title: Risk factors for postoperative depression: A retrospective analysis of 248 subjects operated on for drug-resistant epilepsy.
abstract: The aim of this retrospective case series analysis was to identify the predictors of postoperative depression (PostOp-D) in a sample of 248 subjects with focal drug-resistant focal epilepsy. The presence or absence of PostOp-D during a 12-month follow-up period was the outcome variable. Demographic, neurologic, psychiatric characteristics, and antiepileptic therapy were the explanatory variables. After preliminary bivariate analysis, a multivariate logistic regression model was fitted to identify variables associated with PostOp-D. Sixty-seven patients (27%) experienced PostOp-D. At multivariate analysis, lifetime depression, age at surgery, and levetiracetam (LEV) are positive predictors of PostOp-D; carbamazepine (CBZ) and anxiety disorders are protective factors. LEV increases the risk for PostOp-D by about half; the relative risk (RR) is 1.48. Conversely, CBZ decreases the risk for PostOp-D by about half (RR 0.59). Our results suggest that careful psychiatric evaluation and follow-up should be recommended for subjects at risk. It is advisable to treat patients with depression before surgery. Antiepileptic drugs should be selected carefully when patients present with not modifiable risk factors, such as positive personal history for depression.
authors: Psychiatric Branch, San Paolo Hospital, Milan, Milano, Italy.
authors: Valentina
authors: V
authors: Barbieri
authors: "Claudio Munari" Center for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Francesco
authors: F
authors: Cardinale
authors: "Claudio Munari" Center for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Francesca
authors: F
authors: Gozzo
authors: "Claudio Munari" Center for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Veronica
authors: V
authors: Pelliccia
authors: "Claudio Munari" Center for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Lino
authors: L
authors: Nobili
authors: "Claudio Munari" Center for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Giuseppe
authors: G
authors: Casaceli
authors: "Claudio Munari" Center for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Dalila
authors: D
authors: Fuschillo
authors: "Claudio Munari" Center for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Laura
authors: L
authors: Castana
authors: "Claudio Munari" Center for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Massimo
authors: M
authors: Cossu
authors: "Claudio Munari" Center for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Giorgio
authors: G
authors: Lo Russo
authors: "Claudio Munari" Center for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Laura
authors: L
authors: Tassi
authors: Psychiatric Branch, San Paolo Hospital, Milan, Milano, Italy.
authors: Orsola
authors: O
authors: Gambini
mesh_terms: D000328:Adult; D003863:Depression / Q000209:etiology*; D000069279:Drug Resistant Epilepsy / Q000601:surgery*; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000503:physiopathology*; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Antiepileptic drugs; Epilepsy surgery; Postoperative depression; Risk factors