Transcript Preventing Depression in Epilepsy: Project UPLIFT

Nancy J. Thompson, Ph.D., M.P.H.,
Archna Patel, M.P.H., Linda M. Selwa, M.D.,
Charles E. Begley, Ph.D., Robert T. Fraser, Ph.D.,
Erica Johnson, Ph.D., & Shelley Stoll, M.P.H.
Epilepsy, Depression, & UPLIFT
 Epilepsy and Depression
 32-48% of people with epilepsy are depressed
 May avoid antidepressants because of epilepsy meds
 Psychotherapy attendance limited by driving restrictions
 Project UPLIFT
 Created with CDC funding as a home-based intervention
for depression in epilepsy
 Based upon


Mindfulness (Using Practice)
Cognitive-behavioral Therapy (Learning to Increase Favorable
Thoughts
 Delivered to groups by Web or telephone
 Both Web and telephone were more effective than
treatment-as-usual in reducing symptoms of depression
From Treatment to Prevention
 Mindfulness-based Cognitive Therapy had been used
for prevention, so why not UPLIFT?
 Received stimulus funds from the National Institute of
Minority Health and Health Disparities
 Revised materials and tested in focus groups
 Like the original, comprised of 8 hour-long sessions
Monitoring Thoughts
The Present as a Calm Place
Challenging and Changing Thoughts
Thoughts as Changeable & Impermanent
Coping and Relaxing
Pleasure and Reinforcement
Attention and Mindfulness
Relapse Action Plans
 Co-delivered by trainees and peers with epilepsy from GA
(mostly), supervised by a licensed psychologist
 Supported by a mental health professional in each state
Method
 Design: Randomized, controlled trial
Stratum 1:
Stratum 2:
Stratum 3:
Stratum 4:
Pretest
Pretest
Pretest
Pretest
8 wk phone
8 wk Web
as usual
as usual
Interim
Interim
Interim
Interim
as usual
as usual
8 wk phone
8 wk Web
Follow-up
Follow-up
Follow-up
Follow-up
 Participants






People with epilepsy age 21 and over
With mild-to-moderate symptoms of depression (8<CES-D<27)
Without Major Depressive Disorder (MDD)
No suicidal ideation
Mentally stable
Recruited from their respective states by: Emory University (GA):
University of Michigan (MI); University of Texas, Houston (TX);
University of Washington (WA)
Measures
• Mediators
•
•
•
Knowledge & Skills—developed with UPLIFT
Depression Coping Self-efficacy
Self Compassion
• Outcomes
•
Depression
–
–
–
•
Seizures
–
–
•
Modified Beck Depression Inventory (mBDI)/(BDI)
Patient Health Questionnaire (PHQ-9)
Neurological Disorders Depression Inventory for Epilepsy
(NDDI-E)
Self-reported number of seizures
Liverpool Seizure Severity Scale
Quality of Life
– SF-36 Physical and Mental Health QOL
– Satisfaction with Life
Results
• Incidence of MDD: 10.7% (TAU) vs. o.o% (UPLIFT) (p = 0.028)
BDI
(p = 0.005)
PHQ-9
(p = 0.049)
Knowledge/Skills
(p = 0.043)
Results (continued)
Satisfaction w/ Life
(p = 0.006)
Seizure Severity
(p = 0.10)
# Seizures*
(p = 0.025)
*past 4 weeks
Results (continued)
 There was a dose relationship between number of
sessions attended and mean change in each outcome
0-4
sessions
5-7
sessions
All 8
sessions
Depression
+1.3
-3.0
-4.6
Number of Seizures
+0.5
-0.8
-5.8
Knowledge and Skills
+1.9
+9.7
+13.7
Satisfaction with Life
+1.7
+1.8
+2.9
 All other measures changed in the expected direction,
although they did not achieve significance.
 The effects were maintained over the 8 weeks of follow-up
Conclusions
 Project UPLIFT for treatment constituted a leap forward in
delivery of depression treatment
 Reaches those whose mobility is impaired by disability, or even
the fatigue and loss of energy associated with depression
 Reaches people in rural or otherwise hard-to-reach areas
 Those with specific conditions who live far apart can be brought
together in a group to connect and share experiences
 Builds capacity for intervention among populations with
chronic disease by training peers to deliver the intervention
 This study demonstrates its efficacy for prevention
 Averts disability and lost productivity from depression
 Eliminates tangible and intangible costs of treating depression
 Provides participants with skills to manage future stress and
difficult life circumstances
Acknowledgements
 To the people with epilepsy who took part in this study
 To all of our facilitators with and without epilepsy