COGNITIVE BEHAVIORAL THERAPY FOR TREATMENT OF DEPRESSION IN PATIENTS WITH TEMPORAL LOBE EPILEPSY

Objective: A high percentage of patients with temporal lobe epilepsy suffer from depression, which results in bad seizure control, greater disability and poor quality of life. The treatment of depression in epilepsy has been focused mostly on pharmacologic approach (SSRIs). Little systematic research has been published about the efficacy of cognitive behavioral therapy (CBT) in these patients. The aim of this study was to assess the impact of cognitive behavioral group therapy on the severity of depression and quality of life in patients with temporal lobe epilepsy. Method: Twenty outpatients, with temporal lobe active epilepsy (TLE) and major depression (without psychotic symptoms), according to the Mini International Neuropsychiatric Interview (MINI) and DSM-IV criteria, were enrolled into two groups of ten patients each to receive 16 weekly sessions of CBT. Beck Depression Inventory (BDI), and Quality of life in Epilepsy Scale (QOLIE-31) were applied at basal time, at 8 weeks and at the end of the study (week 16). The patients were not receiving antidepressant pharmacological treatment, and during the study the CBT was the only antidepressant treatment which they received. Results: 13 patients (65% of the initial sample) completed the study. An improvement in the mean scores of the QOLIE-31 was observed with a trends to statistical significance (p=0.16). The CBT effect over the severity of the depression, measured through the BDI, was positive and significant from week 8 and sustained throughout the end of the treatment (p<.00). The subscale analysis shows improvements in 17 of 21 symptoms of depression. Conclusions: In patients with TLE, CBT was effective to improve the global severity of depression, with particular effect on sadness, irritability, pessimism, and weeping symptoms. Effect on seizure severity and somatic symptoms was not significant. Our results should be confirmed through controlled clinic essays.