Depression in children and adolescents with epilepsy

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Abstract

Depression in children and adolescents with epilepsy is a common but often unrecognized disorder. Both epilepsy and depression are characterized by a chronic course and poor long-term psychosocial outcome. The risk of suicide is even greater in depressed youth with epilepsy than in the general youth population. Educating parents about mood disorders may allow them to be more receptive to psychiatric treatment for their child or themselves. Epidemiological and clinical data on depression in children/adolescents with epilepsy are presented. Seizure-related and general risk factors for the development of depression in youth with epilepsy are reviewed. General guidelines for diagnosis and treatment of depression in children and adolescents are discussed. The early identification and treatment of childhood-onset depression is an important clinical task for all pediatric specialists. Safe and effective multimodal treatment approaches are available.

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.

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