), respectively. Method of diagnosis significantly moderated anxiety disorder prevalence (Q statistic with one degree of freedom [Q1 ] = 36.29, p < 0.0001); the prevalence of anxiety disorders based on unstructured clinician assessment was 8.1% (95% CI 5.7-11.4%), compared to a prevalence of 27.3% (95% CI 22.1-33.3%) based on a structured clinical interview. There were no significant moderators of depressive disorder diagnosis. SIGNIFICANCE Findings suggest the prevalence of anxiety and depressive disorders in PWE are equivalent, and variability in prevalence of anxiety disorders across studies can be attributed partly to the method of diagnosis. These findings also challenge widely held assumptions that psychiatric comorbidity is more common in people with drug-resistant epilepsy. Future research should aim to improve the detection and management of these comorbidities in PWE, particularly anxiety disorders, which have remained relatively neglected.
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Affiliation(s)
- Amelia J Scott
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Caroline Hunt
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Milena Gandy
- Department of Psychology, eCentreClinic, Macquarie University, Sydney, New South Wales, Australia
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Rider FK, Danilenko OA, Grishkina MN, Kustov GV, Akzhigitov RG, Lebedeva AV, Guekht AB. [Depression and epilepsy: comorbidities, pathogenesis, principles of therapy]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:19-24. [PMID: 28005042 DOI: 10.17116/jnevro20161169219-24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Numerous trials of last years confirm the bilateral link between depression and epilepsy with mutual complication of both diseases. Depression increases the risk of the first unprovoked paroxysm, worsens the compliance of epileptic patients, leads to decrease of the response both to therapeutic and surgical treatment and to increase of side effects of antiepileptic drugs. Depression is associated with high risk of suicidal behavior and reduces the quality of life level. Depression in epileptic patients is characterized by atypical clinical course in most cases what makes its diagnostics difficult and becomes the reason of the absence of the necessary pharmacologic and psychotherapeutic treatment. All of the above creates significant economical burden for the community because the epileptic patient with comorbid depression visits the physicians 2-4 times more often.
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Affiliation(s)
- F K Rider
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - O A Danilenko
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - M N Grishkina
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - G V Kustov
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - R G Akzhigitov
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - A V Lebedeva
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia; Pirogov Russian Natural Research Medical Univercity, Moscow, Russia
| | - A B Guekht
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia; Pirogov Russian Natural Research Medical Univercity, Moscow, Russia
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10
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Tao K, Wang X. The comorbidity of epilepsy and depression: diagnosis and treatment. Expert Rev Neurother 2016; 16:1321-1333. [PMID: 27327645 DOI: 10.1080/14737175.2016.1204233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Kaiyan Tao
- Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuefeng Wang
- Chongqing Key Laboratory of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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11
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Tuft M, Gjelsvik B, Nakken KO. Ian Curtis: Punk rock, epilepsy, and suicide. Epilepsy Behav 2015; 52:218-21. [PMID: 26496010 DOI: 10.1016/j.yebeh.2015.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 11/28/2022]
Abstract
Ian Curtis was the front man of the post-punk band Joy Division. He suffered from epilepsy and actively incorporated his experiences of the disease in his lyrics. Curtis had frequent epileptic seizures, both on and off stage. After dying from suicide in 1980, he became a legend in the post-punk milieu. The impact which the epilepsy, the epilepsy treatment, and comorbid depression had on his artistic life and premature death is not well known.
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Affiliation(s)
- Mia Tuft
- Neuropsychology Centre, Oslo, Norway.
| | - Bergljot Gjelsvik
- University of Oxford, Department of Psychiatry, Oxford Mindfulness Centre, Warneford Hospital, United Kingdom.
| | - Karl O Nakken
- National Centre for Epilepsy, Oslo University Hospital, Norway.
