Individuals With Epilepsy on Antidepressants Continue to Signal Depression, Anxiety

Limited real-world data exist on the efficacy of prescribing antidepressants to patients with epilepsy, and prior research has shown persistent anxiety and depression among patients with epilepsy despite ongoing antidepressant prescription.

A recent study identified the factors that are linked with a higher likelihood of these patients indicating continuing depression or anxiety while using antidepressant medication.

There are known associations between anxiety and depression in people with epilepsy and poor quality of life, increased health care utilization, medication-related adverse events, drug-resistant epilepsy, and premature mortality. The large, cross-sectional analysis by researchers at Wake Forest University School of Medicine, published in Epilepsy & Behavior Reports, evaluated the absence or presence of anxiety and/or depression in patients with epilepsy who were prescribed antidepressants.

Between April 30, 2018, and June 6, 2019, researchers screened 884 visits from 3 tertiary care clinics for prospective anxiety and/or depression. Sociodemographic and health characteristics were collected on sex, age, race, ethnicity, marital status, education, insurance type, epilepsy type, seizure frequency, seizure freedom (> 6 months), and antiseizure medications (ASMs). Preselected characteristics included in the analysis were antidepressant dose, antidepressant prescriber specialty, ASM (number, potential psychotropic effects), seizure frequency, employment, visit no-shows, and medical insurance.

Of 884 visits, 563 consecutive patients with adult epilepsy were included in the analysis; most of those excluded from the analysis stemmed from a lack of follow-up visits or not having an epilepsy diagnosis.

Of the 563 individuals, 152 had evidence of antidepressant prescription at the time of screening, and of those 152 patients, 48% indicated on self-reported screening instruments that they had signs of anxiety and/or depression.

Statistical analysis showed low dosing of antidepressants and not showing up for medical visits were linked with positive screening results (adjusted OR [aOR], 2.29; 95% CI, 1.00-5.48; and aOR, 3.11; 95% CI, 1.26-8.22, respectively).

Overall, 30.2% of patients screened positive for anxiety and/or depression, and at the time of screening, there was evidence of ongoing antidepressant treatment in 27% of patients.

“This large consecutive analysis of clinic patients screened for anxiety and depression demonstrated high prevalence of positive screens despite existing antidepressant prescriptions, indicating lack of adequate symptom relief among many patients in this care setting,” wrote the authors.

“The findings demonstrate a need for clinical improvement efforts to optimize antidepressant dosing for people with epilepsy and enhance adherence,” the authors wrote. “Future longitudinal studies are needed to evaluate interventions to improve antidepressant care delivery and further evaluate factors associated with antidepressant responsiveness among people with epilepsy.”

The authors acknowledged limitations to this analysis, including a lack of data to thoroughly explore antidepressant use over time. Because of this, the presence or absence of positive screenings for anxiety and/or depression does not regard preexisting antidepressant prescription or the duration of prior prescription, which may not have been optimized by the patient. Another limitation was the lack of adequate screening instruments, which were self-reported on tablets and do not reflect a definitive diagnosis for anxiety and/or depression.

The authors said further research should include multiple centers and nontertiary care centers to increase generalizability in more populations. Additionally, they believe that further studies should investigate nonadherence as a potential intervenable factor in anxiety and depression treatment-related outcomes.

“The study results also suggest greater between-visit care intensity for neurologists among patients with positive anxiety or depression screens and when antidepressants are prescribed by the neurologist. Strategies to meet this clinical care burden should be evaluated,” the authors concluded.

References

Martin SO, Sadeghifar F, Snively BM, et al. Positive anxiety or depression screen despite ongoing antidepressant prescription in people with epilepsy: a large cross-sectional analysis. Epilepsy Behav Rep. Published online November 5, 2022. doi:10.1016/j.ebr.2022.100572