Depression is the most common psychiatric comorbidity in people with epilepsy. Clinical studies have found that 20% to 30% of people with epilepsy have depression; the incidence may be as high as 50% to 55% in people visiting hospital epilepsy centers.
At the 33rd International Epilepsy Congress in Bangkok in June 2019, several sessions focused on psychiatric comorbidities in people with epilepsy and the crucial role of epileptologists in their identification and management.
“Sometimes we think too much about the epileptology and not enough about comorbidities,” said Mike Kerr (UK), co-chair of a session on neuropsychiatric issues in epilepsy. “There is individual clinician variation in this area. We must each recognize our own competency and know what we don’t know. Those are strongly influenced by our training, coworkers, culture, country and interests. But in the end, all clinicians must meet a minimum standard.”
This minimum standard was established by ILAE as part of its new epileptology curriculum. Domain 6 includes competencies and learning objectives about comorbidities, including the following:
6.1.1 Recognize psychiatric comorbidities, such as depression, anxiety, ADHD, psychosis and autism spectrum disorder
6.1.2 Appropriately manage or advise regarding psychiatric comorbidities
6.1.3 Adjust anti-seizure treatment as required by psychiatric comorbidities
However, the gap between knowledge and practice remains relatively wide. In a Bangkok session on psychological and psychiatric learning objectives in the ILAE curriculum, an informal survey found that most audience members did not conduct depression or suicidality screening in their clinics.
“Up to half of your patients will have depression and up to half will have anxiety,” said W. Curt LaFrance, Jr. (USA). “But almost no one in this session is using a depression screening tool.”