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, & UPLIFTEpilepsy and Depression

32-48% of people with epilepsy are depressedMay avoid antidepressants because of epilepsy medsPsychotherapy attendance limited by driving

restrictionsProject 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 ThoughtsDelivered to groups by Web or telephoneBoth Web and telephone were more effective than

treatment-as-usual in reducing symptoms of depression

From Treatment to PreventionMindfulness-based Cognitive Therapy had been used

for prevention, so why not UPLIFT?Received stimulus funds from the National Institute

of Minority Health and Health DisparitiesRevised materials and tested in focus groupsLike the original, comprised of 8 hour-long sessions

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

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

MethodDesign: Randomized, controlled trial

Stratum 1: Pretest 8 wk phone Interim as usual Follow-up

Stratum 2: Pretest 8 wk Web Interim as usual Follow-up

Stratum 3: Pretest as usual Interim 8 wk phone Follow-up

Stratum 4: Pretest as usual Interim 8 wk Web Follow-up

ParticipantsPeople with epilepsy age 21 and overWith mild-to-moderate symptoms of depression (8<CES-D<27)Without Major Depressive Disorder (MDD)No suicidal ideationMentally stableRecruited 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

– Modified Beck Depression Inventory (mBDI)/(BDI)– Patient Health Questionnaire (PHQ-9)– Neurological Disorders Depression Inventory for

Epilepsy (NDDI-E)• Seizures

– 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

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

0-4 sessions

5-7 sessions

All 8 session

s

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

ConclusionsProject UPLIFT for treatment constituted a leap forward in

delivery of depression treatmentReaches those whose mobility is impaired by disability, or

even the fatigue and loss of energy associated with depressionReaches people in rural or otherwise hard-to-reach areasThose with specific conditions who live far apart can be

brought together in a group to connect and share experiencesBuilds capacity for intervention among populations with

chronic disease by training peers to deliver the interventionThis study demonstrates its efficacy for prevention

Averts disability and lost productivity from depressionEliminates tangible and intangible costs of treating depression Provides participants with skills to manage future stress and

difficult life circumstances

AcknowledgementsTo the people with epilepsy who took part in

this studyTo all of our facilitators with and without

epilepsy