IEC 2025 | Associations in the pathophysiology of depression and epilepsy
Rani Sarkis, MD, Brigham and Women’s Hospital, Boston, MA, comments on the associations in the pathophysiology of depression and epilepsy. Dr Sarkis emphasizes the importance of considering common risk factors, including genetic, medical, and lifestyle factors, and acknowledges the impact of depression on quality of life in older adults with epilepsy. This interview took place at the 36th International Epilepsy Congress (IEC) in Lisbon, Portugal.
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Transcript
So traditionally we’ve tried to separate seizures and depressive symptoms as if they were coming from two completely different organs when in fact they’re coming from the same organ and actually the same networks in the brain. The limbic system is probably the area of the brain generating these symptoms, whether it’s the seizures or the depression...
So traditionally we’ve tried to separate seizures and depressive symptoms as if they were coming from two completely different organs when in fact they’re coming from the same organ and actually the same networks in the brain. The limbic system is probably the area of the brain generating these symptoms, whether it’s the seizures or the depression. So I think the first step in the field is to appreciate that these symptoms are a manifestation of an abnormal underlying network. And once we view that, then we can think about all of the risk factors for both, because there are a lot of commonalities in terms of the risk factors for both. And those risk factors could be genetic, for example, APOE4 has been linked to depression later on in life and seizures. Those could be medical, for example, obstructive sleep apnea could be a trigger for both. And then there’s a bigger appreciation nowadays for the role of lifestyle. And there’s a lot of talk about brain health. And so thinking about vascular risk factors, smoking, hypertension, diabetes, hypercholesterolemia as both risk factors for depression and seizures. So not just thinking about antidepressants as the main management option for these symptoms, but actually taking a step back and thinking about lifestyle, thinking about underlying risk factors, vascular risk factors, and even genetics. And we also have to appreciate the impact of depression on quality of life in older adults with epilepsy. They’re not just dealing with the impact of the seizures, but also of depression. And finally, the other thing to keep in mind is the impact of medications. In one of our studies, we actually found that the higher the seizure medication load, the more the depressive symptoms. So that is another intervention that we can keep in mind in clinic, whereby maybe minimizing or picking the right medications might help with the depressive symptoms.
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