08-06-2018| Cognitive-behavioural therapy does not reduce depression in most people with epilepsy

08 June 2018
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Nearly 70% of people with epilepsy do not experience significant reductions in symptoms of depression following cognitive-behavioral therapy (CBT), according to a review from the Journal of Neurology, Neurosurgery, and Psychiatry.

This systematic review analysed the 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 select 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 different articles found, just 8 trials were eligible for review. Data concerning 398 of the 470 participants in these 8 randomized trials were reviewed. After psychological treatment, 66.9% (trial range 46.9-75%) did not experience a reliable change in their depressive symptoms compared with 83.2% of the control group participants.

30.4% felt 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.

Investigators advanced a few different conclusions for the low rates of improvement experienced by people with epilepsy following psychological treatment, including potential limitations of the differing trials, but they also believed the findings may suggest CBT is not appropriate for individuals with the condition. This type of therapy may be not be effective for those 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.

The study concluded that: "CBT treatments have limited benefit for depressive symptoms in PWE. People receiving them are more likely to respond in the short term than if they receive usual care. However, most patients who receive the treatments do not show reliable improvement. The long-term effect of the treatments for depression remains to be determined, as does their benefit for anxiety. Overall, the results imply there is substantial scope for improvements in psychological treatments for distress in PWE. This may be found through exploring alternative psychotherapeutic approaches."

Article reference: Reference

Noble AJ, Reilly J, Temple J, Fisher PL

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