Patients with epilepsy prefer neurologists manage treatment of anxiety, depression

Adults with epilepsy identified treatment for anxiety and depression as a priority and ranked neurologists’ prescribing of pharmacotherapy and wellness activities as their most preferred options for management.

Researchers presented their findings from this single-center study at the Annual Meeting of the American Neurological Association.

“Anxiety and depression are common but undertreated in epilepsy,” Heidi M. Munger Clary, MD, MPH, a neurologist at Wake Forest Baptist Health in Winston-Salem, North Carolina, and colleagues wrote. “Epileptologist survey results indicate equipoise for managing via psychiatry referral vs. prescribing. Patient management preferences are unknown.”

Munger Clary and colleagues conducted a prospective cross-sectional survey that collected data on adult patients with epilepsy as well as anxiety and/or depression (mean age, 42.2; women, 63.5%; white, 76.2%). Most patients had focal epilepsy (61.4%); the others had generalized/unknown epilepsy (38.6%). Only about a third of patients reported being seizure-free for 6 months (33.3%).

In this cohort, 30% of patients (n = 19) reported prior psychiatric hospitalization and 67% (n = 42) reported a current psychotropic medication. Nearly half of respondents (49%; n = 31) of patients reported receiving psychiatry care in the past, but only 16% reported current treatment (n = 10).

Patients most frequently indicated that their preference for anxiety and depression management was pharmacotherapy prescribed or adjusted by their neurologist compared with a referral to a psychiatrist (69.8% vs. 14.3%), though some patients reported preferring neither option (n = 10; 15.9%).

In ranking their treatment modality preferences, patients reported they were very likely (47.6%) or likely (30.2%) to prefer pharmacotherapy managed by a neurologist. Less than 20% of participants (17.5%) said they were very likely to prefer having medication prescribed or adjusted by a psychiatrist.

Nearly half of the cohort (44.4%) reported being very likely to prefer wellness strategies, such as eating well, getting enough sleep and exercising. Participants also reported being very likely (31.7%) or likely (25.4%) to prefer complementary/alternative treatments such as yoga and meditation.

“Treatment of anxiety and/or depression was a priority for this patient sample,” the researchers wrote.