Epilepsy and Mood Disorders

Abstract

Mood disorders are the most common psychiatric comorbid disorder that affects quality of life and prognosis in epilepsy. The relation between depression and epilepsy is bidirectional. Not only the risk of having a depression among epilepsy cases is more than the healthy control cases, but also the risk of having epilepsy among depressive cases is more than the healthy control cases. People diagnosed with epilepsy are five times more likely than their peers to commit suicide. Moreover it seems that some epilepsy types like temporal lobe epilepsy have a much higher risk (25 times) for suicide. Risk of suicide in epilepsy, which is independent from depression, increases more with the presence of depression. The common pathway between epilepsy, depression and suicide is hypofrontality and irregularity of serotonin metabolism. Contrary to depression, data on relationship between bipolar disorder and epilepsy is limited. However, mood disorder, mixed episodes with irritable character and mania are more frequent than assumed. As a matter of fact, both disorders share some common features. Both are episodic and can become chronic. Kindling phenomenon, irregularities in neurotransmitters, irregularities in voltage gate ion channels and irregularities in secondary messenger systems are variables that are presented in the etiologies of both disorders. Anticonvulsant drugs with mood regulatory effects are the common points of treatment. Understanding their mechanisms of action will clarify the pathophysiological processes. In this article, the relationhip between epilepsy and mood disorders, comorbidity, secondary states and treatment options in both cases have been discussed.

Keywords

• Epilepsy, depression, bipolar disorder

Epilepsi ve Duygudurum Bozuklukları

Abstract

Duygudurum bozuklukları epilepside yaşam kalitesini ve prognozu etkileyen önemli bir psikiyatrik eştanıdır. Depresyon ile epilepsi arasındaki ilişki çift yönlüdür. Epileptik olgular arasındaki depresyon geliştirme riski sağlıklı kont-rollerden yüksek olduğu kadar, depresif olgular arasında da epilepsi geliştirme riski sağlıklı kontrollerden yüksektir. Özkıyım epilepside beş kat, temporal lob epilepsisinde 25 kat artar. Epilepside depresyondan bağımsız var olan özkıyım riski, depresyonun varlığında daha da artar. Epilepsi, depresyon ve özkıyım arasındaki ortak yol hipofrontalite ve serotonin metabolizmasındaki düzensizliktir. Dizin daha çok depresyonla ilgili bilgi sağlarken bipolar bozuklukla ilgili veriler daha sınırlıdır. Oysa duygudurum düzensizliği, irritabilite ile karakterli karma dönemler ve mani sanıldığından daha sıktır. Her iki bozukluk da döngüsel olup süregenleşebilir. Ateşleme fenomeni, nörotransmiter, voltaj kapılı iyon kanallarında ve ikincil mesajcı sistemlerdeki düzensizlikler her iki bozukluğun etiyolojisinde öne sürülen değişikliklerdir. Duygudurum düzenleyici etkileri olan antikonvülzan ilaçlar ortak tedavi noktasını oluşturmaktadır. Bu ilaçların etki mekanizmalarının anlaşılması patofizyolojik süreçlere ışık tutacaktır. Bu yazıda epilepsi ile duygudurum bozuklukları arasındaki ilişki, eştanı, ikincil durumlar ve her iki durumda tedavi seçenekleri ele alınmıştır.

Keywords

• Epilepsi, depresyon, bipolar bozukluk

References

1. Mula M, Marotta AE, Monaco F. Epilepsy and bipolar disorders. Expert Rev Neurother 2010; 10:13-23.
2. Lewis AM. A historical review. J Ment Sci 1934; 80:1-42.
3. Robertson MM. Affect and mood in epilepsy: an overview with a focus on depression. Acta Neurol Scand 1992; 140:127-32.
4. Currie S, Heathfield KW, Henson RA, Scott DF. Clinical course and prognosis of temporal lobe epilepsy: a survey of 666 patients. Brain 1971; 94:173-190.
5. Victororff JI, Benson F, Grafton ST, Engel JJr, Mazziotta JC. Depression in complex partial seizures: electroencephalography and cerebral metabolic correlates. Arch Neurol 1994; 51:155-163.
6. Batzel LW, Dodrill CB. Emotional and intellectual correlates of unsuccessful suicide attempts in people with epilepsy. J Clin Psychol 1986; 42:699-702.
7. Indaco A, Carrieri PB, Nappi C, Gentile S, Striano S. Interictal depression in epilepsy. Epilepsy Res 1992; 12:45-50.
8. Mendez MF, Cummings JL, Benson DF. Depression in epilepsy: significance and phenomenology. Arch Neurol 1986; 43:766-770.

