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Ask the Mental Health Expert Archives 2001-2004

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Mesial Temporal Sclerosis and Depression

Q. I have had depression for eight years and I also have epilepsy. Last year I had an MRI that showed I have mesial temporal sclerosis, a condition that causes seizures. I have heard that it can also cause depression. Is this the case? If so, what are my treatment options?

A. I think it's putting it too strongly to say that mesial temporal sclerosis (MTS) can cause depression, though there is some evidence finding an association between MTS and depression in patients with temporal lobe epilepsy (TLE). Specifically, Quiske et al concluded that MTS may be a "...predisposing factor for the development of mood disorders in focal epilepsy." (Epilepsy Res. 2000 Apr;39(2):121-5). TLE itself is associated with a higher than expected rate of mood disorders, versus some other types of epilepsy (Perini et al, J Neurol Neurosurg Psychiatry. 1996 Dec;61(6):601-5).

I don't think we know the therapeutic implications of all this quite yet. There is some evidence that the anticonvulsant lamotrigine [Lamictal] has antidepressant properties, not only in patients with epilepsy, but also in those with bipolar disorder [see Sackellares et al, Epilepsy Behav. 2002 Aug;3(4):376-382]. This could be an option worth discussing with your doctor, though there may be drug-drug interactions or other reasons why lamotrigine would not be realistic for you.

There are also neurosurgical options that may improve both mood and seizures in TLE patients (see Suchy and Chelune, J Clin Exp Neuropsychol. 2001 Aug;23(4):413-23), but this option is usually reserved for the most intractable cases of TLE.

There are, of course, numerous antidepressants that could be of use to you, regardless of the presence of MTS, and this is an issue you might discuss with a neuropsychiatrist familiar with both depression and TLE.

Finally, never underestimate the benefits of good old talk therapy (psychotherapy) for the treatment and prevention of depression, whether in the context of epilepsy or not.

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November 2003

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