Depression in children and adolescents with epilepsy
Introduction
During the past decade considerable research evidence has demonstrated that juvenile-onset depression is a chronic illness characterized by a recurrent course, severe psychosocial morbidity, and the risk of suicide [1]. Studies of the general population have reported 2–6% prevalence rates of depression in children and adolescents [2], [3], [4]. Suicide is the third leading cause of death among adolescents in the United States, with a mortality rate of about 8 per 100,000 among 15- to 19-year-olds [5]. Practice parameters are available from the American Academy of Child and Adolescent Psychiatry to guide in diagnosis and management of youths with depression (available at www.aacap.org). Consensus guidelines for medication treatment algorithms for childhood depression and comorbid psychiatric disorders were proposed in 1999 through the Texas Children’s Medication Algorithm Project [6].
Unfortunately, psychiatric illnesses, including major depressive disorder, are underdiagnosed and undertreated in patients with epilepsy [7]. Ott et al. [8] reported a disconcerting discrepancy between the high rate of psychiatric diagnoses (60%) and the low rate of mental health services (33%) in youth with epilepsy. The rate of depression in youths with chronic epilepsy as measured by self-reporting instruments varies between 23 and 26% [9], [10]. These findings may explain the reported increased suicidality in youths with epilepsy [11], [12]. There are only a few published longitudinal studies exploring the development and course of emotional and behavioral problems, including depression, in youths with epilepsy [13], [14], [15].
This article summarizes the current data on the evaluation and treatment of depression in the general population of youths, with specific focus on issues related to comorbid epilepsy.
Section snippets
Etiological factors
Children and adolescents with epilepsy are vulnerable to the same multietiological risk factors for psychiatric disorders as the general population. Moreover, living with epilepsy creates an additional burden on the child and the entire family. The understanding of childhood depression requires the evaluation of the relationships between biological, social, and iatrogenic risk factors and negative life events. In patients with epilepsy, a fundamental question remains unanswered: do seizures
The clinical issues
The concept of childhood depression is relatively new. As recently as 20–30 years ago, it was generally accepted that prepubertal children were unable to suffer from depression because of insufficient ego and superego development for the understanding of self and for feelings of guilt, which is a central part of depression [37]. Adolescents and children as young as 6 years old exhibit the typical phenomenology of depression, comparable to that in adulthood [38], [39]. The DSM-IV-R adult
Treatment strategies
The explosive increase in new classes of antidepressants and the recognition that children and adolescents with depression grow up to be adults with depression have prompted the development of new standards for safe and effective treatment [50], [53], [54]. However, the treatment of youths with epilepsy and depression presents considerable challenges.
The mean length of a depressive episode in children and adolescents is approximately 7 to 9 months [2], [45] and there is a 40% relapse rate by 2
Conclusion
Depression in youth with epilepsy is a common but often unrecognized disorder. Patients may experience impairment of successful development because both epilepsy and depression are characterized by a chronic course and a poor long-term psychosocial outcome. Safe and effective multimodal treatment approaches are available. More research is necessary to develop effective prevention and intervention strategies and to improve the long-term outcome.
References (95)
- et al.
Major depression in community adolescents: age at onset, episode duration, and time to recurrence
J. Am. Acad. Child Adolesc. Psychiatry
(1994) - et al.
Epidemiology of childhood depressive disorders: a critical review
J. Am. Acad. Child Adolesc. Psychiatry
(1990) - et al.
The Texas Children’s Medication Algorithm Project: report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder
J. Am. Acad. Child Adolesc. Psychiatry
(1999) Overrepresentation of epileptics in a consecutive series of suicide attempts seen at Children’s Hospital
J. Am. Acad. Child Adolesc. Psychiatry
(1986)- et al.
A prospective study of teacher’s ratings of behavior problems in children with new-onset seizures
Epilepsy Behav.
(2003) - et al.
Symptoms of depression in adolescents with epilepsy
J. Am. Acad. Child Adolesc. Psychiatry
(1999) - et al.
Major psychiatric disorders subsequent to treating epilepsy by vagus nerve stimulation
Epilepsy Behav.
(2001) - et al.
Mood state in unilateral temporal lobe epilepsy
Biol. Psychiatry
(1991) - et al.
Safety of tiagabine: summary of 53 trials
Epilepsy Res.
(1999) - et al.
Psychopathology in parents of depressed children and adolescents
J. Am. Acad. Child Adolesc. Psychiatry
(1989)
A case-control family history study of depression in adolescents
J. Am. Acad. Child Adolesc. Psychiatry
Onset of psychopathology in offspring by developmental phase and parental depression
J. Am. Acad. Child Adolesc. Psychiatry
Mother–child interaction in children with epilepsy: relations with child competence
J. Epilepsy
Developmental considerations in the study of childhood depression
Dev. Rev.
