Although most studies have reported a higher risk of depression in people with epilepsy as compared with normal controls, almost all studies (with a few exceptions such as Blumer 2002) report no difference between patients with epilepsy and other chronic disorders (Krishnamoorthy 2002). An argument raised by neuropsychiatrists and epileptologists is that patients with epilepsy have distinct and unique forms of psychopathology (Krishnamoorthy 2000, 2001). Neither traditional systems of classification used in psychiatry, such as the DSM or the ICD, which club the disorders under the broad umbrella of organic mental disorders, nor the ILAE classification, which does not address the psychiatric components of the disorder, do justice to these unique syndromes of “epilepsy-specific” psychopathology. The instruments used for identification of psychopathology in most studies are based on existing classification systems and are perhaps inadequate. Bear and Fedio (Bear and Fedio 1977) showed that while the MMPI failed to identify the difference between patients with TLE and other patient groups, the differences became apparent when the responses to an instrument they developed were analyzed. Blumer’s description of the interictal dysphoric disorder, seen in patients with refractory temporal lobe epilepsy, further endorses the need for a distinct classification system enabling a clearer phenomenological description of psychopathology in these patients.

Diagnosis of depressive states can be difficult. Studies have found that hospital medical and nursing staff fail to detect affective disorders in 34-72% of cases (Mayou 1986), and that General Practitioners correctly diagnose depression at first consultation in only 50% of cases (Roberts 1995). In patients with epilepsy, this problem is further compounded due to the presence of unique depressive syndromes (Hesdorffer 2000). Identification of these variants becomes important from a public health perspective. An increased prevalence of psychiatric co-morbidity in patients with epilepsy as compared with other adequately matched illness groups would warrant the creation of specific mental health resources for this patient group.

Although the first reference to epilepsy and melancholia was made by Hippocrates in 400 BC, two thousand years later, neuropsychiatrists and epileptologists are still grappling with the nuances and challenges posed by this sacred disease. A mere 7% of neurologists treating epilepsy routinely screen for depression in their outpatient clinics (Gilliam et al. 2004). With the description of a six-fold increased risk of unprovoked seizures in older patients with major depression and the possibility of a reverse causality, the relationship between affective disorders and epilepsy becomes even more intriguing (Kanner 2003). Affective disorders in epilepsy classically exemplify the expanding interface between psychiatry and neurology, the mind-body conundrum. Is it not time that neurologists and psychiatrists start talking to one another (Kanner 2003).

Epileptic Disorders. Volume 9, Number 1, 1-10, March 2007, Review article
John Libbey Eurotext
Author(s) : R Seethalakshmi, Ennapadam S Krishnamoorthy