Intervention For Epilepsy Patients Helped Prevent Depression

A home-based intervention that incorporated components of mindfulness and cognitive-behavioral therapy led to the prevention of depression, a reduction in seizures, and increased life satisfaction, a randomized study of patients with epilepsy demonstrated.

“Reports are that 32%-48% of people with epilepsy experience depression,” Nancy J. Thompson, Ph.D., said at the annual meeting of the American Epilepsy Society. “We know clinically that people with epilepsy may avoid antidepressants because of their epilepsy medications, but at the same time psychotherapy attendance is limited by driving restrictions, so a great number of people with epilepsy and depression go untreated.”

Nancy J. Thompson, Ph.D.

The intervention, known as Project UPLIFT, was created at Emory University with funding from the Centers for Disease Control and Prevention as a home-based intervention to address depression in people with epilepsy. The acronym stands for Using Practice, which is a reference to mindfulness, and Learning to Increase Favorable Thoughts, which is a reference to cognitive-behavioral therapy (CBT).

“CBT teaches people to notice how their thoughts and their mood are related and to challenge and in some cases change their thoughts,” said Dr. Thompson, a psychologist with the Rollins School of Public Health at Emory University, Atlanta, who helped originate the intervention. “Mindfulness-based cognitive therapy takes it a step further and teaches people to let thoughts pass, which is a little bit less of a cognitive burden and part of why we chose to use mindfulness-based cognitive therapy.”

UPLIFT is delivered to groups of seven people by Web or by telephone over the course of eight hour-long sessions. “In our initial study, both the Web and telephone were more effective than treatment as usual in reducing symptoms of depression for people with epilepsy,” Dr. Thompson said.

For the current analysis, which was funded by the National Institute on Minority Health and Health Disparities, the researchers recruited 130 patients from clinics at Emory; the University of Michigan, Ann Arbor; the University of Texas Health Science Center, Houston; and the University of Washington, Seattle. The intervention was delivered from Emory by trainees in the mental health program and cofacilitated by a person with epilepsy. Dr. Thompson supervised all of the sessions.

“We randomized people to the intervention or to the treatment-as-usual condition,” she said. “Then we allowed them to choose their preferred means of delivery. Everyone got the intervention at some point in time.”

Dr. Thompson presented results from 108 patients: 52 in the intervention group and 56 in the treatment-as-usual group. Study participants were adults with epilepsy who had been diagnosed for at least 3 months. They had mild to moderate symptoms of depression but did not meet criteria for major depressive disorder. They had no suicidal ideation and were mentally stable. The measures of interest included knowledge and skills gained in the program, their coping self-efficacy, and their self-compassion. The outcomes evaluated were depression based on the modified Beck Depression Inventory (mBDI), the Patient Health Questionnaire–9 (PHQ-9), and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E); seizures based on the self-reported number of seizures and the Liverpool Seizure Severity Scale, and quality of life as measured by the Short Form 36 Physical and Mental QOL and the Satisfaction With Life Scale.

Dr. Thompson reported that 11% in the treatment-as-usual group developed major depressive disorder compared with none in the intervention group (P = .028). Compared with their counterparts in the treatment-as-usual group, those in the intervention group also had better scores on the mBDI (P = .005), the PHQ-9 (P = .049), knowledge/skills (P = .043), the Satisfaction With Life Scale (P = .006), seizure severity (P = .10), and the number of seizures (P = .025).

The researchers observed a dose-response relationship between the number of sessions attended and the mean change in depression, number of seizures, knowledge and skills, and satisfaction with life. “All other measures changed in the expected direction, although they did not achieve significance,” she said. “The effects were maintained over the 8 weeks of follow-up.”

The intervention “constituted a leap forward in the delivery of depression treatment,” Dr. Thompson concluded. “It reaches those whose mobility is impaired by disability, or even the fatigue and loss of energy associated with depression. It also reaches people in rural or otherwise hard-to-reach areas. Those with specific conditions who live far apart can be brought together in a group to connect and share experiences.”

She also noted that the study demonstrates the efficacy of UPLIFT as a preventive intervention. It “averts disability and lost productivity from depression, eliminates tangible and intangible costs of treating depression, and provides participants with skills to manage future stress and difficult life circumstances.”

The cost effectiveness of the intervention will be a focus of future analyses, she said.

Dr. Thompson said she had no relevant financial disclosures.

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