Chapter 42: Depression and Anxiety Disorders in Children with Epilepsy

INTRODUCTION

Children with epilepsy are at an increased risk for behavioral or psychiatric comorbidities.^1,2 Symptoms of depression, anxiety, and other behavioral difficulties (e.g., impulsivity, inattention) may be reported by the child, parent, teacher, or even the physician. It is increasingly evident that anxiety and depression are significant comorbidities among children with epilepsy.^3,4 If left unrecognized and untreated, psychiatric comorbidities may have an adverse psychosocial impact on the child in terms of academic and social development as well as family functioning as demonstrated in the general population. Psychiatric comorbidities in childhood can have long-term implications overflowing into adulthood impeding lifetime achievement and negatively impacting overall quality of life.

Contemporary psychiatric diagnostic systems (DSM [Diagnostic and Statistical Manual], ICD [International Classification of Diseases]) have only recently been used to comprehensively characterize the nature and type of these problems in children with epilepsy. There is minimal understanding of the additional complications caused by comorbid mental health disorders (e.g., cognitive problems, academic underachievement, increased health care utilization, adverse impact on family), and most striking is the lack of randomized controlled intervention trials to treat psychiatric comorbidities in youth with epilepsy with the exception of ADHD. Recently, research has indicated that epilepsy variables (i.e., seizure frequency, AEDs, and seizure type) are often not implicated in the occurrence of psychiatric comorbidities. This chapter will highlight the prevalence rates of anxiety and depression in children with epilepsy compared to children in the general population and review the current literature regarding recognition and treatment of anxiety and depression.

EPIDEMIOLOGICAL EVIDENCE IN THE GENERAL POPULATION

Among children and adolescents in the general population, depression and anxiety disorders appear to be the most common psychiatric disorders⁵ and represent a major public health problem.⁶ The prevalence rates range from 4% to 24% for major depression and around 20% for all anxiety disorders including specific phobias (8%), social phobias (5%), GAD (4%), and all other anxiety disorders (3%).⁵ Depression during childhood frequently occurs before, during, or after another psychiatric disorder;⁷ as a result, if a child presents with a depressive disorder, another psychiatric disorder may be lurking in the shadows. Anxiety disorders in childhood and adolescence are risk factors for depressive disorders later in life.⁸ Spady et al⁹ reported that children and adolescents with psychiatric disorders in general had greater medical service usage compared to children with no psychiatric disorders. Increased direct costs associated include clinic visits, counseling, hospitalizations, prescription medications, and emergency room care. Increased indirect costs are attributable to reduced productivity, absenteeism from work and school, and suicide.¹⁰ The majority of cost analyses have focused on adults. Greenberg et al¹⁰ reported that in the United States anxiety disorders costs totaled $42.3 billion in 1990 dollars and half of these costs were for nonpsychiatric medical treatment. Anxiety disorders have been linked to academic difficulties, low self-esteem, peer relationship ...