Depression and anxiety are common comorbid conditions in people with epilepsy. Their presence is associated with an increase in suicide risk, increase healthcare costs, increase in mortality and reduced quality of life.

There are also knock-on effects for seizure control, in persons with epilepsy who report symptoms of depression, subsequently reporting poorer seizure control.
Psychotherapy, particularly cognitive-behavioral therapy (CBT), is recommended for the treatment of depression and anxiety in persons with epilepsy.  A study concluded psychotherapy is efficacious for treatment of distress in persons with epilepsy. However, the clinical relevance of the interventions is unclear as estimates of clinical significance were not include.


In the review, which included individual patient data from 315 people Dr. Adam J. Noble from the University of Liverpool, U.K., and his colleagues focused on the likelihood of clinically relevant improvements in symptomatology.  Following cognitive therapy (CBT), 66.9% of participants with epilepsy experienced no reliable change in depression symptoms, 30.4% experienced reliable improvements and 2.7% experienced reliable deteriorations compared with 83.2%, 10.2% and 6.6%, respectively, among control individuals.


Reported in the Journal of Neurology, Neurosurgery & Psychiatry on average, 20% more participants in the intervention group than in the control group showed a reliable improvement.
Reliable improvement rates with CBT were somewhat higher following individual face-to-face treatment (40.4%) than following other forms of treatment (25.0%).  None of the effect sizes for the five trials researched reached any statistical significance, although the pooled standardized mean difference indicates a significant small effect favoring therapy.
“Available CBT treatments have limited benefit for depressive symptoms in people with epilepsy,” the authors conclude. “People receiving them are more likely to respond in the short term than if they receive usual care. However, most patients who receive the treatments do not show reliable improvement.”
In the end, the results of the study implied there is substantial room for improvement in psychological treatments for depression, anxiety and other mental health issue for persons with epilepsy.

J Neurol Neurosurg Psychiatry 2018.