Therapy of depression in patients with focal epilepsy: experience with citalopram use

Objective: to evaluate the efficacy, tolerability, and safety of citalopram (pram, «Lannacher Heilmittel, Austria) used to treat depressive disorders in adult patients with symptomatic or cryptogenic (presumptively symptomatic) focal epilepsy.

Subjects and methods. One hundred and twenty-one patients with symptomatic or cryptogenic (presumptively symptomatic) focal epilepsy were examined; 24 patients were found to have varying symptoms of depression. The Hospital Anxiety and Depression Scale (HADS) was used as a screening test for the symptoms of depression and anxiety. Citalopram was given orally for the treatment of depressive disorder. The Hamilton Depression Rating Scale (HDRS) was used to evaluate the efficiency of the performed therapy and to estimate the time course of changes in parameters. Quality of life was estimated by the special QOLIE-31 questionnaire. The duration of the follow-up was 12 weeks.

Results. The study enrolled 24 patients (14 women and 10 men). Their mean age was 47.5±7.6 years; the duration of epilepsy was 9.71±3.15 years. The first visit showed a pronounced preponderance of the symptoms of anxiety according to the HADS: the mean scores for anxiety and depression were 13.38±2.15 and 11.19±3.28, respectively. After citalopram therapy, the mean scores for anxiety and depression decreased to 6.19±2.60 and 7.58±1.86, respectively. During the first visit, the mean Hamilton depression score was 21.73±3.19 and that was 14.60±2.19 and 11.18±2.33 after 30 days and 12 weeks of citaloprom therapy, respectively. Analysis of the time course of changes in quality of life indicators during citalopram therapy, by applying the QOLIE-31 scale, revealed a significant increase in their total scores 2 and 3 months following the treatment with unchanged antiepileptic therapy. There was an inverse correlation between the total QOLIE-31 score for quality of life and the degree of depression rated by HDRS (r=-0.94, p<0.05) prior to and 12 weeks after citalopram therapy ((r=-0.92, p<0.05). No increases in the number of episodes were found in any of the patients.

Conclusions. By using the selective serotonin reuptake inhibitor citalopram, the patients with focal epilepsy showed a regression in the symptoms of depression and anxiety and an improvement in the quality of life. At the same time none patient was found to have any increases in the number of attacks. The side effects of the therapy were few and short-time and required no drug discontinuation.

1. <div><p>Гехт А.Б., Авакян Г.Н., Гусев Е.И. Современные стандарты диагностики и лечения эпилепсии в Европе. Журн неврол и психиатр им. С.С. Корсакова 1999;7:4-7.</p><p>Kanner A.M., Balabanov A. Depression and epilepsy: how closely related are they?Neurology 2002;58;8 (Suppl. 5):S27-39.</p><p>Аведисова А. С. Общие вопросы психофаpмакотеpапии психогений в pезультате действия экстpемальных факторов. Рос психиатр журн 2003;2:5-17.</p><p>Лебедева А.В., Билалова П.И., Гехт А.Б. и др. Особенности эмоциональных нарушений у больных эпилепсией. Журн неврол и психиатр им. С.С. Корсакова 2009;11:52.</p><p>Barry J., Lembke A., Huynh N. Affective disorders in epilepsy. Psychiatric issues in epilepsy. A practical guide to diagnosis and treatment. A. Ettinger, A. Kanner. Philadelphia, 2001;45-71.</p><p>Blumer D. Epilepsy and suicide: a neuropsychiatric analysis. The neuropsychiatry of epilepsy. M. Trimble, B. Schmitz (eds.). Cambridge, 2002;107-16.</p><p>Kanner A., Nieto J. Depressive disorders in epilepsy. Neurology 1999;53(Suppl. 2):26-32.</p><p>Kanner A. Depression in neurological disorders. Lundbeck Institute, Cambridge Medical Communication Ltd., 2005;161 p.</p><p>Michaud C.M., Murray C.J., Bloom C.M. Burden of disease: Implications for future research. JAMA 2001;285(5):535-9.</p><p>Воронкова К.В., Петрухин А.С., Пылаева О.А. и др. Рациональная антиэпилептическая фармакотерапия. Рук-во для врачей. М.: Бином, 2008;192 с.</p><p>Гехт А.Б., Лебедева А.В., Ковалева И.Ю. и др. Эпилепсия и депрессия. Материалы докладов пленума правления Российского общества психиатров с участием главных психиатров и наркологов, руководителей психиатрических и наркологических учреждений субъектов Российской Федерации. М., 2009.</p><p>Blum D., Reed M., Metz A. Prevalence of major affective disorders and manichypomanic symptoms in persons with epilepsy: a community survey. Neurology 2002;Suppl. 3:A175.</p><p>Gilliam F.G., Santos J., Vahle V. et al. Depression in epilepsy: ignoring clinical expression of neuronal network dysfunction? Epilepsia 2004;46(Suppl. 2):28-33.</p><p>Blumer D., Herzog A.G., Himmelhoch J. et al. To what extent do premenstrual and interictal dysphoric disorders overlap? Significance for therapy. J Affect Disorders 1998;48:215-25.</p><p>Blumer D. Dysphoric disorders and paroxysmal affects: recognition and treatment of epilepsy - related psychiatric disorders. Harvard Rev Psychiatry 2000;8:8-17.</p><p>Kanner A.M. Recognition of the various expressions of anxiety, psychosis, and aggression in epilepsy. Epilepsia 2004;45(2):22-7.</p><p>Калинин В.В., Полянский Д.А. Факторы риска развития суицидального поведения у больных эпилепсией. Журн неврол и психиатр им. С.С. Корсакова 2003;103(3):18-21.</p><p>Карлов В.А. Эпилепсия у детей и взрослых, женщин и мужчин. М.: Медицина, 2010;720 с.</p><p>Мосолов С.Н. Клиническое применение современных антидепрессантов. СПб.: МИА, 1995;568 с.</p><p>Hovorka J., Herman E., Nemcova I. Treatment of interictal depression with citalopram in patients with epilepsy. Epilepsy Behav 2000;1:444-7.</p><p>Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6:278-96.</p><p>Zigmond A.S., Snaith R.P. The Hospital Anxiety and Depression scale. Acta Psychiatr Scand 1983;67(6):361-70.</p><p>Cramer J., Perrine K., Devinsky O. et al. Development and Cross-cultural translation of a 31-item quality of life in epilepsy inventory. Epilepsia 1998;39(1):81-8.</p></div><br />