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Hippocampal volume and depression: Insights from epilepsy surgery
  1. Joanne M Wrench (joanne.wrench{at}unimelb.edu.au)
  1. The University of Melbourne, Australia
    1. Sarah J Wilson (sarahw{at}unimelb.edu.au)
    1. The University of Melbourne, Australia
      1. Peter F Bladin (pbladin{at}ozemail.com.au)
      1. Comprehensive Epilepsy Program, Austin Health, Australia
        1. David C Reutens (david.reutens{at}med.monash.edu.au)
        1. Monash University, Australia

          Abstract

          Background: Major depression is common after epilepsy surgery. It has previously been suggested that surgical removal of limbic system structures such as the hippocampus may contribute to this co-morbidity. Recent magnetic resonance imaging studies have found smaller hippocampal volumes in depressed patients in comparison to controls.

          Aims: The current study examined whether pre-operative hippocampal volumes were associated depression experienced after epilepsy surgery. Patients undergoing mesial (n=26) and non-mesial (n=16) temporal lobe resections were assessed pre-operatively, and for one year post-operatively. Assessment included a clinical interview and the Beck Depression Inventory (BDI-II). Hippocampal volumes were measured on the pre-operative T1-weighted magnetic resonance imaging scans of the patients and 41 neurologically normal controls.

          Results: A similar proportion of mesial and non-mesial temporal patients had a pre-operative history of major depression. Post-operatively, 42% of mesial and 19% of non-mesial temporal patients were depressed. There was no relationship between hippocampal volume and pre-operative depression in either group. Depression after surgery was associated with significantly smaller hippocampal volumes contralateral to the resection in the mesial temporal group (p=0.005). This effect was seen in mesial temporal patients who developed de novo depression (p=0.006). Hippocampal volume was unrelated to post-operative depression in the non-mesial group.

          Conclusion: This study highlights the role of neurobiological factors in the development of post-operative depression. These initial findings have implications for understanding depression following epilepsy surgery as well as the pathogenesis of depression more generally.

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