Proposed Recommendations for the Management of Depression in Adults with Epilepsy: An Expert Consensus

Vicente Villanueva; Jesús Artal; Clara-Isabel Cabeza-Alvarez; Dulce Campos; Ascensión Castillo; Gerardo Flórez; Manuel Franco-Martin; María Paz García-Portilla; Beatriz G Giráldez; Francisco Gotor; Luis Gutiérrez-Rojas; Albert Molins Albanell; Gonzalo Paniagua; Luis Pintor; Juan José Poza; Teresa Rubio-Granero; Manuel Toledo; Diego Tortosa-Conesa; Juan Rodríguez-Uranga; Julio Bobes

doi:10.1007/s40120-023-00437-0

Proposed Recommendations for the Management of Depression in Adults with Epilepsy: An Expert Consensus

Neurol Ther. 2023 Apr;12(2):479-503. doi: 10.1007/s40120-023-00437-0. Epub 2023 Jan 24.

Authors

Vicente Villanueva¹, Jesús Artal², Clara-Isabel Cabeza-Alvarez³, Dulce Campos⁴, Ascensión Castillo⁵, Gerardo Flórez⁶, Manuel Franco-Martin⁷, María Paz García-Portilla⁸, Beatriz G Giráldez⁹, Francisco Gotor¹⁰, Luis Gutiérrez-Rojas¹¹, Albert Molins Albanell¹², Gonzalo Paniagua^{13

14}, Luis Pintor¹⁵, Juan José Poza¹⁶, Teresa Rubio-Granero¹⁷, Manuel Toledo¹⁸, Diego Tortosa-Conesa¹⁹, Juan Rodríguez-Uranga²⁰, Julio Bobes²¹

Affiliations

¹ Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
² Psychiatry Department, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Spain. jesusartalsimon@gmail.com.
³ Neurology Department, Hospital Universitario de Toledo, Toledo, Spain.
⁴ Neurology Department, University Clinical Hospital of Valladolid, Valladolid, Spain.
⁵ Neurology Department, Consorcio Hospital General Universitario Valencia, Valencia, Spain.
⁶ Psychiatry Department, Addiction Treatment Unit, Orense, Spain.
⁷ Psychiatry Department, Zamora Hospital (Complejo Asistencial de Zamora), Zamora, Spain.
⁸ Psychiatry Department, University of Oviedo, ISPA, CIBERSAM, INEUROPA, and Mental Health Services of Principality of Asturias, Oviedo, Spain.
⁹ Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
¹⁰ Psychiatry Department, School of Medicine, University Hospital Virgen del Rocio, Seville, Spain.
¹¹ Psychiatry Department, Hospital San Cecilio, Granada, Spain.
¹² Neurology Department, Hospital de Girona-Salt, Salt, Spain.
¹³ Psychiatry Department, University of Oviedo, Oviedo, Spain.
¹⁴ Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain.
¹⁵ Psychiatry Department, Hospital Clínico of Barcelona, Barcelona, Spain.
¹⁶ Neurology Department, Hospital Universitario Donostia, Donostia, Spain.
¹⁷ Psychiatry Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
¹⁸ Epilepsy Unit, Vall D'Hebron University Hospital, Barcelona, Spain.
¹⁹ Neurology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
²⁰ Neurology Department, Centro de Neurología Avanzada (CNA), Seville, Spain.
²¹ Medicine-Psychiatry, Universidad de Oviedo, Oviedo, Spain.

Abstract

Introduction: Experts agree that there is a need for protocols to guide health professionals on how to best manage psychiatric comorbidities in patients with epilepsy (PWE). We aimed to develop practical recommendations for key issues in the management of depression in PWE.

Methods: This was a qualitative study conducted in four steps: (1) development of a questionnaire on the management of depression in PWE to be answered; (2) literature review and, if evidence from guidelines/consensus or systematic reviews was available, drafting initial recommendations; (3) a nominal group methodology for reviewing initial recommendations and formulating new recommendations on those issues without available evidence; and (4) drafting and approving the final recommendations. A scientific committee (one neurologist and one psychiatrist) was responsible for the development of the project and its scientific integrity. The scientific committee selected a panel of experts (nine neurologists and nine psychiatrists with experience in this field) to be involved in the nominal group meetings and to formulate final recommendations.

Results: Fifteen recommendations were formulated. Four on the screening and diagnosis: screening and diagnosis of depression, evaluation of the risk of suicide, and diagnosis of depression secondary to epilepsy; nine on the management of depression: referral to a psychiatrist, selection of the antiseizure medication, change of antiseizure medication, antidepressant treatment initiation, selection of antidepressant, use of antidepressants during pregnancy, use of psychotherapy, antidepressant treatment duration, and discontinuation of antidepressant treatment; two on the follow-up: duration of the follow-up under usual conditions, and follow-up of patients at risk of suicide.

Conclusion: We provide recommendations based on expert opinion consensus to help healthcare professionals assess depression in PWE. The detection and treatment of major depressive disorders are key factors in improving epilepsy outcomes and avoiding suicide risk.

Keywords: Depression; Diagnosis; Epilepsy; Expert consensus; Suicide risk; Treatment.