9. Locke DE, Fakhoury TA, Berry DT, Locke TR, Schmitt FA. Objective evaluation of personality and psychopathology in temporal lobe versus extratemporal lobe epilepsy. Epilepsy Behav 2010; 17:172-177.
10. Palia SS, Herper MA. Mood disorders in epilepsy: a survey of psychiatric patients. Presented at the Annual meeting of the Royal College of Psychiatrists. The University of Southampton, United Kingdom, 8-10 July 1986.
11. Altshuller LL, Devinsky O, Post RM, TheodoreW. Depression, anxiety and temporal lobe epilepsy: laterality of focus and symptoms. Arch Neurol 1990; 47:284-288.
12. Whitmann S, Herman BP. The architecture of research in the epilepsy/ psychopathology field. Epilepsy Res 1989; 3:93-99.
13. Kanner AM. Mood disorder and epilepsy: a neurobiologic perspective of their relationship. Dialogues Clin Neurosci. 2008; 10:39-45.
14. Kharatishvili I, Pitkanen A. Posttraumatic epilepsy. Curr Opin Neurol 2010; 23:183- 188.
15. Zyss T. May depression be a form of epilepsy? Some remarks on the bioelectric nature of depression. Med Hypotheses 2009; 73:746-752.
16. Ikuta T, Furuta N, Kihara S, Okura M, Nagamine I, Nakayama H et al. Differences in wave of cerebral evoked potentials among healthy subjects, schizophrenics, manic- depressives and epileptics. J Med Invest 2007; 54:303-315.
17. Bjork MH, Sand T, Brathen G, Linaker OM, Morken G, Nilsen BM. Quantitative EEG findings in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department. BMC Psychiatry 2008; 8:89.
18. Belmaker RH, Bersudsky Y. Lithium-pilocarpine seizures as a model for lithium action in mania. Neurosci Biobehav Rev 2007; 31:843-849.
19. Pineda E, Shin D, Sankar R, Mazarati AM. Comorbidity between epilepsy and depression: experimental evidence for the involvement of serotonergic, glucocorticoid, and neuroinflammatory mechanisms. Epilepsia 2010; 51(Suppl 3):110-114.
20. Mazarati A, Siddarth P, Baldwin RA, Shin D, Caplan R, Sankar R. Depression after status epilepticus: behavioural and biochemical deficits and effects of fluoxetine. Brain 2008; 131:2071-2083.
21. Karr L, Pan YZ, Rutecki PA. CB1 receptor antagonism impairs the induction of epileptiform activity by group I metabotropic glutamate receptor activation. Epilepsia 2010; 51(Suppl 3):121-125.
22. Seidenberg M, Pulsipher DT, Hermann B. Association of epilepsy and comorbid conditions. Future Neurol 2009; 4:663-668.
23. Zeber JE, Copeland LA, Amuan M, Cramer JA, Pugh MJ. The role of comorbid psychiatric conditions in health status in epilepsy. Epilepsy Behav 2007; 10:539-546.
24. Herken H, Karaca S, Demir O, Aşkın R, Demir F, Şahinoğlu DG. Epilepsi ve migren hastalarında depresyon düzeyleri ve kişilik özellikleri. Yeni Symposium 1999; 37:92- 99.
25. Akçalı A, Altındağ A, Geyik S, Cansel N. Epilepsi hastalarında yaşam kalitesi, depres- yon, anksiyete ve çok boyutlu algılanan sosyal destek. Nöropsikiyatri Arşivi 2009; 46:91-97.
26. Cankurtaran EŞ, Uluğ B, Saygı S. Epilepsiye eşlik eden psikiyatrik bozukluklar. Klinik Psikofarmakoloji Bülteni 2004; 14:97-106.
27. Neze H, Havle N, İlnem MC, Yener F. Epilepsi tanısı ile takip edilen kişilerde psiki- yatrik hastalıklar ve bunun yaşam kalitesi üzerine etkisi. Yeni Symposium 2009; 47:147-154.
28. Nadkarni S, Devinsky O. Psychotropic effects of antiepileptic drugs. Epilepsy Curr 2005; 5:176-181.
