title: Identifying depression in epilepsy in a busy clinical setting is enhanced with systematic screening.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Use of the NDDI-E significantly improved the ability to detect depression in epilepsy patients in a busy clinical practice.
authors.affiliation: Peter Kellaway Section of Neurophysiology and Baylor Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX 77030, USA. defriedm@bcm.tmc.edu
authors.forename: David E
authors.initials: DE
authors.lastname: Friedman
authors.forename: Doris H
authors.initials: DH
authors.lastname: Kung
authors.forename: Somchai
authors.initials: S
authors.lastname: Laowattana
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Kass
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hrachovy
authors.forename: Harvey S
authors.initials: HS
authors.lastname: Levin
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003863:Depression / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D016017:Odds Ratio; D012649:Self Concept; D011795:Surveys and Questionnaires