Profiling the evolution of depression after epilepsy surgery

• Published in: Epilepsia (Copenhagen) 2011-05, Vol.52 (5), p.900-908
• Main Authors: Wrench, Joanne M., Rayner, Genevieve, Wilson, Sarah J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anterior Temporal Lobectomy; Anticonvulsants. Antiepileptics. Antiparkinson agents; Biological and medical sciences; Depression; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - epidemiology; Diagnostic and Statistical Manual of Mental Disorders; Epilepsy; Epilepsy surgery outcome; Epilepsy, Temporal Lobe - psychology; Epilepsy, Temporal Lobe - surgery; Etiology; Evolution; Female; Follow-Up Studies; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Longitudinal Studies; Male; Medical sciences; Mental depression; Middle Aged; Mood; Nervous system (semeiology, syndromes); Neurology; Neuropharmacology; Pharmacology. Drug treatments; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Prevalence; Psychiatric Status Rating Scales - statistics & numerical data; Psychosocial adjustment; Quality of Life; Risk Factors; Seizures; Surgery; Temporal lobe; Temporal Lobe - surgery; Temporal lobe epilepsy; Treatment Outcome
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1111/j.1528-1167.2011.03015.x

Summary Purpose:  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 η2 = 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