29. Barabas G, Matthews WS. Barbiturate anticonvulsants as a cause of severe depression. Pediatrics 1988; 82:284-285.
30. Ring HA, Heller AJ, Farr IN, Reynolds EH. Vigabatrin: rational treatment for chronic epilepsy. J Neurol Neurosurg Psychiatry 1990; 53:1051-1055.
31. Eken B, Verimli A, İzbırak G, Er FO. Psikiyatrik bozukluklarda lamotrijin kullanımı. Anadolu Psikiyatri Dergisi 2008; 9:169-178.
32. Smith D, Chadwick D, Baker G, Davis G, Dewey M. Seizure severity and the quality of life. Epilepsia 1993; 34(Suppl 5):S31-S35.
33. Ojemann LM, Friel PN, Trejo WJ, Dudley DL. Effect of doxepin on seizure frequency in depressed epileptic patients. Neurology 1983; 33:646-648.
34. Robertson MM, Trimble MR. The treatment of depression in patients with epilepsy: a double-blind trial. J Affect Disord 1985; 9:127-136.
35. Zyss T. Electroconvulsive treatment and phenomenon of kindling in depression. Psychiatr Pol 2009; 43:529-543.
36. Kellner CH, Knapp R, Husain MM, Rasmussen K, Sampson S, Cullum M et al. Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial. Br J Psychiatry 2010; 196:226-134.
37. Lim HW, Song HS, Hwang YH, Lee HW, Suh CK, Park SP et al. Predictors of suicidal ideation in people with epilepsy living in Korea. J Clin Neurol 2010; 6:81- 88.
38. Arana A, Wentworth CE, Ayuso-Mateos JL, Arellano FM. Suicide-related events in patients treated with antiepileptic drugs. N Engl J Med 2010; 363:542-551.
39. VanCott AC, Cramer JA, Copeland LA, Zeber JE, Steinman MA, Dersh JJ et al. Suicide-related behaviors in older patients with new anti-epileptic drug use: data from the VA hospital system. BMC Med 2010; 8:4.
40. Ciechanowski P, Chaytor N, Miller J, Fraser R, Russo J, Unutzer J et al. PEARLS depression treatment for individuals with epilepsy: A randomized controlled trial. Epilepsy Behav 2010; 19:225-231.
41. Grunze HC. Anticonvulsants in bipolar disorder. J Ment Health 2010; 19:127-141.
42. Lewy AB, Drake ME, Shy KE. EEG evidence of epileptiform paroxysms in rapid cycling bipolar patients. J Clin Psychiatry 1988; 49:232-234.
43. Howland RH. Bipolar disorder associated with primary generalised epilepsy Br J Psychiatry. 1993; 162:699-700.
44. Sakkas P, Theleritis CG, Psarros C, Papadimitriou GN, Soldatos CR. Jacksonian seizure in a manic patient treated with rTMS. World J Biol Psychiatry 2008; 9:159- 160.
45. Kaplan PW, Birbeck G. Lithium-induced confusional states: nonconvulsive status epilepticus or triphasic encephalopathy? Epilepsia 2006; 47:2071-2074.
46. Suzuki K, Miura N, Awata S, Ebina Y, Takano T, Honda T et al. Epileptic seizures superimposed on catatonic stupor. Epilepsia 2006; 47:793-798.
47. Espinosa GR, Benavides SE. The possible temporal lobe syndrome of Ivan IV the Terrible. Rev Med Chil 2006; 134:1465-1469.
48. Bahalı MK, Zengin M, Tamam L, Özpoyraz N, Bozdemir H. Zorunlu normalleşme: psikiyatrik bozukluklar ve epilepsi ilişkisinde önemli bir fenomen. Klinik Psikofarmakoloji Bülteni 2008; 18:322-326.
49. Nishida T, Kudo T, Inoue Y, Nakamura F, Yoshimura M, Matsuda K et al. Postictal mania versus postictal psychosis: differences in clinical features, epileptogenic zone, and brain functional changes during postictal period. Epilepsia 2006; 47:2104-2114.
