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Anxiety and Depression

Anxiety and Depression

While both depression and anxiety are common mood disorders in the general population, there is a growing body of evidence that the prevalence rate of these disorders is also substantial in people with epilepsy. Based on this premise Joyce Cramer, Associate Research Scientist, Department of Psychiatry, Yale University and colleagues recently conducted a study examining symptoms of anxiety and depression as well as health-related quality of life (HRQOL) among epilepsy patients whose seizures were not fully controlled. Their findings were published in the journal Epilepsy & Behavior (Cramer JA, Brandenburg N, Xu X. Differentiating anxiety and depression symptoms in patients with partial epilepsy. Epilepsy Behav 2005;6:563-9).Adult epilepsy patients taking two or more antiepileptic drugs completed the Hospital Anxiety and Depression (HADS) questionnaire and the Quality of Life in Epilepsy (QOLIE-10) questionnaire.

Hospital Anxiety and Depression Scale (HADS)

HADS is a research tool designed to measure both anxiety and depression. The anxiety subscale of the HADS contains seven questions designed to measure generalized anxiety including: anxious mood, restlessness, anxious thoughts, and panic attacks. The depression subscale also includes seven questions and is geared towards lost interest and diminished pleasure (“lowering of hedonic tone”). Each subscale score ranges from 0 to 21, with higher scores representing poorer emotional well-being. Scores of 0–7 on either subscale are considered to represent “normal”, 8–10 represents “mild”, 11–14 represents “moderate”, and 15–21 represents “severe” levels of anxiety and depression.

Quality of Life in Epilepsy (QOLIE-10)

Dimensions of health-related quality of life in epilepsy were assessed by the QOLIE10. This instrument includes 10 questions assessing energy, overall quality of life (QOL), cognitive and social functioning, emotional well-being, the effects of epilepsy medications, and worry about seizures. Previous work has demonstrated that this abbreviated instrument is as reliable as the longer QOLIE-31 instrument, using the same format of seven subscales and a total score. Higher scores represent more favorable health states.

Findings and Implications of the Study

Anxiety and depression are separate psychiatric conditions that are often inter-related. This study examined whether they exist independently, and whether they affect all quality-of-life domains. “What our study revealed is that approximately half of the patients had symptoms of anxiety and depression. Patients reporting more severe anxiety or severe depression had worse HRQOL than patients with no or mild symptoms. Depression symptoms had a greater influence on HRQOL than anxiety symptoms, but both were related to overall HRQOL”, said Cramer. She suggested that patients may benefit from increased attention to the role of anxiety separately from depression. She further contended that screening, diagnosis and treatment of anxiety and depression could be an important contribution to the wellness of people with epilepsy whether or not seizures are controlled. “Future studies are needed to determine the individual correlations with epilepsy, and specific medications. Studies should be performed with patients having purely anxiety or depression, and taking a single antiepileptic drug,” added Cramer.

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