Minimal reduction of depression with CBT in people with epilepsy

May 24, 2018

By Reuters Staff

NEW YORK (Reuters Health) - Depression in people with epilepsy improves with cognitive-behavioral therapy (CBT), but not to a meaningful extent, according to a systematic review.

CBT is recommended for the treatment of depression, which is common in people with epilepsy and is associated with an increase in suicide risk, healthcare costs, mortality and a reduced quality of life.

In their review, which includes individual patient data from 315 people with epilepsy in five randomized clinical trials, Dr. Adam J. Noble from the University of Liverpool, U.K., and colleagues focused on the likelihood of clinically relevant improvements in symptomatology.

Following CBT, 66.9% of participants experienced no reliable change in depression symptoms, 30.4% experienced reliable improvements and 2.7% experienced reliable deteriorations compared with 83.2%, 10.2% and 6.6%, respectively, among controls.

On average, 20% more participants in the intervention group than in the control group showed a reliable improvement, the researchers report in the Journal of Neurology, Neurosurgery & Psychiatry, online May 11.

Reliable improvement rates with CBT were somewhat higher following individual face-to-face treatment (40.4%) than following other forms of treatment (25.0%).

None of the effect sizes for the five trials reached statistical significance, although the pooled standardized mean difference (SMD) indicated a significant small effect favoring CBT.

"Available CBT treatments have limited benefit for depressive symptoms in people with epilepsy," the authors conclude. "People receiving them are more likely to respond in the short term than if they receive usual care. However, most patients who receive the treatments do not show reliable improvement."

"The long-term effect of the treatments for depression remains to be determined, as does their benefit for anxiety," they note. "Overall, the results imply there is substantial scope for improvements in psychological treatments for distress in people with epilepsy. This may be found through exploring alternative psychotherapeutic approaches."

Dr. Noble did not respond to a request for comments.


J Neurol Neurosurg Psychiatry 2018.

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