50. Ettinger AB, Reed ML, Goldberg JF, Hirschfeld RM. Prevalence of bipolar symptoms in epilepsy vs other chronic health disorders. Neurology 2005; 65:535- 540.
51. Mula M, Schmitz B, Jauch R, Cavanna A, Cantello R, Monaco F et al. On the prevalence of bipolar disorder in epilepsy. Epilepsy Behav 2008; 13:658-661.
52. de Oliveira GN, Kummer A, Salgado JV, Portela EJ, Sousa-Pereira SR, David AS et al. Psychiatric disorders in temporal lobe epilepsy: an overview from a tertiary service in Brazil. Seizure 2010; 19:479-484.
53. Aksoy-Poyraz C, Ozdemir A, Ozmen M, Arikan K, Ozkara C. Electroconvulsive therapy for bipolar depressive and mixed episode with high suicide risk after epilepsy surgery. Epilepsy Behav 2008; 13:707-709.
54. Mula M, Monaco F. Antiepileptic drug-induced mania in patients with epilepsy: what do we know? Epilepsy Behav 2006; 9:265-267.
55. Ishihara L, Webb DJ, Irizarry M, Weil J. Exploring differential prescribing between anti-epileptic drugs in epilepsy patients with a history of mood disorders. Pharmacoepidemiol Drug Saf 2010; 19:289-295.
56. Kanner AM. Depression in epilepsy: prevalence, clinical semiology, pathogenic mechanisms, and treatment. Biol Psychiatry 2003; 54:388-398.
57. Vaaler AE, Morken G, Iversen VC, Kondziella D, Linaker OM. Acute Unstable Depressive Syndrome (AUDS) is associated more frequently with epilepsy than major depression. BMC Neurol 2010; 10:67.
58. Mula M, Jauch R, Cavanna A, Collimedaglia L, Barbagli D, Gaus Vet al. Clinical and psychopathological definition of the interictal dysphoric disorder of epilepsy. Epilepsia 2008; 49:650-656.
59. Post RM, Altshuler LL, Frye MA, Suppes T, McElroy SL, Keck PE Jr et al. Preliminary observations on the effectiveness of levetiracetam in the open adjunctive treatment of refractory bipolar disorder. J Clin Psychiatry 2005; 66:370-374.
60. Salpekar JA, Conry JA, Doss W, Cushner-Weinstein S, Pearl PL, Weinstein SL et al. Clinical experience with anticonvulsant medication in pediatric epilepsy and comorbid bipolar spectrum disorder. Epilepsy Behav 2006; 9:327-334.
61. Shukla S, Mukherjee S, Decina P. Lithium in the treatment of bipolar disorders associated with epilepsy: an open study. J Clin Psychopharmacol 1988; 8:201-204.
62. Gualtieri CT, Johnson LG. Comparative neurocognitive effects of 5 psychotropic anticonvulsants and lithium. MedGenMed 2006; 8:46.
63. Johannessen Landmark C. Antiepileptic drugs in non-epilepsy disorders: relations between mechanisms of action and clinical efficacy. CNS Drugs 2008; 22:27-47.
64. Mula M, Jauch R, Cavanna A, Collimedaglia L, Barbagli D, Gaus V et al. Manic/hypomanic symptoms and quality of life measures in patients with epilepsy. Seizure 2009; 18:530-532.
65. Manchanda R, Schaefer B, McLachlan RS, Blume WT, Wiebe S, Girvin JP et al. Psychiatric disorders in candidates for surgery for epilepsy. J Neurol Neurosurg Psychiatry 1996; 61:82-89.
66. Blumer D, Wakhlu S, Davies K, Hermann B. Psychiatric outcome of temporal lobectomy for epilepsy: incidence and treatment of psychiatric complications Epilepsia 1998; 39:478-486.
67. Sermin Kesebir, Doç. Dr., Erenköy Ruh ve Sinir Hastalıkları Hastanesi, İstanbul; Sertaç Güven, Dr., Erenköy
68. Ruh ve Sinir Hastalıkları Hastanesi, İstanbul; İsmail Koç, Dr., Erenköy Ruh ve Sinir Hastalıkları Hastanesi, İstanbul