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 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 ThoughtsThe Present as a Calm Place Challenging and Changing ThoughtsThoughts as Changeable & Impermanent Coping and RelaxingPleasure and Reinforcement Attention and MindfulnessRelapse Action Plans

Method Design: 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 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 – 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 sessions Depression Number of Seizures Knowledge and Skills Satisfaction with Life

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