Depression and anxiety in children and adolescents with epilepsy: Prevalence,
risk factors, and treatment
, Jeffrey B. Titus
, Ayse Arman Rodopman
, Meral Berkem
, Edwin Trevathan
Department of Child Psychiatry, School of Medicine, Marmara University, Istanbul, Turkey
Department of Psychology, St. Louis Children’s Hospital, and Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
Director of National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
Received 2 June 2008
Revised 21 August 2008
Accepted 26 August 2008
Available online 18 October 2008
Among the psychiatric comorbid conditions in children and adolescents with epilepsy, depression and
anxiety disorders require further attention because they carry the risk of reduced quality of life and
life-threatening complications (e.g., suicide). Research in recent years has shed light on both the preva-
lence of emotional problems in youth with epilepsy and the safety and efﬁcacy of treatment options. A
number of challenges exist in treating patients with epilepsy. This is particularly true when seizures
are difﬁcult to control and medication regimens are more complex. Some pharmaceutical options may
provide assistance with both seizures and emotional distress, but care is needed when considering such
treatment approaches. In addition, integration of mental health professionals into the care of patients is
necessary when cases are complicated and risk factors are high. Thorough methods to accurately diag-
nose emotional conditions and regular monitoring of symptoms can help prevent serious problems that
can negatively affect the success of children and adolescents in everyday life. Collaboration between dis-
ciplines offers the best hope for early identiﬁcation and treatment of these conditions.
Ó 2008 Elsevier Inc. All rights reserved.
Epilepsy is the most common neurological disorder in children,
and its prevalence in childhood is estimated to be 0.05–1% [1–3].
Among these children, up to 28.6% may have coexisting psychiatric
conditions. This increases to 58.3% in children with a known neuro-
logical disorder that may cause or be associated with epilepsy .
Various investigations focusing on the prevalance of psychopa-
thology in pediatric epilepsy have documented that children with
epilepsy have an estimated overall risk of 21–60% for childhood psy-
chopathology [5,6]. This is at least three to six times higher than the
risk for psychopathology in the general population (i.e., 6.6%) and
among children with a chronic medical condition not involving the
central nervous system (i.e., 11.6%) . An epidemiological study
by Davies et al.  revealed that the rate of psychiatric disorders
was 37% in children with epilepsy, 11% in children with diabetes
mellitus, and 9% in healthy controls. Moreover, children with com-
plicated epilepsyhave been found to have twice as much risk for psy-
chopathology than children with uncomplicated epilepsy [4,7].
Historically, psychiatric disorders in epilepsy have been consid-
ered a consequence of psychosocial disturbance due to poor adap-
tation to a chronic disease, particularly one with signiﬁcant stigma
. However, more recent investigations have suggested that epi-
lepsy and psychiatric disorders are best conceptualized as epiphe-
nomena rather than cause–consequence factors [9–11]. In a study
completed by Austin et al. , approximately one-third of the chil-
dren with new-onset seizures had psychiatric symptoms prior to
the onset of seizures. Such a ﬁnding provides support for a bidirec-
tional relationship between psychiatric disorders and epilepsy,
suggesting that behavioral and psychosocial impairment in epi-
lepsy may be the consequence of an unrecognized psychiatric dis-
order, rather than the cause of a psychiatric condition .
A number of psychiatric and neuropsychiatric disorders have
been found to occur at a higher rate in children and adolescents
with epilepsy. These include mental retardation [12,13], autism
, attention problems and/or attention-deﬁcit/hyperactivity dis-
order (ADHD) [15,16], depression [17,18], anxiety [19,20], and psy-
chotic disorders [21,22].
Among these comorbid conditions, depression and anxiety
seem to be highly common [17,19]. In fact, depression symptoms
alone have an estimated prevalence of 23–26%, based on self-re-
port instruments [20,23]. The prevalence of anxiety, in comparison,
is estimated to be between 15 and 20% . Unfortunately, how-
ever, these conditions are often unrecognized and left untreated
in children with epilepsy [20,25], which can lead to negative out-
comes on quality of life [17,26].
Although the general outcome and prognosis of children with
epilepsy can be highly affected by psychiatric comorbid conditions
1525-5050/$ - see front matter Ó 2008 Elsevier Inc. All rights reserved.
* Corresponding author. Address: Yeldegirmeni Sok. Rasimpasa Mah. No: 40/13,
34710 Kadıkoy/Istanbul, Turkey. Fax: +90 216 3250323.
E-mail address: firstname.lastname@example.org (O. Ekinci).
Epilepsy & Behavior 14 (2009) 8–18
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Epilepsy & Behavior
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