Cognitive-Behavioral Therapy Does Not Improve Depression in Epilepsy

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Most participants did not experience symptom improvement with cognitive behavioral therapy.
Most participants did not experience symptom improvement with cognitive behavioral therapy.

Nearly 70% of people with epilepsy do not experience meaningful reductions in depressive symptoms following cognitive-behavioral therapy (CBT), according to a systematic review published in the Journal of Neurology, Neurosurgery, and Psychiatry.

This systematic review examined the English language literature published on trials of CBT for people with epilepsy by searching the databases AHMED, CINAHL, clinicaltrails.gov, EThOS, Medline, PsycARTICLES, PsycINFO, and SIGLE from inception until March 2017. Eligible trials had to randomly assign participants to a psychological treatment that involved at least 1 CBT element or a control condition, have participants at least ≥18 years, and use a standardized measure of depression and/or anxiety to determine the primary outcome.

Out of the 580 unique articles found in the search, only 8 trials were eligible for review. Data concerning 398 of the 470 participants in these 8 randomized trials were analyzed. After psychological treatment, 66.9% of participants (trial range 46.9-75%) did not experience a reliable change in depressive symptoms compared with 83.2% of the control group participants, 30.4% experienced reliable improvements (trial range 21.2-50.0%) compared with 10.2% of controls, and 2.7% (trial range 0-5.3%) experienced reliable deterioration compared with 6.6% of controls. The rates of reliable improvements were slightly higher for trails that used face-to-face CBT instead of other forms, e.g. 40.4% compared with 17.2% of the control group.

Study investigators posited a few different explanations for the low rates of improvement experienced by individuals with epilepsy following psychological treatment, including possible limitations of the various trials, but they also felt the findings may indicate CBT is not appropriate for individuals with epilepsy. This form of therapy may be ineffective for individuals with epilepsy because their negative cognitions may be realistic, regarding issues such as medication side effects, the fact that seizures could occur at any time, or that their condition strains their families.

Study investigators conclude that “overall, the results imply there is substantial scope for improvements in psychological treatments for distress in [individuals with epilepsy]. This may be found through exploring alternative psychotherapeutic approaches.”

Reference

Noble AJ, Reilly J, Temple J, Fisher PL. Cognitive-behavioural therapy does not meaningfully reduce depression in most people with epilepsy: a systematic review of clinically reliable improvement [published online May 7, 2018]. J Neurol Neurosurg Psychiatry. doi: 10.1136/jnnp-2018-317997

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