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Take control of your epilepsy and seizures. Seizure management has never been easier.
TAKE CONTROL TODAYInterictal depression , occurs in 25% to 55% of patients (1,2). Further, the suicide rate of persons with epilepsy is more than five times that of controls (1,3). Interictal depression has biological mechanisms (family history of depression, structural lesions, AEDs) and psychosocial-reactive mechanisms (1,2,4–6). The burden of suffering depression causes is enormous. In one study of patients with medically refractory epilepsy, depression was by far the most significant predictor of poor quality of life, overriding seizure frequency and severity (7). Depression was common (54%), underdiagnosed, and largely untreated in this population (only 17% were taking antidepressants) (7). In two separate studies, use of tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) by patients with epilepsy more frequently led to reduced seizure frequency than to exacerbation (8,9). If corroborated by larger, prospective studies, this finding may be secondary to improved sleep and mood, factors associated with reduction of seizure frequency.
SSRIs and related drugs (e.g., venlafaxine and nefazodone) are the first line of therapy for most patients with depression. However, the efficacy and safety of any specific SSRI has not been proved (38). Drug interactions are more likely with fluoxetine, fluvoxamine, and paroxetine than with escitalopram, citalopram, or sertraline. Fluoxetine’s long half-life (>24 hours) is an advantage during tapering off, since it reduces the frequency of withdrawal symptoms. However, a long half-life is a disadvantage if the patient cannot tolerate the drug or experiences an adverse drug interaction.
Reproduced and adapted with permission from Orrin Devinsky, M.D. and Epilepsia.
Topic Editor: Steven C. Schachter, M.D.
Last Reviewed:12/15/06
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