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Fountoulakis KN, Gonda X, Baghai TC, Baldwin DS, Bauer M, Blier P, Gattaz W, Hasler G, Möller HJ, Tandon R, Vieta E, Kasper S. Report of the WPA section of pharmacopsychiatry on the relationship of antiepileptic drugs with suicidality in epilepsy. Int J Psychiatry Clin Pract 2015; 19:158-67. [PMID: 25547437 DOI: 10.3109/13651501.2014.1000930] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This report from the World Psychiatric Association Section on Pharmacopsychiatry examines the possible relationship of antiepileptic drugs with suicide-related clinical features and behaviors in patients with epilepsy. MATERIALS AND METHODS A systematic review of the MEDLINE search returned 1039 papers, of which only 8 were considered relevant. A critical analysis of the Food and Drug Administration (FDA) report on the increase risk for patients under antiepileptics to manifest suicidality is also included in this report. RESULTS The analysis of these studies revealed that the data are not supportive of the presence of a "class effect" on suicide-related behavior; on the contrary, there are some data suggesting such an effect concerning treatment with topiramate, lamotrigine, and levetiracetam for which further research is needed. DISCUSSION For the majority of people with epilepsy, anticonvulsant treatment is necessary and its failure for any reason is expected to have deleterious consequences. Therefore, clinicians should inform patients and their families of this increased risk of suicidal ideation and behavior, but should not overemphasize the issue. Specific subgroups of patients with epilepsy might be at a higher risk, and deserve closer monitoring and follow-up. Future research with antiepileptics should specifically focus on depression and suicidal thoughts.
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Abstract
ABSTRACT: Suicidal behavior is not uncommon in epilepsy patients. Risk factors for suicidal ideation are associated with social and vocational disturbances, such as low economic status, lack of social support and unemployment and psychiatric comorbidity. In epilepsy patients, interictal dysphoric disorder presents a depressive mood that may be associated with episodic suicidal ideation. Suicide may occur among patients with very severe epilepsy, but also in patients that recently achieved a complete seizure freedom. Recent research suggests that almost a third of epilepsy patients that endorsed suicidal ideation were euthymic or had only very mild depressive symptoms. People with epilepsy should be specifically asked about their psychiatric problems and potential suicidal ideation. Neurobiology of suicidal behavior in epilepsy patients is still unclear.
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Pugh MJV, Hesdorffer D, Wang CP, Amuan ME, Tabares JV, Finley EP, Cramer JA, Kanner AM, Bryan CJ. Temporal trends in new exposure to antiepileptic drug monotherapy and suicide-related behavior. Neurology 2013; 81:1900-6. [PMID: 24174583 DOI: 10.1212/01.wnl.0000436614.51081.2e] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Because some recent studies suggest increased risk for suicide-related behavior (SRB; ideation, attempts) among those receiving antiepileptic drugs (AEDs), we examined the temporal relationship between new AED exposure and SRB in a cohort of older veterans. METHODS We used national Veterans Health Administration databases to identify veterans aged ≥65 years who received a new AED prescription in 2004-2006. All instances of SRB were identified using ICD-9-CM codes 1 year before and after the AED exposure (index) date. We also identified comorbid conditions and medication associated with SRB in prior research. We used generalized estimating equations with a logit link to examine the association between new AED exposure and SRB during 30-day intervals during the year before and after the index date, controlling for potential confounders. RESULTS In this cohort of 90,263 older veterans, the likelihood of SRB the month prior to AED exposure was significantly higher than in other time periods even after adjusting for potential confounders. Although there were 87 SRB events (74 individuals) the year before and 106 SRB events (92 individuals) after, approximately 22% (n = 16) of those also had SRB before the index date. Moreover, the rate of SRB after AED start was gradually reduced over time. CONCLUSIONS The temporal pattern of AED exposure and SRB suggests that, in clinical practice, the peak in SRB is prior to exposure. While speculative, the rate of gradual reduction in SRB thereafter suggests that symptoms may prompt AED prescription.
