Colin B Josephson1, Mark Lowerison2, Isabelle Vallerand3, Tolulope T Sajobi1, Scott Patten4, Nathalie Jette1, Samuel Wiebe5. 1. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada2Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada3Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada4O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada. 2. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada5Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada. 4. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada3Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada4O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada6Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 5. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada2Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada3Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada4O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada5Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Abstract
Importance: A bidirectional relationship exists between epilepsy and depression. However, any putative biological gradient between depression severity and the risk of epilepsy, and the degree to which depression mediates the influence of independent risk factors for epilepsy, has yet to be examined. Objective: To determine the effect of depression on the risk of epilepsy and seizure outcomes. Design, Setting, and Participants: An observational study of a population-based primary care cohort (all patients free of prevalent depression and epilepsy at 18-90 years of age who were active after the Acceptable Mortality Reporting date in The Health Improvement Network database) and a prospectively collected tertiary care cohort (all patients whose data were prospectively collected from the Calgary Comprehensive Epilepsy Programme). The analyses were performed on March 16, 2016. Main Outcome and Measures: The hazard of developing epilepsy after incident depression and vice versa was calculated. In addition, a mediation analysis of the effect of depression on risk factors for epilepsy and the odds of seizure freedom stratified by the presence of depression were performed. Results: We identified 10 595 709 patients in The Health Improvement Network of whom 229 164 (2.2%) developed depression and 97 177 (0.9%) developed epilepsy. The median age was 44 years (interquartile range, 32-58 years) for those with depression and 56 years (interquartile range, 43-71 years) for those with epilepsy. Significantly more patients with depression (144 373 [63%] were women, and 84 791 [37%] were men; P < .001) or epilepsy (54 419 [56%] were women, and 42 758 [44%] were men; P < .001) were female. Incident epilepsy was associated with an increased hazard of developing depression (hazard ratio [HR], 2.04 [95% CI, 1.97-2.09]; P < .001), and incident depression was associated with an increased hazard of developing epilepsy (HR, 2.55 [95% CI, 2.49-2.60]; P < .001) There was an incremental hazard according to depression treatment type with lowest risk for those receiving counselling alone (HR, 1.84 [95% CI, 1.30-2.59]; P < .001), an intermediate risk for those receiving antidepressants alone (HR, 3.43 [95% CI, 3.37-3.47]; P < .001), and the highest risk for those receiving both (HR, 9.85 [95% CI, 5.74-16.90]; P < .001). Furthermore, depression mediated the relationship between sex, social deprivation, and Charlson Comorbidity Index with incident epilepsy, accounting for 4.6%, 7.1%, and 20.6% of the total effects of these explanatory variables, respectively. In the Comprehensive Epilepsy Programme, the odds of failing to achieve 1-year seizure freedom were significantly higher for those with depression or treated depression. Conclusions and Relevance: Common underlying pathophysiological mechanisms may explain the risk of developing epilepsy following incident depression. Treated depression is associated with worse epilepsy outcomes, suggesting that this may be a surrogate for more severe depression and that severity of depression is associated with severity of epilepsy.
Importance: A bidirectional relationship exists between epilepsy and depression. However, any putative biological gradient between depression severity and the risk of epilepsy, and the degree to which depression mediates the influence of independent risk factors for epilepsy, has yet to be examined. Objective: To determine the effect of depression on the risk of epilepsy and seizure outcomes. Design, Setting, and Participants: An observational study of a population-based primary care cohort (all patients free of prevalent depression and epilepsy at 18-90 years of age who were active after the Acceptable Mortality Reporting date in The Health Improvement Network database) and a prospectively collected tertiary care cohort (all patients whose data were prospectively collected from the Calgary Comprehensive Epilepsy Programme). The analyses were performed on March 16, 2016. Main Outcome and Measures: The hazard of developing epilepsy after incident depression and vice versa was calculated. In addition, a mediation analysis of the effect of depression on risk factors for epilepsy and the odds of seizure freedom stratified by the presence of depression were performed. Results: We identified 10 595 709 patients in The Health Improvement Network of whom 229 164 (2.2%) developed depression and 97 177 (0.9%) developed epilepsy. The median age was 44 years (interquartile range, 32-58 years) for those with depression and 56 years (interquartile range, 43-71 years) for those with epilepsy. Significantly more patients with depression (144 373 [63%] were women, and 84 791 [37%] were men; P < .001) or epilepsy (54 419 [56%] were women, and 42 758 [44%] were men; P < .001) were female. Incident epilepsy was associated with an increased hazard of developing depression (hazard ratio [HR], 2.04 [95% CI, 1.97-2.09]; P < .001), and incident depression was associated with an increased hazard of developing epilepsy (HR, 2.55 [95% CI, 2.49-2.60]; P < .001) There was an incremental hazard according to depression treatment type with lowest risk for those receiving counselling alone (HR, 1.84 [95% CI, 1.30-2.59]; P < .001), an intermediate risk for those receiving antidepressants alone (HR, 3.43 [95% CI, 3.37-3.47]; P < .001), and the highest risk for those receiving both (HR, 9.85 [95% CI, 5.74-16.90]; P < .001). Furthermore, depression mediated the relationship between sex, social deprivation, and Charlson Comorbidity Index with incident epilepsy, accounting for 4.6%, 7.1%, and 20.6% of the total effects of these explanatory variables, respectively. In the Comprehensive Epilepsy Programme, the odds of failing to achieve 1-year seizure freedom were significantly higher for those with depression or treated depression. Conclusions and Relevance: Common underlying pathophysiological mechanisms may explain the risk of developing epilepsy following incident depression. Treated depression is associated with worse epilepsy outcomes, suggesting that this may be a surrogate for more severe depression and that severity of depression is associated with severity of epilepsy.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Robert S Fisher; Walter van Emde Boas; Warren Blume; Christian Elger; Pierre Genton; Phillip Lee; Jerome Engel Journal: Epilepsia Date: 2005-04 Impact factor: 5.864
Authors: James D Lewis; Rita Schinnar; Warren B Bilker; Xingmei Wang; Brian L Strom Journal: Pharmacoepidemiol Drug Saf Date: 2007-04 Impact factor: 2.890
Authors: Robert S Fisher; Carlos Acevedo; Alexis Arzimanoglou; Alicia Bogacz; J Helen Cross; Christian E Elger; Jerome Engel; Lars Forsgren; Jacqueline A French; Mike Glynn; Dale C Hesdorffer; B I Lee; Gary W Mathern; Solomon L Moshé; Emilio Perucca; Ingrid E Scheffer; Torbjörn Tomson; Masako Watanabe; Samuel Wiebe Journal: Epilepsia Date: 2014-04-14 Impact factor: 5.864
Authors: Kirsten M Fiest; Jonathan Dykeman; Scott B Patten; Samuel Wiebe; Gilaad G Kaplan; Colleen J Maxwell; Andrew G M Bulloch; Nathalie Jette Journal: Neurology Date: 2012-11-21 Impact factor: 9.910
Authors: Phil B Fontanarosa; Annette Flanagin; John Z Ayanian; Robert O Bonow; Neil M Bressler; Dimitri Christakis; Mary L Disis; S Andrew Josephson; Melina R Kibbe; Dost Öngür; Jay F Piccirillo; Rita F Redberg; Frederick P Rivara; Kanade Shinkai; Clyde W Yancy Journal: JAMA Neurol Date: 2021-08-01 Impact factor: 29.907