Depression Screening in Teens With Epilepsy Feasible, Effective

Depression Screening in Teens With Epilepsy Feasible, Effective

Establishing a depression screening protocol for young epilepsy patients is feasible and effective and helps fill an unmet need, new research shows.

“We’re trying to make other clinics aware that screening is feasible; it’s easy to do, even in a large volume clinic,” study investigator and pediatric psychologist Hillary Thomas, PhD, UT Southwestern Medical Center, Children’s Health System, Dallas, told Medscape Medical News.

Screening for depression among patients with epilepsy was included in recently updated quality measures for epilepsy care, published by the American Academy of Neurology.

“Screening is greatly needed in this population as teens and children with epilepsy have a higher risk for developing depressive symptoms,” she said.

Thomas and her co-investigators found that about 16% of teens attending their epilepsy clinic required some type of behavioral health intervention.

This finding, she said, highlights the need for a behavioral health protocol within an epilepsy clinic.

The study was presented here at the American Epilepsy Society (AES) 2018 Annual Meeting.

Depression Highly Prevalent

Based on various research studies, the prevalence of depression in children with epilepsy ranges from 5% to 38%. This is about two to three times higher than the general population, said Thomas.

“We know that many AEDs can have depression or mood effects as a side effect, and so we worry sometimes that our treatment could be causing or worsening depression,” study coauthor Susan T. Arnold, MD, professor, pediatrics, neurology and neurotherapeutics, and director of the Comprehensive Epilepsy Center at UT Southwestern, told Medscape Medical News.

There’s a “fair amount of evidence” that some factors that increase the risk for epilepsy also raise the risk for depression, said Arnold. Abnormalities in certain neurotransmitters or structural abnormalities in the brain can increase this risk.

Screening kids helps identify those who are vulnerable, “which is so easy for us to overlook otherwise,” said Arnold.

In general, a score of 0 to 9 on this scale indicates mild depression, 10 to 20 moderate depression, and more than 20 means severe depression.

The clinic has developed a protocol for responding to the varying levels of depressive symptoms.

“If they’re in that mild to minimal range of depressive symptoms, we don’t necessarily do anything specific in clinic, but we do educate regularly” and keep families up to date on monitoring, said Thomas.

For young patients in the moderate to severe range of depression, providers will speak to families and the clinic will connect them to behavioral health resources, she said.

A “gold standard” for treating depression is cognitive behavioral therapy, which helps patients identify negative thought patterns and change their behavior to improve mood. Some patients need a referral to a psychiatrist for medical management.

“We know for sure that those two interventions work for depression in general, but there is not a lot of research to show how effective they are in a pediatric epilepsy population,” said Thomas.

No Disruption

If a child indicates any suicidal ideation, regardless of the level of depressive symptoms, a pediatric psychologist or clinical social worker is paged.

“We then provide further risk assessment and create safety plans for families,” said Thomas.

For the study, researchers included 394 children aged 15 to 18 years who completed the PHQ-9 between June 2017 and May 2018.

The study found that 64% of subjects had minimal depressive symptoms, 20% had mild symptoms, and 9% had moderate or severe symptoms. About 7% had suicidal ideation and 16% required the behavioral health protocol.

Children should ideally be screened at every clinic visit, but at minimum once per year, said Arnold. Most kids come to the clinic every 6 months so it’s done at that time.

Staff at the clinic were a “a little reluctant” at first to start doing depression screening, said Arnold.

“One of the concerns initially was how we were going to get through our very busy day and provide care for the child’s epilepsy if we’re sidetracking ourselves to care for depression.”

But staff were “positively surprised” at how smooth and nondisruptive the introduction was.

“Although we do sometimes need to call a social worker or psychologist down to clinic, it’s not that often; most of the time, children are not in a crisis situation. In retrospect, we wish we had started the screening sooner,” Arnold said.

Thomas and Arnold said they want to show other epilepsy experts that introducing depression screening wasn’t disruptive.

“It didn’t complicate the clinic visit that much and we found ways of organizing our ability to refer to local mental health services when needed, and ways of building this information into our clinic workflow,” said Arnold.

The clinic has about 8000 visits a year from children with epilepsy.

“With such a large population, we feel that the information we’re collecting is something that is very valuable to share with other clinics,” said Arnold.

Clinic patients now fill out questionnaires using paper forms, but the aim is to introduce an online format that patients can complete on iPads when they come in.

Commenting on the findings for Medscape Medical News, Amy Brooks-Kayal, MD, codirector of the Translational Epilepsy Research ProgramPonzio Family Chair in Pediatric Neurologyand chief of pediatric neurology, Children’s Hospital Colorado in Aurora, said the study finding that 16% of the population needed some type of behavioral health intervention was informative.

“It highlights the importance of screening for emotional and behavioral comorbidities in adolescents with epilepsy. It also underlines the need for having a behavioral health protocol in place to manage the patients identified as needing intervention,” she said.

SOURCE: Medscape by P. Anderson

Arnold, Thomas, and Brooks-Kayal have disclosed no relevant financial relationships.

American Epilepsy Society (AES) 2018 Annual Meeting: Abstract 1.388 Presented December 1, 2018.

Severe depression: Vagus nerve stimulator improves lives

Severe depression: Vagus nerve stimulator improves lives

For people with treatment-resistant depression, adding vagus nerve stimulation to medication can drastically improve their quality of life, concludes a new study.

People with severe depression may benefit from the neurostimulation technique ‘vagus nerve stimulation.’

The National Institute of Mental Health suggest that over 16 million people in the United States have had at least one episode of major depression in the past year.
Of these, more than 10 million adults report that the condition severely impaired their quality of life.

There are a variety of treatments available for depression, including therapy, medication, and making changes to one’s lifestyle. However, for some, these therapies are not enough to relieve the symptoms and improve quality of life.

Some with treatment-resistant depression turn to neurostimulation. One type of neurostimulation is vagus nerve stimulation (VNS).

In VNS, a device is fitted in the patient’s chest or neck, under the skin. These devices send pulses of electrical stimulation to the vagus nerve, which starts in the brain, goes through the neck, and ends in the chest and abdomen.

However, does VNS really improve the quality of life of those who opt for it? A new study, just published in The Journal of Clinical Psychiatry, aims to answer this question.

The researchers were led by Dr. Charles R. Conway, a professor of psychiatry at Washington University in St. Louis, MO.

Source: By A. Sandoiu/fact checked by J. Collier for

Why does depression make you feel tired?

Why does depression make you feel tired?

Depression can cause debilitating fatigue and make the simplest activities, such as getting out of bed, too difficult to manage.

According to a 2018 report, fatigue affects over 90 percent of people with major depressive disorder.

In this article, learn about the link between depression and fatigue, as well as how to cope.



A Chronic Childhood Illness Like Epilepsy Could Increase Risk of Adult Depression, Study Reports

A Chronic Childhood Illness Like Epilepsy Could Increase Risk of Adult Depression, Study Reports

Chronic childhood illnesses such as epilepsy could increase the risk that a person will develop clinical depression as an adult, according to new research.

The study, “Research Review: Childhood chronic physical illness and adult emotional health – a systematic review and meta-analysis,” was published in the Journal of Child Psychology and Psychiatry. (more…)