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Old 02-20-06, 05:07 AM
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I have somewhat of a vested interest in posting this article for 'awareness' purposes, considering I have Temporal Lobe Epilepsy in conjunction to having Bipo w/ADHD.
Hey..whatcha gonna do..
Sing 'If I only had a brain'?
I have one, LOL !!
And it's a 'good one' too. (0:

I, now, am prescribed Depakote ER at 1000 mgs. daily, in conjunction to being prescribed Topamax 400 mgs. daily.



Depression is a not an uncommon problem in patients with epilepsy. In epileptics, the reported rates of depression range from 8-48% (mean 29%, median 32%); the prevalence of depression in the general population ranges, in different epidemiologic studies, from 6-17% (Hermann and Jones, 2005). Hippocrates noted the association—"Melancholics ordinarily become epileptics and epileptics melancholics." In a study of epileptic patients admitted to a psychiatric hospital, Betts found that depression was the most common psychiatric diagnosis. The frequency of anxiety also has been commented upon.

Two possibilities exist—the depression is a reaction to the chronic illness or the depression is a part of the epilepsy. Mendez et al compared patients with epilepsy to matched controls without epilepsy but with a similar degree of disability from other chronic medical diseases and found that, while 55% of the patients with epilepsy reported depression, only 30% of the matched controls reported depression. They concluded that depression is related to a specific epileptic psychosyndrome. On the other hand, Robertson concluded that, with few exceptions, the phenomenology of the depression is not to a large degree attributable to neuroepilepsy variables; however, not all studies have found this difference.

The etiology of depression in people with epilepsy is complex and includes the following:
  • Genetic vulnerability
  • Reaction to life events, including the epilepsy
  • Effect of antiepileptic drugs
  • The epilepsy, particularly temporal lobe and complex partial epilepsy

Jobe et al have presented evidence that some depressions and some epilepsies may be associated with decreased noradrenergic and serotonergic transmission in the brain.

Characteristics of patients with epilepsy who also have depression include the following:
  • Fewer neurotic traits
  • More psychotic traits
  • Higher trait and state anxiety scores
  • More abnormal affect and chronic dysthymic disorder
  • High hostility scores, especially for self-criticism and guilt
  • Sudden onset and brief duration of symptoms

Risk factors for the development of depression in patients with epilepsy include the following:
  • Temporal lobe and not frontal lobe partial complex seizures
  • Vegetative auras
  • Family history of psychiatric illness, particularly depression
  • Laterality effects, which are controversial
    • Flor-Henry speculated that depression might be related to right (nondominant) foci, a finding confirmed by a few other investigators. Some authors have suggested that elation is associated with right-sided lesions and depression or sadness with left-sided lesions. Most studies that find a relationship between laterality and depression have found depression to be more common with left-sided foci.
    • Lopez-Rodriguez et al found that major depressive episodes were statistically more frequent in patients with left temporal lobe seizures than in patients with right temporal lobe seizures.
    • Other authors report no laterality differences in depression rates.

Categorizing depression in patients with epilepsy as depression occurring peri-ictally (preictally, ictally, or postictally) and that occurring interictally may be useful. Robertson argued that Julius Caesar may have had depression as part of his seizures. Williams studied 2000 patients with epilepsy and found that depressed mood was part of the attack in 21, the second most common emotion constituting part of the attack. Fear was the most common; others have found similar results.

Perhaps 10-20% of persons with epilepsy have a peri-ictal prodrome consisting of depressed-irritable mood, sometimes with anxiety or tension and headaches. Although Williams noted in his patients that the mood disturbance would persist for 1 hour to 3 days after the ictus, postictal affective syndromes have received little attention in the literature. Blumer has defined an interictal dysphoric disorder (IDD) in patients with epilepsy in which symptoms tend to be intermittent. On average, the patients tend to have 5 of the following symptoms (range 3-8):
  • Depressed mood
  • Anergia
  • Pain
  • Insomnia
  • Fear
  • Anxiety
  • Paroxysmal irritability
  • Euphoric moods

Kanner has noted that the symptoms of depression in patients with epilepsy are different from those in patients without epilepsy. He believes that patients with epilepsy who are felt to warrant antidepressant therapy often do not meet formal DSM criteria for a mood disorder and concludes that the problem of depression in epilepsy may be underestimated by using screening instruments designed for use in psychiatric patients. Kanner also believes that the depression in epilepsy most resembles a dysthymic disorder, and he has named this condition the dysthymiclike disorder of epilepsy.


The treatment of mood disorders in patients with epilepsy includes re-evaluation of the anticonvulsant regimen, cautious but aggressive use of antidepressants, and psychotherapy, which also may be of use.

Improvement in seizure control should help in the treatment of ictal depression. A phenomenon analogous to alternative psychosis, worsening of behavior with better seizure control, has been reported in epilepsy-associated mood disorders. Phenobarbital is known to produce depression. According to Schmitz, vigabatrin has been linked to both psychoses and major depression, and phenytoin has been associated with toxic encephalopathies. McConnell and Duncan (1998b) cite some patients in whom phenytoin had been linked to both depression and mania. A case has been made that the GABAergic drugs may be associated with an increased incidence of psychiatric problems.

Virtually all non-monoamine oxidase-inhibiting antidepressants have been reported to lower seizure threshold. In the treatment of epilepsy-related depression, priority should be given to optimizing seizure control, since improved psychosocial functioning tends to accompany seizure remission. Antidepressants may manifest convulsant and anticonvulsant effects. Maprotiline and amoxapine have the greatest seizure risk; doxepin, trazodone, and fluvoxamine appear to have the lowest risk.

Several studies have documented that the quality of life improves significantly in epileptics who are made seizure free. If those patients are excluded, Boylan et al have found that the quality of life is related to depression but not to degree of seizure control. Both Elger et al and Harden et al have shown, in small studies, that treatment with vagal nerve stimulation improves depression in epileptics independent of effect on seizure frequency. Vagal nerve stimulation is a useful therapeutic tool in treatment-resistant depression.


The risk of suicide in the general population averages about 1.4%. Depression is one of the psychiatric disorders that increase the risk of suicide. The risk of suicide in depressed patients is believed to be around 15%. A recent study of over 9000 manic-depressive patients identified a suicide rate of 18.9%. Pokorny has estimated that the risk of suicide in depressed patients is as high as 50 times that of the general population.

On average, the risk of suicide in patients with epilepsy is about 13% (prevalence rate ranges from 5-10 times that of the general population). Although some authors question its methodological and patient selection techniques, most authors cite Barraclough's meta-analysis, which revealed that the risk of suicide in patients with temporal lobe epilepsy is increased to as much as 25-fold that of the general population.


The best-known examples of preictal elated mood are Dostoevsky's descriptions of ictal experiences in his works The Idiot and The Possessed. In a carefully selected series of epileptic patients, Williams found that only 165 of 2000 patients had complex, including emotional, ictal experiences. Of those 165, only 3 described elation. Mania and hypomania are rare in association with epilepsy. Manic-depressive illness is also rare; of 66 patients with epilepsy and major depression, only 2 had bipolar disease. This rarity is probably, to some degree, secondary to the antimanic effect of drugs such as carbamazepine and valproate. Mania was uncommonly associated with epilepsy even before the use of modern antiepileptic drugs.
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Old 06-05-06, 02:39 AM
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Hey, that's great the notes u posted! Learnt a lot. kip it up
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