Prevalence of Depression among Epileptic Patients and its Association with Drug Therapy: A Systematic Review and Meta-Analysis.

Abstract Background: Despite the high prevalence of epilepsy in sub-Saharan Africa and the established relationship between depression and epilepsy, the extent of comorbid epilepsy and depression in the region is still poorly understood. This systematic review and meta-analysis aims to address this gap in the literature by determining the pooled prevalence of depression among epileptic patients in sub-Saharan Africa. Methods: A systematic desk review and electronic web-based search of PubMed, Google Scholar, EMBASE, PsycINFO and the World Health Organization’s Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases) identified peer-reviewed research studies and doctoral dissertations on the prevalence of depression among patients with epilepsy using pre-defined quality and inclusion criteria. Relevant data were extracted and descriptive summaries of the studies presented in tabular form. The I2 test was used to assess heterogeneity across studies. A random effects model was used to estimate the pooled prevalence of comorbidity at a 95% confidence interval (CI). Funnel plot asymmetry and Egger’s tests were used to check for publication bias. The final effect size was determined by applying a trim and fill analysis in a random-effects model. Results: Our search identified 167 studies, of which 16 articles were eligible for inclusion the final analysis. The pooled estimate of prevalence of depression among patients with epilepsy was 32.71 (95% CI: 25.50 - 39.91). Regional sub-group analysis found that the pooled prevalence in East Africa was 34.52 (95% CI: 23.53 - 45.51) and 29.69 (95% CI: 22.7 - 36.68) in Southern and West Africa. The odds of depression among epileptic patients receiving polytherapy were 2.65 higher than in those receiving monotherapy (95% CI: 1.49 - 4.71, I2=79.1%, p < 0.05). Conclusion: Our findings indicate high comorbidity in sub-Saharan Africa and suggests that it may be more prevalent there than elsewhere. Comorbidity is statistically associated with polytherapy. Given the high levels of epilepsy in the region, more attention should be paid to incorporating depression screening and treatment into existing epilepsy programs and to revising treatment guidelines on comorbid depression to reduce polytherapy. Keywords: depression, drug therapy, epilepsy, prevalence, meta-analysis, Africa