Profiling the evolution of depression after epilepsy surgery

Abstract

SUMMARYPurpose: Both neurobiologic and psychosocial factors have been proposed to account for the high prevalence of depression surrounding epilepsy surgery. Using a prospective longitudinal approach, this study aimed to profile the evolution of depression after epilepsy surgery at multiple time points, including early and longer-term follow-up. We also sought to identify neurobiologic and psychosocial predictors of depression before and after surgery, including whether patients undergoing mesial temporal lobe resection (MTR) were at greater risk of depression than patients undergoing nonmesial temporal lobe resection (NMTR). Methods: Sixty patients undergoing epilepsy surgery (38 MTR, 22 NMTR) for the treatment of medically intractable seizures were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively in the Comprehensive Epilepsy Program of Austin Health. The diagnosis of depression was based on DSM-IV criteria for major depressive disorder, as assessed from a mental state examination. The Austin CEP Interview was used to obtain a detailed psychosocial assessment of each patient and family members. Key Findings: Before surgery, 43% of patients had a lifetime prevalence of depression, with no difference between the proportion of patients in the MTR (40%) and NMTR groups (50%). Predictive factors included a family history of psychiatric illness (p = 0.015) and financial dependence of either family members or government income benefits (p = 0.024). Discriminant function analysis indicated that these factors classified 69% of cases correctly (p = 0.006, partial g 2 = 0.06). In the 12 months following surgery, 37% of MTR and 27% of NMTR patients experienced major depression, with no significant difference between the two groups. The majority of depressed patients (70%) were diagnosed in the first 3 months and in 65% of diagnosed cases, the depression persisted for at least 6 months within the follow-up period. The pattern of recurrent and de novo depression differed significantly between the groups, with 13% of MTR patients developing de novo major depression in comparison to no NMTR patients (p = 0.05). A preoperative history of depression (p = 0.003) and poor postoperative family dynamics (1 month, p < 0.001; 3 months, p = 0.007; 6 months, p = 0.021; 12 months, p = 0.097) were predictive of depression after surgery. These factors correctly classified 78% of cases (p = 0.000, partial g 2 = 0.19). Significance: The findings of this study confirm high rates of major depression before and after epilepsy surgery, the etiology of which is multifactorial. They highlight the need for thorough assessment and diagnosis before surgery, as well as the provision of routine follow-up and psychological support, particularly early after surgery. When estimating level of risk for depression, patients should be counseled about the role of both neurobiologic and psychosocial factors. Before surgery, these include a family history of psychiatric illness and financial dependence, whereas poor family adjustment to lif...

The comorbidity of epilepsy and depression: diagnosis and treatment

“…In 2011, Wrench et al [46] followed 60 epileptics for 12 months after surgery and found that the prevalence of postoperative major depression (MD) was increased with time, but was still lower than the preoperative prevalence (30% vs 43%). In 2015, Barbieri et al [47] followed 248 PWE for 12 months after epilepsy surgery and found that 27% of patients experienced postoperative depression, 3 patients committed suicide after the end of the study, and one was diagnosed with de novo depression within 6 months after surgery.…”

“…In 2011, Wrench et al [46] found that 8% (5/60) of patients had de novo major depression. In 2011, Barbieri et al.…”

Lennox-Lombroso Lecture, 2013: Psychiatric Comorbidities through the Life of the Seizure Disorder: A Complex Relation with a Not So Complex Solution

“…For example, in a study of 60 PWE undergoing a temporal lobectomy (38 had a resection of mesial structures, and 22 had resection of temporal lateral neocortical structures) (19), a lifetime history of depression was identified in 43% of patients, with no difference between those who had mesial and those who had temporal lateral resections. In the 12 months after surgery, 20 patients (33%) experienced an MDE (occurring in the first 3 postsurgical months in 70% and persisting for at least 6 months in 65% of patients).…”

Complications of Epilepsy Surgery: A Single Surgeon's Experience from South India

“…32,33 Most depressive episodes are diagnosed in the first 3 months and persist for at least 6 months, with rates of depression steadily declining across a 24-month follow-up period. 33 Surgical resections disrupting mesial temporal structures increase the risk of de novo depression after surgery.…”

“…33 Risk factors for depression after surgery include a positive preoperative history of psychological disturbances and poor postoperative family support. 32 Globally, there is considerable variability in the psychiatric evaluation and follow-up of patients in epilepsy surgery programs. However, the existing literature suggests heightened risk for psychological comorbidity in patients with epilepsy who are surgically managed.…”