Objective: Despite the availability of literary data on the concomitant of epilepsy and depression, in adolescents this problem is almost not developed.

Materials and Methods: The aim: to study the concomitant of epilepsy and depression in children. The study included 156 patients with epilepsy. The severity of depression was studied by using the Hamilton scale and ICD-10. The return of patients ranged from 12 to 17 years.

Results: Depression of varying severity was detected in 68 % of the examined patients. From 106 patients suffered mild depression=83; moderate depression=21 and severe depression=2.

Conclusion: In children with epilepsy, there is a high incidence of concomitant of epilepsy and depression.

In a leading article, we showed that among the mental disorders in epilepsy, depression in varying degrees of severity is the most common [1]. Moreover, this article reports that the incidence of sudden death, which accounts for 7-17% of deaths among patients with epilepsy, is estimated to be 27 times higher in patients with seizures than in those without seizures. The incidence of epilepsy in Europe and the United States is about 40-70 cases per 100,000 populations, while in developing countries the incidence is much higher. Interestingly, the incidence of epilepsy in men, especially in the elderly and senile age, is higher than in women [2, 3]. According to other authors, the incidence of depression in patients with epilepsy ranges from 22% to 58%. [4]. Historical data in world literature show that as far back as 400 BC, Hippocrates stated: “usually melancholics are epileptic and epileptics are melancholic” [5].   

Summing up the brief data of the introduction, we can focus on the following questions:

• Lack of treatment and detection of depressive disorders in people with epilepsy has serious consequences on several levels;

• Increased risk of suicide. Depression in patients with epilepsy is associated with significantly higher suicide rates than in the general population;

• Negative impact on quality of life. Drug-resistant epilepsy has shown that depression is the most powerful predictor of health-related decline in quality of life;

• Impact on the cost and use of medical services. Depression in patients with epilepsy significantly increases the health costs associated with the treatment of seizure disorders. The presence and severity of depression were predictors of lower rates of disability regardless of the duration of the seizure disorder.

Thus, the aim of the present study was to identify the various forms of epilepsy and the severity of depression and to develop their simultaneous treatment.

We examined 156 patients with G40.3 Generalized idiopathic epilepsy G 40.0 Focal epilepsy. Patients were examined in the interictal period.

Patients were observed at the Children’s neurological hospital of the Main Health Department of the city of Baku, Azerbaijan from January 2019 to January 2022. Patients are randomized as they go to the children’s neurological hospital. A total of 156 patients were examined. At the same time, various forms of epilepsy and the severity of depression were found in 106 patients. The return of patients ranged from 12 to 17 years. That is, 68% of patients with epilepsy have various degrees of severity of depression. Clinical characteristics of enrolled children were shown in the Table 1. 

Informed written consent to participate was gave from parents of the patients. In accordance with the Helsinki Declaration of the World Medical Association “Recommendations for doctors engaged in biomedical research involving people”, adopted by the 18th World Medical Assembly (Finland, 1964, revised in Japan in 1975, Italy - 1983, Hong Kong - 1989, the South African Republic- 1996, Edinburgh- 2000); The Constitution of the Republic of Azerbaijan, the Law “On Psychiatric Assistance” (adopted on 12.06.2001, with amendments and additions - 11.11.2011, Decisions of the Cabinet of Ministers of the Republic of Azerbaijan No. 83, dated April 30, 2010 “On Approval of the Rules for Conducting Scientific, Preclinical and Clinical studies of medicines” are established. The conditions of the conducted researches corresponded to the generallyaccepted norms of morality, the requirements of ethical and legal norms, as well as the rights, interests and personal dignity of the participants of the studies were observed. 
Of the identified patients, 11 were previously treated with both appropriate anticonvulsants and an antidepressant.

The question may arise, we used antidepressant venlafaxine. The literature suggests that venlafaxine is the least effective antidepressant for seizures [6, 7]. 

Of the identified patients, 11 were previously treated with both appropriate anticonvulsants and an antidepressant. The effectiveness of therapy was determined by the Wilcoxon W test. The Wilcoxon W test is a non-parametric analogue of the paired Student's t-test (t-test for dependent samples) for comparing patients before and after treatment. This non-parametric test is based on ranks.

