Identifying depression in epilepsy in a busy clinical setting is enhanced with systematic screening

Seizure. 2009 Jul;18(6):429-33. doi: 10.1016/j.seizure.2009.03.001. Epub 2009 May 5.


Purpose: Depression is a highly prevalent, relatively underdiagnosed and undertreated comorbid condition in epilepsy. The purpose of this study was to determine the effect of using a validated self-reporting depression scale on the ability to detect depression in people with epilepsy receiving care in a busy clinical setting.

Methods: The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) is a 6-item questionnaire validated to screen for depression in people with epilepsy. We performed a retrospective chart review of 192 consecutive patients who had completed the NDDI-E while receiving care at a seizure clinic in the largest public hospital in Houston, Texas. For comparison, charts of 192 consecutive patients receiving care immediately prior to the implementation of the NDDI-E in the same clinic were assessed.

Results: Fifty-five (28.6%) of patients screened positive for depression with the NDDI-E. They subsequently received a semi-structured psychiatric interview based on the DSM-IV model and 89% (n=49) were confirmed to have major depression. Use of the NDDI-E thus resulted in the detection of active depression in 25.5% (n=49) of the patients, whereas only 2.6% (n=5) of patients in the group not systematically screened were found to have active depression (p<0.0001). Thirty-two of the 49 (65%) patients with depression detected by screening were not previously diagnosed or treated. Multivariate analysis revealed that a history of depression, seizure frequency, and topiramate use were independent predictors of depression. Lamotrigine use was protective against depression.

Discussion: Use of the NDDI-E significantly improved the ability to detect depression in epilepsy patients in a busy clinical practice.

MeSH terms

  • Adult
  • Ambulatory Care Facilities / statistics & numerical data
  • Confidence Intervals
  • Depression / complications
  • Depression / diagnosis
  • Depression / epidemiology
  • Electroencephalography
  • Epilepsy / complications*
  • Epilepsy / epidemiology*
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Odds Ratio
  • Self Concept
  • Surveys and Questionnaires