The mental health problems going undiagnosed

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Depression is often an undiagnosed element of major illness, heaping further problems on patients already struggling with their condition. Mike Waites reports.

DESPITE BEING one of the earliest documented illnesses in history, much remains unknown about epilepsy.

Around one in 100 people suffer from the condition characterised by seizures of varying severity. Advances in medicine mean the majority have their condition under control but, like other neurological conditions among them Parkinson’s disease and dementia, depression can be an additional burden for patients.

Some estimates suggest it affects as many as a half of patients. Rates of suicide are a shocking three times the national average.

But evidence for the best treatments to tackle depression in those with epilepsy is worryingly scant. A review of research worldwide in the field, led by experts in Yorkshire, has found only three small trials into the use of anti-depressants, prompting concerns people could be left untreated.

Yet the issue is not confined to epilepsy. A study today of 21,000 patients in Scotland with cancer found rates of clinical depression ranging from six to 13 per cent, compared with a prevalence of just two per cent in the general population.

Almost three quarters of 1,130 people who had been diagnosed were not receiving any kind of effective treatment for depression.

Consultant neurologist Melissa Maguire, who is based at Leeds General Infirmary and co-authored the review into epilepsy and depression, said people could remain untreated partly due to uncertainty over which anti-depressants work best amid concerns about the risk of exacerbating seizures. There was also little known about why those with epilepsy were at greater risk of depression.

She said: “It is clearly a problem that could be better treated. Many of those with epilepsy suffer from depression at some stage in their illness so it is a major issue. I suspect people might not be getting the treatment they need - it might result in delays in treatment or people not getting treated at all. This group might be at higher risk.”

It is a similar picture for cancer although a team reporting their findings in the journal The Lancet Psychiatry today say a trial of new treatment is proving successful.

Prof Michael Sharpe, from Oxford University, said: “Major depression is really quite common in people with cancer and the perhaps surprising finding is that most of it goes untreated. The outcome with usual care is poor.”

The new treatment involves talking to patients, helping them to be active and engaged, “problem solving therapy” aimed at putting people more in control of their situation, and intensive monitoring for up to a year.

Prof Sharpe said: “What this programme does is get people back engaged with life and feeling more in control of their lives again. One of the biggest barriers we have to overcome is people thinking being depressed is part and package of cancer.”

Finding better treatments for epilepsy and other neurological complaints, among them Parkinson’s disease, multiple sclerosis and dementia, is a major goal of the Yorkshire Brain Research Centre appeal which is aiming to raise £2 million for a world-class research centre of excellence in Leeds.

One in six adults suffer from diseases of the brain but numbers are likely to increase significantly in coming decades as the population ages.

Fund-raisers are being invited to attend a record-breaking effort at Temple Newsam in Leeds on Sunday for numbers of people dressed as Sherlock Holmes. The fictional detective was born in Yorkshire and suffered from depression.

Tickets for the event, including a deerstalker hat, magnifying glass and pipe, cost £15. For more information go to www.sherlockworldrecord.com.