Peri-Ictal Changes in Depression and Anxiety in Persons With Epileptic and Non-epileptic Seizures

Jennifer Hopp; Autusa Pahlavan; Mary Richert; Kathryn Grimes; Kate Turlington; Maureen Cassady; Mark D Kvarta; Scott M Thompson

doi:10.3389/fpsyt.2022.912697

Peri-Ictal Changes in Depression and Anxiety in Persons With Epileptic and Non-epileptic Seizures

Front Psychiatry. 2022 Jul 22:13:912697. doi: 10.3389/fpsyt.2022.912697. eCollection 2022.

Authors

Jennifer Hopp¹, Autusa Pahlavan¹, Mary Richert¹, Kathryn Grimes¹, Kate Turlington², Maureen Cassady¹, Mark D Kvarta^{3

4}, Scott M Thompson^{3

4}

Affiliations

¹ Division of Epilepsy, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States.
² Department of Pediatrics, University of Virginia, Charlottesville, VA, United States.
³ Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States.
⁴ Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, United States.

Abstract

Objective: We tested the hypothesis that epileptic, but not non-epileptic, seizures would produce an improvement in comorbid depression and anxiety symptoms in the peri-ictal period, much like the antidepressant effects of electroconvulsive therapy.

Methods: We examined depression and anxiety symptoms in patients admitted to an inpatient unit for continuous video electroencephalography as part of routine clinical care. Patients completed three questionnaires that included the Beck Depression Inventory-II (BDI), Montgomery Asberg Depression Rating Scale (MADRS), and Beck Anxiety Inventory (BAI) after admission, in the 24 h following a seizure, then again 2 weeks after the last seizure.

Results: In patients with epilepsy, depression and anxiety scores improved in the 24 hrs following a seizure (change in BDI = 24%; change in MADRS = 19%; change in BAI = 21%) but returned toward baseline after 2 weeks. In patients with non-epileptic seizures, depression and anxiety scores also improved in the 24 hrs following a psychogenic non-epileptic seizure (change in BDI = 17%, change in MADRS = 27%, change in BAI = 36%). There was a greater improvement in depression and anxiety scores in patients with focal-onset epilepsy (BDI = 30%, MADRS = 22%, BAI = 30%) compared to generalized seizure onset (BDI = 6%, MADRS = 12%, BAI = 8%).

Conclusion: We conclude that single seizures can result in transient improvements in mood. Because seizures need not be generalized or epileptic to exert this effect, the underlying mechanisms are uncertain.

Keywords: anxiety; depression; focal epilepsies; generalized epilepsies; psychogenic seizure.