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Affiliation(s)
- Mary Jo V Pugh
- From the South Texas Veterans Health Care System (VERDICT) (M.J.V.P., C.-P.W., J.V.T., E.P.F.), San Antonio; Department of Epidemiology & Biostatistics (M.J.V.P., C.-P.W.), University of Texas Health Science Center at San Antonio; Department of Medicine (M.J.V.P.), Texas A & M University, College Station; Mailman School of Public Health (D.H.), Sergievsky Center, The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY; Edith Nourse Rogers Memorial Hospital (The Center for Health Quality, Outcomes and Economic Research [CHQOER]) (M.E.A.), Bedford, MA; Yale University School of Medicine (J.A.C.), New Haven, CT; Epilepsy Therapy Project (J.A.C.), Houston, TX; Rush University Medical Center (A.M.K.), Chicago, IL; and National Center for Veterans Studies (C.J.B.), University of Utah, Salt Lake City
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Abstract
OBJECTIVE Suicidal ideation and behavior have been associated with a variety of neurological illnesses. Studies are ongoing in combat veterans and other groups to examine possible mechanisms and pathways that account for such associations. METHOD This article provides a review of the literature on suicide ideation and suicidal behavior in patients with neurological illnesses including publications on veteran's health and military medicine. Studies of suicide attempts and deaths in people with neurological illnesses are also reviewed. RESULTS The studies summarized in this review indicate that there are important linkages between suicidal ideation and behavior and neurological conditions, including epilepsy, multiple sclerosis, and amyotrophic lateral sclerosis. CONCLUSION Additional studies are needed to further clarify why suicide ideation and suicidal behavior are associated with neurological diseases, in order to improve quality of life, alleviate patient distress, and prevent nonfatal and fatal suicide attempts in veteran and non-veteran populations.
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Affiliation(s)
- Steven S Coughlin
- Post-Deployment Health Epidemiology Program, Office of Public Health, Department of Veterans Affairs, Washington, DC, USA
| | - Leo Sher
- James J. Peters Veterans’ Affairs Medical Center, New York, USA
- Mount Sinai School of Medicine, New York, USA
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Epps SA, Weinshenker D. Rhythm and blues: animal models of epilepsy and depression comorbidity. Biochem Pharmacol 2012; 85:135-46. [PMID: 22940575 DOI: 10.1016/j.bcp.2012.08.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 08/16/2012] [Accepted: 08/17/2012] [Indexed: 12/12/2022]
Abstract
Clinical evidence shows a strong, bidirectional comorbidity between depression and epilepsy that is associated with decreased quality of life and responsivity to pharmacotherapies. At present, the neurobiological underpinnings of this comorbidity remain hazy. To complicate matters, anticonvulsant drugs can cause mood disturbances, while antidepressant drugs can lower seizure threshold, making it difficult to treat patients suffering from both depression and epilepsy. Animal models have been created to untangle the mechanisms behind the relationship between these disorders and to serve as screening tools for new therapies targeted to treat both simultaneously. These animal models are based on chemical interventions (e.g. pentylenetetrazol, kainic acid, pilocarpine), electrical stimulations (e.g. kindling, electroshock), and genetic/selective breeding paradigms (e.g. genetically epilepsy-prone rats (GEPRs), genetic absence epilepsy rat from Strasbourg (GAERS), WAG/Rij rats, swim lo-active rats (SwLo)). Studies on these animal models point to some potential mechanisms that could explain epilepsy and depression comorbidity, such as various components of the dopaminergic, noradrenergic, serotonergic, and GABAergic systems, as well as key brain regions, like the amygdala and hippocampus. These models have also been used to screen possible therapies. The purpose of the present review is to highlight the importance of animal models in research on comorbid epilepsy and depression and to explore the contributions of these models to our understanding of the mechanisms and potential treatments for these disorders.
