Should More Physicians be Screening Teens With Epilepsy for Depression?

December 10, 2018

The director of the Epilepsy Center at Children's Health spoke about the findings of the clinical screening program, and how depression is often overlooked in patients with epilepsy.

Susan T. Arnold, MD

In a single-center study, screening teenage patients with epilepsy for depression during their clinical visit revealed a similar incidence of depression among these patients that have been shown in previous literature, suggesting a need to implement this practice elsewhere.

Presented at the American Epilepsy Society’s 72nd annual meeting in New Orleans, Louisiana, the research was conducted by Susan T. Arnold, MD, a professor at UT Southwestern Medical Center and director of the Epilepsy Center at Children's Health, and colleagues. They screened 394 youth with epilepsy during their visit, finding that 87% fell into the minimal/mild range of depressive symptoms; 8% fell into the moderate/moderately severe depressive symptoms range; and 5% of the patients rated suicidal ideation or previous suicide attempt.1

All told, 13% of those screened required a referral to a behavioral health specialist or other intervention.

To find out more about the clinical importance of screening patients with epilepsy, Arnold sat with NeurologyLive to discuss the study and what the investigators learned from screening their patients.

NeurologyLive: How can physicians treating patients with epilepsy best be aware of them developing depression?

Susan Arnold, MD: We instituted a depression screening program for children with epilepsy in the pediatric epilepsy center because we recognize that this is really an under-recognized comorbidity of epilepsy. Specifically, if you don't ask about it, you won't know that it's there. When children come to see us for management of their epilepsy, we're asking about seizures, we're asking about how school is going, we ask about health, but, as a group, physicians are not very good about specifically asking about depression. Instituting a screening program that asked all of our teenagers, before they came in to see the physician, whether or not there were signs or symptoms of depression helped us to really focus on that symptom and make sure that we weren't overlooking children who needed intervention or help in the area of mental health services.

We were tremendously helped by the fact that we have both a psychologist and a social worker aligned with our clinic that could come and help us when we did identify children with need. That's one of the difficulties for screening in many settings—that the mental health services available for children are not as robust as we would like them to be. Sometimes, I think practitioners are hesitant to ask a question if they're not sure they have services available to refer a child to, but what we discovered was that it was a relatively small number of children that really needed acute intervention. But, beginning that conversation with families really helped us identify a lot of issues we might not have recognized otherwise, and helped us steer families in the direction to programs that could be helpful to their children. And, I hope, eventually helped us to where will help us to head off some problems and some of our kids because we know that antiepileptic medicines can have an impact on depression.

How does screening patients with epilepsy improve their management?

Screening children for depression also helped us to be aware of when that might be a possible side effect of our medication. In some children, looking at that depression screening score led us to consider changing medication or adjusting medicine to see if that might be one possible way to help these children improve their quality of life.

Has there been any indication of a specific type of medication or a specific type of epilepsy where depression is most common?

We are very interested in looking at which types of seizures, or which types of epilepsy, and which types of medication might place children at a higher risk for depression. There is not a tremendous amount of evidence about seizure types or epilepsy types related to depression, and what evidence there is tends to be more in adults than in children, and so we're very interested in looking at that in our population but at the moment we don't have that information. Regarding medications, we are aware that some of the antiepileptic medicines have a higher risk than others, but, again, we have not yet had the opportunity to break down our data looking specifically at medication. As in all pediatrics, we’re interested in preventative care and being proactive, so if we can identify those children who might be at a higher risk that would be something that we would want to be proactive about, both in educating families to look for signs and symptoms of depression and being even a little more aware as kids come in that these are children we should be screening.

Is there a goal for the future for this screening process?

We'd like to start screening our younger kids and that's one of our goals for the future because we began with a small age range and what we felt was a manageable adjustment to our clinic workflow. But it's our plan over the next year or two to extend to younger teenagers and, eventually, to preteens because we think that depression is probably underdiagnosed there. We know that, in children who present with depression, the signs and symptoms start early, and we shouldn't be neglecting it in our younger children, so those are plans for the future.

Transcript edited for clarity.

REFERENCE

1. Thomas HM, Suttle L, Morrison K, Arnold ST. Depression screening in pediatric epilepsy. Presented at: American Epilepsy Society Annual Meeting; New Orleans, Louisiana; December 1, 2018. aesnet.org/meetings_events/annual_meeting_abstracts/view/507033.