Many people with epilepsy - even those with mild forms of the condition - also experience depression, but do not always discuss those symptoms with their physicians, study findings show.

“Patients must do a much better job of talking about this problem,” study author Dr. Alan Ettinger of the Long Island Jewish Medical Center in New Hyde Park, New York told AMN Health.

Previous studies conducted at hospitals or epilepsy centers have shown that depression may affect up to 60 percent of epilepsy patients, yet it has been unclear whether this high prevalence of depressive symptoms exists among community-dwelling patients with less severe forms of the neurological condition and less related disability.

To investigate, Ettinger and his colleagues analyzed survey responses from 775 people with epilepsy who lived in the general community. For comparison, their study also included 395 people with asthma and 362 people with no chronic disease.

More than a third (36.5 percent) of the participants with epilepsy reported experiencing symptoms of depression, as did approximately 28 percent of asthmatics and 12 percent of healthy individuals, Ettinger and his colleagues report in the journal Neurology.

Yet, nearly 39 percent of these epilepsy patients and 44 percent of the asthmatics had never been evaluated for depression, the report indicates.

“What this tells us is that this is a very important problem even in the general epilepsy population,” as well as among those with severe epilepsy, Ettinger said.

Further, “this is a highly under-recognized problem,” according to Ettinger, who as co-chair of the Epilepsy Foundation of America’s patient education committee is working to increase depression awareness among people with epilepsy.

The reason for the low rate of evaluation for depression may be partly due to patients’ reluctance to talk about it, Ettinger said. Some people may not realize they should discuss depressive symptoms with their physicians and others may be too embarrassed to do so.

It may also be explained by the scenario of the “typically rushed doctor” who does not focus on asking the questions necessary to uncover signs of depression among patients, he added.

In other findings, depressive symptoms among the epilepsy-affected study participants were most common among females, younger individuals and lower-income people.

Further, those who reported more depressive symptoms were also more likely to have been unemployed during the previous month and tended to report having more disabilities, a lower quality of life and more social concerns, such as a fear of injuring themselves during a seizure, than did their non-depressed peers, the report indicates.

Depression is a “very readily treatable” problem, Ettinger said, calling the findings a “wake up call.” He added that it would be a “terrible shame” if depressive symptoms continue to go unrecognized and untreated, thereby increasing the risk of difficulties in social functioning, lack of employment and other problems seen among the current study’s participants.

“If patients are having symptoms of distress… they need to be much more proactive about raising these concerns” with their healthcare providers, Ettinger said. They should also “insist on proper interventions,” such as a referral to a psychiatrist or antidepressant treatment, he added.

To help arm patients with the knowledge necessary to raise such issues with their doctors, Ettinger and his wife, Dr. Deborah Weisbrot, of the University Medical Center at Stony Brook, New York have authored “The Essential Patient Handbook.” The project grew out of their first-hand experience - during Weisbrot’s illness- - with the communication challenges inherent in the doctor-patient relationship.

The current study was conducted by Ettinger, Dr. Michael Reed and Joyce Cramer for the Epilepsy Impact Project Group, which was supported by GlaxoSmithKline.

SOURCE: Neurology, September 28, 2004.