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Affiliation(s)
- S Alisha Epps
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Hamed SA, Elserogy YB, Abdou MA, Abdellah MM. Risks of suicidality in adult patients with epilepsy. World J Psychiatry 2012; 2:33-42. [PMID: 24175166 PMCID: PMC3782174 DOI: 10.5498/wjp.v2.i2.33] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 10/16/2011] [Accepted: 02/25/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine the prevalence and risks of suicidality in a group of patients with epilepsy.
METHODS: Included were 200 adult patients and 100 matched healthy subjects. The clinical interview using The Diagnostic and Statistical Manual of Mental Disorders (4th edition), Beck Depression Inventory (2nd edition) (BDI-II), Hamilton Anxiety Rating Scale (HAM-A), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Eysenck Personality Questionnaire-Revised Rating Scale testings were used for diagnosis and assessment of severity of psychiatric symptoms. Blood concentrations of serotonin, catecholamines and dopamine were also measured.
RESULTS: Suicidality was reported in 35% (compared to 9% for controls), of them 80%, 72.86%, 55.71% and 52.9% had depression, anxiety, obsession and aggression respectively. Patients with suicidality had higher scores of BDI-II (P = 0.0001), HAM-A (P = 0.0001), and Y-BOCS (P = 0.037) and lower scores of psychotic (P = 0.0001) and extroversion (P = 0.025) personality traits. Regardless the presence or absence of suicidality, patients with epilepsy had low serotonin (P = 0.006), noradrenaline (P = 0.019) and adrenaline (P = 0.0001) levels. With suicidality, significant correlations were identified between: (1) age and scores of BDI-II (r = 0.235, P = 0.0001) and HAM-A (r = 0.241, P = 0.046); (2) age at onset and concentrations of noradrenaline (r = -0.502, P = 0.024); (3) duration of illness and scores of BDI-II (r = 0.247, P = 0.041), Y-BOCS (r = 0.270, P = 0.025) and neurotic personality trait (r = -0.284, P = 0.018); and (4) doses of antiepileptic drugs and scores of psychotic personality traits (r = -0.495, P = 0.006 for carbamazepine; r = -0.508, P = 0.0001 for valproate).
CONCLUSION: This is the first study which systematically estimated the prevalence and risks of suicidality in a homogenous group of patients with epilepsy. This study emphasizes the importance of epilepsy itself as a risk for suicidality and not its treatment.
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Affiliation(s)
- Sherifa A Hamed
- Sherifa A Hamed, Yaser BE Elserogy, Department of Neurology and Psychiatry, Assiut University Hospital, PO Box 71516, Assiut, Egypt
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Hamed SA. Psychiatric symptomatologies and disorders related to epilepsy and antiepileptic medications. Expert Opin Drug Saf 2011; 10:913-34. [PMID: 216194860 DOI: 10.1517/14740338.2011.588597] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Psychiatric comorbidities (such as depression, anxiety, psychosis, inattention, obsession, personality traits, aggression and suicide) are frequent in patients with epilepsy and have a significant impact on medical management and quality of life. AREAS COVERED A literature search was performed in MEDLINE for epidemiological, longitudinal, prospective, double-blind clinical trial studies published between 1990 and 2011 using the following words: epilepsy, antiepileptic drugs (AEDs), behavioral/emotional/psychiatric comorbidities, suicide and aggression. In this review, the author discusses: i) the characterization and prevalence of behavioral disturbances associated with epilepsy, ii) variables correlated with behavioral comorbidities which include: psychosocial-, clinical- and treatment-related variables, iii) the complex mechanisms of behavioral comorbidities associated with epilepsy, which include both psychosocial (functional) and organic; the process of epileptogenesis, neuronal plasticity, abnormalities in hypothalamic-pituitary axis and neurotransmitters and pathways are fundamental determinants, iv) the negative psychotropic effects of AEDs and their mechanisms and v) the suggested biopsychosocial model of management (pharmacological and non-pharmacological). EXPERT OPINION The relationship between psychiatric disorders and epilepsy has relevant therapeutic implications which should be directed towards a comprehensive biopsychosocial approach that focuses on the whole person rather than simply on the disease process.
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