How seizure disorders change depression treatment

Psychotherapy. Because psychosocial factors can play a role in the expression of depression in patients with epilepsy, cognitive, behavioral, and interpersonal therapy may be useful.⁶ These treatment modalities provide an opportunity to educate patients and families about epilepsy, explore emotional reactions to the condition, and correct false beliefs about the illness. Goldstein¹⁷ showed that after 12 sessions of cognitive-behavioral therapy, 6 patients with chronic, poorly controlled epilepsy reported reduced depression scores. Their initial epilepsy-related problem had less impact on their daily lives and self-rated work and social adjustment improved significantly.

CASE CONTINUED: Seeing results

We treat Ms. A’s mood episodes with carbamazepine, titrated up to 400 mg bid. Her seizures decrease in frequency, and after 1 month her depressive symptoms subside. Her coworkers describe Ms. A as more outgoing and full of energy.

We refer Ms. A to an epilepsy support group that meets twice a month, and she is relieved to know other patients experience similar symptoms. She continues individual psychotherapy, which helps her adjust to epilepsy’s chronic nature and complications.

Related resources

• Epilepsy Foundation. Epilepsy and mood disorders. www.epilepsyfoundation.org/programs/mood.
  
• Epilepsy Foundation. Neurological Disorders Depression Inventory for Epilepsy Screening Tool. www.epilepsyfoundation.org/about/related/mood/nddietool.cfm.
  

Drug brand names

• Amitriptyline • Elavil
  
• Amoxapine • Asendin
  
• Bupropion • Wellbutrin
  
• Carbamazepine • Tegretol
  
• Citalopram • Celexa
  
• Clomipramine • Anafranil
  
• Desipramine • Norpramin
  
• Doxepin • Sinequan
  
• Duloxetine • Cymbalta
  
• Fluoxetine • Prozac
  
• Fluvoxamine • Luvox
  
• Imipramine • Tofranill
  
• Lamotrigine • Lamictal
  
• Lithium • Eskalith, Lithobid
  
• Nomifensine • Merital
  
• Maprotiline • Ludiomil
  
• Mirtazapine • Remeron
  
• Nefazodone • Serzone
  
• Nortriptyline • Aventyl, Pamelor
  
• Oxcarbazepine • Trileptal
  
• Paroxetine • Paxil
  
• Phenytoin • Dilantin
  
• Primidone • Mysoline
  
• Sertraline • Zoloft
  
• Tiagabine • Gabitril
  
• Topiramate • Topamax
  
• Trazodone • Desyrel
  
• Valproic acid • Depakote
  
• Venlafaxine • Effexor
  

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.