Is major depressive disorder specifically associated with mesial temporal sclerosis?
OBJECTIVE
Whether a specific lesion such as mesial temporal sclerosis (MTS) increases the risk for a mood disorder in epilepsy remains subject to debate. Despite evidence of limbic system involvement in the genesis of emotional symptoms, recent studies fail to support an association between depression and MTS. We aimed to clarify this controversial issue by overcoming prior methodologic limitations, hypothesizing that rates of major depressive disorder (MDD) would be higher in patients with MTS.


METHODS
Three hundred eight patients with focal epilepsy (International League Against Epilepsy [ILAE] criteria), were classified into three groups on the basis of neuroimaging findings: MTS, a lesion different from MTS, or absence of lesion. Patients were assessed using the Structured Interview for DSM-IV axis I psychiatric disorders (SCID-I), by a psychiatrist blinded to epilepsy subtype. The Spanish version of the Hospital Anxiety and Depression Scale (HADS) was also administered. A complete logistic regression analysis was performed to investigate the association between MTS and MDD.


RESULTS
MTS increased the likelihood of a lifetime MDD by nearly 2.5. No other current or "postseizure onset" lifetime Axis I DSM-IV psychiatric disorder was associated with MTS. Female gender, primary education, comorbid anxiety disorders, and antidepressant treatment were also associated with an increased risk of MDD. Marriage was found to be a protective factor for MDD.


CONCLUSIONS
Our results support a specific association between MTS and lifetime "postseizure onset," MDD. The lack of association with current depression is in line with the hypothesis that the link between MTS and depression is more of a chronic than a state-dependent condition.
Department of Child and Adolescent Psychiatry, Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain. vgistau@clinic.ub.es
Vanessa
V
Sanchez-Gistau
Gisela
G
Sugranyes
Eva
E
Baillés
Mar
M
Carreño
Antonio
A
Donaire
Nuria
N
Bargalló
Luis
L
Pintor
D000328:Adult; D003865:Major Depressive Disorder / Q000150:complications* / Q000473:pathology; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000473:pathology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D012598:Sclerosis; D013702:Temporal Lobe / Q000473:pathology*