Long-term outcomes from the PEARLS randomized trial for the treatment of depression in patients with epilepsy☆
Research Highlights
► Long-term outcomes of depression treatment in epilepsy have not been reported. ► The PEARLS intervention resulted in reduction in depression symptoms. ► The PEARLS intervention resulted in reduction in suicidal ideation. ► The PEARLS intervention resulted in improvement in emotional well-being. ► This improvement persisted to the 18-month follow-up.
Introduction
Depression affects 30–50% of individuals with epilepsy [1], [2], [3] and contributes to functional impairment [4], [5], [6], unemployment [7], lower quality of life (QOL), and suicide rates 5–25 times higher than those in the general population [2], [4]. Epilepsy leads to unique challenges that contribute to depression, including driving restrictions [8], physical inactivity [9], social isolation, and unemployment [10]. Depression is suboptimally treated in epilepsy [4], [11], [12], and there are few clinical trials of psychotherapeutic or pharmacological depression treatment in this population. We adapted PEARLS [13] to treat adults with epilepsy through collaboration between public health, psychiatric, and epilepsy professionals. We conducted a randomized controlled trial of PEARLS for treatment of clinically significant depression in people with epilepsy. In 2010, we published the short-term findings from this study showing that PEARLS reduced depression and suicidal ideation and increased emotional well-being compared with usual care over 1 year [14]. Because depression is chronic and recurrent, it is important to explore the long-term impact of this intervention. The current study extends our previous findings to include the 18-month outcome of the PEARLS intervention (i.e., 13 months after services were withdrawn). The PEARLS intervention focuses on teaching participants problem-solving skills and encouraging more active and pleasurable lives, as well as initiation of psychotropic medication when appropriate. It was expected that these skills and behaviors would be maintained after the intervention was withdrawn and result in long-lasting benefits. Specifically, we hypothesized that the benefits of the PEARLS intervention would be maintained over 18 months despite the withdrawal of in-home treatment sessions at 5 months.
Section snippets
Methods
The PEARLS trial was conducted at the University of Washington Regional Epilepsy Center and neurology clinics in Seattle, WA, USA. This study was reviewed and approved by the University of Washington Human Subjects Division and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All persons gave their informed consent prior to their inclusion in the study. The 80 study participants were recruited by neurologist referrals or identified by
Results
Of the 80 subjects enrolled in the study at baseline, 51 completed all three follow-up assessments (6, 12, and 18 months); 29 (36.3%) had at least one missing assessment. Nine (11.3%) subjects did not complete any follow-up assessment. Of the 40 subjects in each arm, 30 PEARLS subjects and 28 UC subjects completed the 18-month follow-up assessment (PEARLS: 6 were unreachable, 2 moved, 1 withdrew, and 1 died; UC: 7 were unreachable, 1 moved, 3 withdrew, and 1 died). There was no significant
Discussion
The PEARLS trial is the first published randomized controlled effectiveness trial of an intervention specifically tailored to treat depression in patients with epilepsy, to our knowledge. The PEARLS intervention resulted in improvement in depressive symptoms, suicidal ideation, and emotional well being that persisted to the 18-month follow-up despite withdrawal of in-home treatment sessions at 19 weeks and monthly phone contacts at 12 months. This persistence of treatment effect is even more
Acknowledgments
We acknowledge the generous funding of the Prevention Research Centers Program and Epilepsy Program of the Centers for Disease Control and Prevention and the University of Washington Health Promotion Research Center (No. U48DP000050) and the support of CHAMMP (Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations) at Harborview Medical Center, Seattle WA, USA. We also thank our PEARLS research staff: Eddie Edmondson, Emily Rosenberger, Gina
References (27)
- et al.
Psychiatric comorbidity in epilepsy
Epilepsy Behav
(2005) Depression in epilepsy: a frequently neglected multifaceted disorder
Epilepsy Behav
(2003)Depression in epilepsy: prevalence, clinical semiology, pathogenic mechanisms, and treatment
Biol Psychiatry
(2003)- et al.
Treatment of depressive disorders in epilepsy patients
Epilepsy Behav
(2002) - et al.
Risk factors for depression in patients with epilepsy
Epilepsy Behav
(2006) - et al.
What is effective treatment of depression in people with epilepsy?
Epilepsy Behav
(2005) - et al.
PEARLS depression treatment for individuals with epilepsy: A randomized controlled trial
Epilepsy Behav
(2010) - et al.
Differential effects of seizure control and affective symptoms on quality of life in people with epilepsy
Epilepsy Behav
(2010) - et al.
Living Well II: a review of progress since 2003
Epilepsy Behav
(2006) - et al.
The ecological validity of neuropsychological assessment and the role of depressive symptoms in moderate to severe traumatic brain injury
J Int Neuropsychol Soc
(2007)
Correlates of functional status 3–5 years after traumatic brain injury with CT abnormalities
J Neurotrauma
Epilepsy: patient and family guide
Driving and flying with epilepsy
Curr Neurol Neurosci Rep
Cited by (61)
Underutilization of epilepsy surgery: Part II: Strategies to overcome barriers
2021, Epilepsy and BehaviorThe factor structure of depressive symptoms in patients with obesity enrolled in the RAINBOW clinical trial
2021, Journal of Affective DisordersBridging the divide between epilepsy and mental health to drive solutions
2019, Epilepsy and BehaviorMultidisciplinary management improves anxiety, depression, medication adherence, and quality of life among patients with epilepsy in eastern China: A prospective study
2019, Epilepsy and BehaviorCitation Excerpt :First of all, we found that the 12-month intervention alleviated both depressive and anxiety symptoms. Previous trials have consistently proved a positive impact of psychological interventions on depression [24,25]. Notably, most of the trials targeted only at PWE with a severe depression.
- ☆
Trial registration: ClinicalTrials.gov identifier: NCT00459329.