Faculty Bibliography

OBJECTIVES/OBJECTIVE:To assess the frequency of depression symptoms, quality of life, and disability in a community-based sample of epilepsy (EPI), asthma, and healthy control (NCH) subjects, and the relationship of depression with EPI-specific aspects of quality of life, social concerns, antiepileptic drug-related side effects, and employment. METHODS:Mail survey with depression (Center for Epidemiology Studies-Depression Scale [CES-D]), quality of life (Short Form [SF]-36), and Sheehan Disability (SDS) scales to 775 EPI, 395 asthma, and 362 NCH subjects. EPI subjects completed Quality of Life in Epilepsy-89 (QOLIE-89), Social Concerns Index, Adverse Events Profile, and employment questions. RESULTS:A total of 36.5% EPI, 27.8% asthma, and 11.8% NCH were positive on CES-D (p < 0.001). EPI had the most prior consultations and treatments for depression but 38.5% of EPI-CES-D+ and 43.7% of asthma-CES-D+ were never previously evaluated for depression. EPI subjects had worse quality of life on SF-36 subscales and greater SDS disability but were similarly disabled as asthma subjects in the presence of depression. Among EPI subjects, CES-D-based depression was significantly associated with being female, being younger, lower income, worse QOLIE-89 scores, more SDS disability, more social concerns, more adverse drug events, less past-month employment, and fewer working days. CONCLUSIONS:Depression is common in community-based epilepsy and asthma patients, and is associated with diverse impairments.

PURPOSE/OBJECTIVE:To determine the relation between depressive symptoms and seizure severity among people with epilepsy. METHODS:A postal questionnaire was used to survey a nationwide community sample about seizures and depression. The Seizure Severity Questionnaire (SSQ) assessed the severity and bothersomeness of seizure components. The Centers for Epidemiological Studies-Depression scale categorized levels of depression. RESULTS:Respondents categorized as having current severe (SEV, n = 166), mild-moderate (MOD, n = 74), or no depression (NO, n = 443) differed significantly in SSQ scores (all p < 0.0001). People with SEV or MOD reported significantly worse problems than did those with NO depression for overall seizure recovery (mean, 5.3, 4.9, 4.5, respectively); overall severity (5.0, 4.5, 4.2); and overall seizure bother (5.3, 4.8, 4.4) (all p < 0.005). Cognitive, emotional, and physical aspects of seizure recovery also were rated worse among people with SEV than with NO depression (all p < 0.05). Symptoms of depression were significantly correlated with higher levels of all components of generalized tonic-clonic seizure severity (r = 0.33-0.48; all p < 0.0001), and partial seizures (r = 0.31-0.38; all p < 0.01). CONCLUSIONS:Clinically depressed people with epilepsy reported higher levels of perceived severity and bother from seizures, as well as greater problems with overall seizure recovery than did nondepressed people experiencing similar types of seizures. The pervasive influence of depressive symptoms on reports of seizure activity suggests that people with epilepsy should be screened for depression. These data highlight the importance of detecting and treating depression among people with epilepsy.

As a common component of mood disorders, aggression can have many adverse effects on the child's or adolescent's life, including disrupting school performance and causing personal rejection by family, peers, and teachers. The problems of children and adolescents with mood disorders are compounded by comorbid aggressiveness. Without effective treatment for both problems, many of these aggressive, depressed children and adolescents go on to experience multiple failures in life leading to disturbances in character and the inability to establish fulfilling interpersonal relationships. This article is intended to heighten clinician awareness of the complex relationship between mood disorders and aggression.