Depressive and anxiety disorders in epilepsy: Do they differ in their potential to worsen common antiepileptic drug–related adverse events

Epilepsia, 05/29/2012

Depressive and anxiety disorders worsen antiepileptic drug (AED)–related AEs even when presenting as a subsyndromic type. These data suggest that the presence of psychiatric comorbidities must be considered in their interpretation, both in clinical practice and AED drug trials.

Methods

  • The study included 188 consecutive PWE from five U.S. outpatient epilepsy clinics, all of whom underwent structured interviews (SCID) to identify current and past mood disorders and other current Axis I psychiatric diagnoses according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria.
  • A diagnosis of SSDE was made in patients with total Beck Depression Inventory-II (BDI-II) scores >12 or the Centers of Epidemiologic Studies-Depression (CES-D) > 16 (in the absence of any DSM diagnosis of mood disorder.
  • The presence and severity of AEs was measured with the Adverse Event Profile (AEP).

Results

  • Compared to asymptomatic patients (n=103), the AEP scores of patients with SSDE (n=26), MDE only (n=10), anxiety disorders only (n=21), or mixed MDE/anxiety disorders (n=28) were significantly higher, suggesting more severe AED-related AEs.
  • Univariate analyses revealed that having persistent seizures in the last 6 months and taking antidepressants was associated with more severe AEs.
  • Post hoc analyses, however, showed that these differences were accounted for by the presence of a depressive and/or anxiety disorders.

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