Preschool major depressive disorder (MDD): preliminary validation for developmentally modified DSM-IV criteria
J. Am. Acad. Child Adolesc. Psychiatry
The clinical picture of depression in preschool children
J. Am. Acad. Child Adolesc. Psychiatry
Psychiatric comorbidity among referred juveniles with major depression: fact or artifact?
J. Am. Acad. Child Adolesc. Psychiatry
Suicidal behaviors and childhood-onset depressive disorders: a longitudinal investigation
J. Am. Acad. Child Adolesc. Psychiatry
Rate and predictors of prepubertal bipolarity during follow-up of 6- to 12-year-old depressed children
J. Am. Acad. Child Adolesc. Psychiatry
The course of major depressive disorder in adolescents: I. recovery and risk of manic switching in a follow-up study of psychotic and nonpsychotic subtypes
J. Am. Acad. Child Adolesc. Psychiatry
Adult outcomes of childhood and adolescent depression: II. Links with antisocial disorders
J. Am. Acad. Child Adolesc. Psychiatry
Childhood and adolescent depression: a review of the past 10 years. Part I
J. Am. Acad. Child Adolesc. Psychiatry
The outcome of adolescent depression in the Ontario Child Health Study follow-up
J. Am. Acad. Child Adolesc. Psychiatry
Nonsomatic treatment of depression
Child Adolesc. Psychiatr. Clin. North Am.
Somatic treatment for depressive illnesses in children and adolescents
Child Adolesc. Psychiatr. Clin. North Am.
Vagus nerve stimulation (VNS) for major depressive episodes: one-year outcomes
Biol. Psychiatry
Compliance with recommendations to remove firearms by families participating in a clinical trial for adolescent depression
J. Am. Acad. Child Adolesc. Psychiatry
Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled study
J. Am. Acad. Child Adolesc. Psychiatry
Multicenter open-label sertraline study in adolescent outpatients with major depression
J. Am. Acad. Child Adolesc. Psychiatry
The use of sertraline in patients with epilepsy: is it safe?
Epilepsy Behav.
Treatment of interictal depression with citalopram in patients with epilepsy
Epilepsy Behav.
Comparative effects of nefazodone and fluoxetine on sleep in outpatients with major depressive disorder
Biol. Psychiatry
Depressed adolescents grown up
JAMA
Depression, depressive symptoms, and depressed mood among a community sample of adolescents
Am. J. Psychiatry
Deaths: leading causes for 2000
Natl. Vital Statist. Rep.
Co-morbid psychiatric disorder in chronic epilepsy: recognition and etiology of depression
Neurology
Behavioral disorders in pediatric epilepsy: unmet psychiatric need
Epilepsia
Behaviour issues in pediatric epilepsy
Neurology
Symptoms of depression and anxiety in pediatric epilepsy patients
Epilepsia
Relationship of epilepsy-related factors to anxiety and depression in epileptic children
J. Child Neurol.
Recurrent seizures and behavior problems in children with first recognized seizures: a prospective study
Epilepsia
Psychosocial, behavioral and medical outcomes in children with epilepsy: a developmental risk factor model using longitudinal data
Pediatrics
Depression in epilepsy: relationship to seizures and anticonvulsant therapy
J. Nerv. Ment. Dis.
Cerebral metabolism and depression in patients with complex partial seizures
Arch. Neurol.
Psychiatric profiles and patterns of cerebral blood flow in focal epilepsy: interactions between depression, obsessionality, and perfusion related to the laterality of the epilepsy
J. Neurol. Neurosurg. Psychiatry
Phenobarbital treatment and major depressive disorder in children with epilepsy
Pediatrics
Vigabatrin
Cited by (84)
Internalizing symptoms in intractable pediatric epilepsy: Structural and functional brain correlates
2020, Epilepsy and BehaviorDissociation and other clinical phenomena in youth with psychogenic non-epileptic seizures (PNES) compared to youth with epilepsy
2019, SeizureCitation Excerpt :This scale includes items regarding: feelings of sadness, unhappiness, loneliness; episodes of tearfulness, depressive cognitions such as guilt, and self-denigration, self-injuriousness and suicidality. This finding is especially noteworthy since depression in children and adolescents with epilepsy is in fact a common comorbidity, and suicide risks are reported to be higher than in the general population [20]. Higher depression scores in YPNES suggest they may even be at a greater risk than YWE for this comorbidity.
How can transition to adult care be best orchestrated for adolescents with epilepsy?
2019, Epilepsy and Behavior