Antidepressive treatment in patients with temporal lobe epilepsy and major depression: a prospective study with three different antidepressants.
Major depression (MD) is underdiagnosed and undertreated in patients with temporal lobe epilepsy (TLE). Side effects of some antidepressants, like increased risk of seizures and drug-drug interactions with anticonvulsants, contribute to undertreatment of MD in patients with TLE. We analyzed post hoc the data from 2 years of treatment of inpatients with MD and TLE. Seventy-five patients received standard treatment with citalopram, mirtazapine, or reboxetine, respectively, at recommended dosage. Examinations were done with the Hamilton Rating Scale for Depression at admission and after 4 and 20-30 weeks. Plasma levels of anticonvulsants were examined at admission and discharge. Seizures were documented. The antidepressive treatment was efficacious in all antidepressant groups. No case of serious adverse event or drug interaction occurred. There was no increase in frequency or severity of seizures. At endpoint the dropout rate for mirtazapine was significantly higher than that for reboxetine or citalopram. Reboxetine showed a trend to be more efficacious than citalopram but not mirtazapine at Week 4.
Kühn
Kai Uwe
KU
Department of Psychiatry, University of Bonn, Bonn, Germany.
Quednow
Boris B
BB
Thiel
Markus
M
Falkai
Peter
P
Maier
Wolfgang
W
Elger
Christian E
CE
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000927:Anticonvulsants / Q000097:blood / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000097:blood / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015283:Citalopram / Q000627:therapeutic use; D003710:Demography; D003865:Major Depressive Disorder / Q000097:blood / Q000188:drug therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004347:Drug Interactions; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D009025:Morpholines / Q000627:therapeutic use; D010352:Patient Dropouts / Q000706:statistics & numerical data; D010555:Personality Inventory; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D000077593:Reboxetine; D013997:Time Factors
D000927:Anticonvulsants; D000928:Antidepressive Agents; D009025:Morpholines; D015283:Citalopram; D008803:Mianserin; D000077593:Reboxetine; D000078785:Mirtazapine