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New research project to launch into epilepsy and depression in primary care
A new study, headed by Professor Mike Kerr with the help of GPs in South Wales, is planned for 2009 with the aim of exploring how the primary care team can detect depression in people with epilepsy (PWE).
Depression levels are thought to be high in the population of people with epilepsy, but depression is often not picked up in individuals with epilepsy, leading to delays in offering treatment. It is difficult to identify depression in PWE and one reason for this is that many symptoms of depression are also common side effects of anti-epileptic medication. Another reason might be that individuals suffering comorbid depression and epilepsy may under-report their symptoms of depression.
Comorbid depression has a reported prevalence of over 10% in primary care studies (1), and this figure is much higher in specialist centres (2). GPs are the doctors that people see most often and so identifying depression at this level could potentially improve quality of life for many individuals.
Depression in PWE is an important issue, since this is the most commonly described inter-ictal illness. Depression is likely to factor in the heightened suicide and suicidal ideation levels in epilepsy (3) and PWE suffering depression are more likely to utilise health services (4), increasing the cost of care. Effective treatment for comorbid depression is likely to increase overall wellbeing and adherence to treatment routines, and for these reasons screening for depression in primary care is crucial.
Two short screening measures will be compared in the EDPC study, assessing their accuracy and acceptability for detection of comorbid depression in PWE. The Patient Health Questionnaire-2 (PHQ-2) (5) is already used by GPs for identifying depression in people who have diabetes and coronary heart disease. This shall be contrasted with the Neurological Disorders Depression Inventory (NDDI-E) (6), which was recently developed specifically for depression screening in PWE.
The study is funded by Epilepsy Research UK.
References
(1) Mensah, S. A., Beavis, J. M., Thapar, A. K., & Kerr, M. (2006). The presence and clinical implications of depression in a community population of adults with epilepsy. Epilepsy & Behaviour, 8, 213-219.
(2) Lehrner, J., Kalchmayr, R., Serles, W., Olbrich, A., Pataraia, E., Aull, S., Bacher, J., Luetmezer, F., Groppel, G., Deecke, L., & Baumgartner, C. (1999). Health-related quality of life (HRQOL), activity of daily living (ADL) and depressive mood disorder in temporal lobe epilepsy patients. Seizure, 8, 88-92.
(3) Diehl, L. W. (1986). Epilepsie und suizid (epilepsy and suicide). Psychitrie,
Neurologie, und Medizinische Psychologie, 38, 625-633.
(4) Cramer, J. A., Blum, D., Fanning, K., & Reed, M. (2004). The impact of comorbid depression on health resource utilization in a community sample of people with epilepsy. Epilepsy & Behaviour, 5, 337-342.
(5) Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2003). The patient health
questionnaire-2 – Validity of a two-item depression screener. Medical Care, 41, 1284-1292.
(6) Gilliam, F. G., Barry, J. J., Hermann, B. P., Meador, K. J., Vahle, V., & Kanner, A. M. (2006). Rapid detection of major depression in epilepsy: A multicentre study. Lancet Neurology, 5, 399-405.
