Article

Cognitive-behavioral therapy for depression in patients with temporal lobe epilepsy: a pilot study.

Neuropsychiatry Unit, Mexico's National Institute of Neurology and Neurosurgery, México City, México.
Epilepsy & Behavior (Impact Factor: 1.84). 12/2011; 23(1):52-6. DOI: 10.1016/j.yebeh.2011.11.001
Source: PubMed

ABSTRACT Depression has a high prevalence among patients with temporal lobe epilepsy (TLE). A pilot study was carried out to evaluate group cognitive-behavioral therapy (CBT) as a treatment for depression in patients with TLE. Twenty-three outpatients with TLE and major depressive disorder, according to DSM-IV criteria, were enrolled and divided into two groups to receive 16 weekly sessions of CBT. The primary outcome measures were depression severity (assessed with the Beck Depression Inventory) and quality of life (measured with the Quality of Life in Epilepsy-31). Sixteen patients (70%) completed at least 80% of the sessions. From week 8, CBT had a significant positive effect on severity of depression that lasted until the end of treatment. A significant improvement in quality of life was also observed. CBT seems to be a useful intervention for treating depression and improving quality of life in patients with TLE.

0 Bookmarks
 · 
140 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: One of every three patients with epilepsy (PWE) will experience a depressive disorder in the course of their life, often associated with anxiety symptoms or a full blown anxiety disorder. Clearly, the high prevalence of these psychiatric comorbidities calls for their early identification and management. This article provides practical strategies in the management of depressive episodes in PWE. Contrary to long-held beliefs, the use of antidepressant drugs are safe in PWE when used at therapeutic doses. Antidepressant drugs of the selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) families are the first line of therapy in depressive disorders, and failure to achieve complete symptom remission after a trial of an SSRI or SNRI at optimal doses should be followed by a second trial with a drug from the other antidepressant family. In developing countries, antidepressant drugs of these two antidepressant families are not always available, and tricyclic antidepressants (TCAs) are the drugs of choice. Although there are no differences in efficacy among the three families of antidepressants, TCAs have a lower tolerability and higher toxicity, with greater mortality risk associated with cardiotoxic effects in overdoses. Cognitive behavior therapy is another treatment modality that has been shown to be effective in the treatment of depressive disorders in patients with and without epilepsy. Its use should be considered together with pharmacotherapy or by itself.
    Epilepsia 03/2013; 54 Suppl 1:3-12. · 3.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cognitive behavioral therapy (CBT) is a recommended treatment for depression in people with epilepsy (PWE); however, a recent Cochrane review found that there was insufficient evidence that any psychological therapy is effective. This conclusion provides little help to clinicians who provide interventions for depressed PWE. The aim of this review was to systematically and qualitatively review the literature on the efficacy of CBT for depression in PWE based on randomized controlled trials (RCTs) and case series. We aim to determine patterns in the literature to inform the type of CBT, if any, that should be offered to PWE who are depressed. Databases MEDLINE, PsycINFO, and the Cochrane EBM Reviews were searched via OVID. Selection criteria included the following: (1) participants with epilepsy; (2) use of CBT; (3) valid depression outcome measure; and (4) published in peer-reviewed journal in English. Inclusions of studies were assessed by two independent researchers. We identified 14 outcome papers for 13 CBT trials including 6 randomized controlled trials (RCTs) and 7 case series. Positive effects of CBT on depression were reported in three of six RCTs. A review of their content revealed that all effective RCTs specifically tailored CBT to improve depression. Conversely, two of three RCTs that failed to find depression-related effects focused on improving seizure-control. This pattern was also observed in the case series. Although limited in number and having methodologic limitations, the treatment studies included in our review suggest that interventions tailored toward improving depression are possibly efficacious, whereas those that focus on improving seizure control do not appear to be. However, this review highlights that there is need for further RCTs in this area in order to confirm the possible efficacy of CBT for depression in PWE.
    Epilepsia 09/2013; · 3.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We describe the physical, psychological, and social complications and adaptation demands after epilepsy surgery and the risks of the development of psychiatric disorders when adequate stress processing fails. Practical strategies that can be followed in the prevention and treatment of postsurgical psychiatric complications are reviewed. The postoperative period is divided in three phases: (1) the early postoperative phase of stress processing until discharge from hospital; (2) the coping phase during the first months after discharge; and (3) the reorientation phase. The early postoperative course is often dominated by physical problems that hamper success in convalescence. They may initiate early psychiatric disturbances especially in patients with preoperative psychiatric comorbidity. The second phase after discharge from hospital is the typical time in which various psychiatric disorders may develop (either de novo or exacerbations of known disorders). At this time it is mandatory to keep in contact with patients, to start psychiatric treatments if necessary, and to assess for suicidal risk. The course of the third phase of reorientation depends on seizure outcome and on psychiatric state. Seizure-free persons without psychiatric comorbidities start to forget their epilepsy; those with less successful outcome conditions may need further support, especially for vocational integration. Epilepsy surgery brings about an overall strong improvement of psychiatric morbidity and quality of patients' life. Nevertheless, the first postoperative year is a fragile period that includes multiple physical, psychological, and social adaptation tasks. Patients with a history of psychiatric disorders are at a special risk of failing to cope with those health-related demands, but also for nonpsychiatric patients the months after epilepsy surgery are often stressful and exhausting. Professional help must be available during the postoperative coping time.
    Epilepsia 03/2013; 54 Suppl 1:46-52. · 3.96 Impact Factor

Full-text

View
39 Downloads
Available from
Jun 2, 2014