Help-seeking and treatment preferences for depression in epilepsy.

Depression among people with a diagnosis of epilepsy is common, underrecognized, and undertreated, yet the reasons for this are unclear. In this study people with a diagnosis of epilepsy recruited from primary care were mailed a questionnaire covering help seeking for psychological distress, treatment preferences for depression, and current symptoms of depression using the Patient Health Questionnaire-2 (PHQ2). Eighty-six people with epilepsy responded to the survey and 44% of the sample reported they would not seek help if they were feeling stressed, worried, or low and it was affecting their daily lives. Almost 40% of the participants screened positive for current depression and PHQ2 scores were statistically unchanged over an average of 8.6 months. The most popular treatment for depression was advice from a general practitioner or from family and friends. The majority of respondents felt speed of treatment should take priority over receiving preferred treatment for depression care.

A community study of the presence of anxiety disorder in people with epilepsy.

Anxiety represents a major problem for people with epilepsy, and it is important to understand why it arises and how to reduce its potential debilitating and adverse effects. The aim of this study was to determine the prevalence of anxiety in a community-identified sample of people with epilepsy and to identify which demographic and clinical factors are most closely associated with anxiety and which factors predict the presence of anxiety among people with epilepsy. Adults with epilepsy in the community (n=515) were identified through primary care records and sent validated questionnaires, which included the Hospital Anxiety and Depression Scale (HADS). The mailout also included items on demographic and clinical variables. The prevalence of anxiety (HADS score >11) in this sample was 20.5% (95% CI: 16.9-24.1%) and was associated with a current history of depression, perceived side effects of antiepileptic medication, lower educational attainment, chronic ill health, female gender, and unemployment. It was not associated with the duration of epilepsy. The findings from this study suggest that anxiety disorders in a community population with epilepsy are most strongly predicted by factors independent of epilepsy-related variables, with the exception of patient-reported side effects. It is important to be aware of these factors when evaluating an individual with epilepsy.

The presence and clinical implications of depression in a community population of adults with epilepsy.

Depression is the most common psychiatric comorbidity in epilepsy, but clinical and other factors associated with this observation and their impact on detection and management of depression in people with epilepsy are poorly understood. This study used a community-based postal questionnaire of primary care-identified people with epilepsy. We were therefore able to explore depression in a nonspecialist care-identified population. Clinical and demographic associative factors were examined. The dependent variable was depression, as defined by a score of 11 or greater on the Hospital Anxiety and Depression Scale (HADS). The prevalence of depression in our sample (n = 499) was found to be 11.2% (95% CI: 8.3-13.7%). Depression was most strongly associated with unemployment. It was also associated with having had a recent seizure and complaints of side effects of antiepileptic medications. Depression was not associated with gender, marital status, or monotherapy or polytherapy antiepileptic medication. The prevalence of depression in epilepsy is greater than in the general population, with no associated female preponderance. Our findings underline important variations in the associative features between depression in the general population and in people with epilepsy, with particular implications for management of this comorbidity.