The principle of the criterion is the following. For each patient, the magnitude of the sign change is calculated. All changes are ordered by absolute value (ignoring the sign). Then the sign of the change is assigned to the ranks and these "sign ranks" are summed up - the result is the value of the Wilcoxon criterion W. Comparison of observations before and aft’ treatment WILCOXON criterion [8]. 

Our research has shown that 68% of epilepsy patients examined have varying degrees of depression. The literature shows that depression is extremely common among epileptic patients and is associated with intense individual suffering and a sharp decline in quality of life [9].  According to another systematic study, 23.1% of epilepsy patients suffered from depression last year compared to 6.6% of the general population [10, 11].  Lifelong prevalence of depression is estimated to be 30–35% among epileptic patients compared to 16.2% in the general population [12, 13].   

Swinkels, et al. The results of their research show that mood and anxiety disorders are more common in patients with epilepsy than in the general population [14].  The authors then note that. These disorders are more common in sciatica (GPE). However, some methodological points in their designs do not rule out the possibility of more pronounced differences between groups of GPE and GPE-peripheral epilepsy.

The frequency of depression varies depending on the different conditions of epileptic patients: 1) from 20% to 30% of patients with recurrent seizures; 2) from 6% to 9% of patients in remission; 3) 50% to 55% of epilepsy patients receiving treatment in hospital clinics [15].  Men with epilepsy have a higher risk of developing depression, while women are more likely to have depression in the general population [16]. 

According to some literature, the prevalence of depression is 5 times higher in patients with controlled seizures and 10 times higher in uncontrolled patients. It is not known whether depression in these patients can be considered primarily as part of the primary pathology of the central nervous system or as a clear response to epileptic disorders with all the difficulties of daily struggle [17]. 

Depression is known to affect the outcome of treatment of seizures. There is a high comorbidity between depression and seizures. The incidence of depression is higher in patients with epilepsy than in the general population (1% to 3% in men and 2% to 9% in women) [20]. Men with epilepsy have a higher risk of developing depression, while women are more likely to have depression in the general population [18]. 

 Depression is one of the most common diseases in epileptic patients, occurring in 1 in 4 patients, and is associated with psychological and neurobiological causes. The general neurobiological mechanisms of epilepsy and depression and depression have a complex two-way relationship, suggesting that some epileptic syndromes may be premorbid symptoms. Sertraline and citalopram may be the first choice for the treatment of moderate to severe depression, although psychological treatment should always be used in moderation [19].  The limitations of our research are as follows: 1) a small number of patients; 2) short-term observation.

Thus, depression is somewhat severe for a group of patients with epilepsy who are more than half. The concomitant study of epilepsy and depression is of great theoretical and practical importance. First, it will help detect depression early. Second, prevent suicides. Third, it will help reduce refractory epilepsy. Finally, it helps improve quality of life for epilepsy patients.

Thus, in more than half of the cases, depression is characterized by a degree of severity for the group of patients with epilepsy examined. Concomitant study of epilepsy and depression is of great theoretical and practical importance. First, it will facilitate early detection of depression. Second, it can prevent suicide. Third, it will help reduce resistant epilepsy. Finally, it provides an opportunity to improve the quality of life of epilepsy patients.

In particular, the risks and benefits of pharmacological treatment with the risks and benefits of not being treated with antidepressants should be carefully weighed and documented in the patient's medical records. Patients should be monitored regularly, especially during the first few days of treatment. It is important to observe the activation of known or unknown bipolar disorder and / or suicidal ideation. Parents or guardians should be informed of this risk to help monitor adolescent patients. During treatment with venlafaxine, parents or guardians should be instructed to monitor children and adolescents for persistent depression and anxiety disorders.

Conflict of Interest Statement 

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Acknowledgment

 The author would like to thank staff of the Mental Health Center of the Ministry of Health of the Republic of Azerbaijan

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. 

The author expresses his deep gratitude to the staff of the Children's Neurological Hospital for their assistance in carrying out this work.

The work was carried out at our own expense.