Depression and mood disorders are linked with many chronic health conditions and commonly seen in people with epilepsy. At least 20-30 percent of people with epilepsy suffer from a mood disorder and this is closely associated with lack of seizure control. Psychosocial and biological variables play a role in this complex relationship.
From a psychosocial perspective, the stigma, social limitations, and the discrimination associated with epilepsy and seizures can lead to disheartenment and poor self-esteem. On the biological side, the seizures, especially in temporal lobe epilepsy, and the effects of antiepileptic medications seem to be relevant contributors to mood problems in people with epilepsy.
Depression and anxiety are the most frequently seen mood disorders in people with epilepsy.
Depression is the most common mood disorder to affect people with epilepsy, yet it is frequently under-recognised and under-treated. Untreated depression has negative consequences in the lives of people with epilepsy and the people around them.
There is a two way relationship between depression and epilepsy.
- People with poor control of their seizures are at a higher risk of becoming depressed, and
- Severely depressed people are at a higher risk of having more seizures.
Some people with epilepsy may find that problems with their mood can affect their epilepsy and how it is managed.
For more about the symptoms of depression click here
When does depression affect people with epilepsy?
It’s hard to say exactly but depression may actually be present before the diagnosis of epilepsy. People with a history of depression are 4-6 times more likely to develop epilepsy because the genetic or biological factors that cause both epilepsy and depression sometimes show before the first seizure.
For some people with epilepsy, symptoms of depression can be directly connected to seizures – either beforehand or for several days after a seizure. Or the depression may be long-term.
Depression (or anxiety) may develop soon after diagnosis
Depression (or an anxiety disorder) may happen as a consequence of living with epilepsy.
How is depression treated in people with epilepsy?
The most important step in appropriately managing mood disorders is making the diagnosis.
Treating depression and epilepsy at the same time can be a challenge. Antiepileptic and antidepressant medications may affect your symptoms or seizures. These medications may also affect each other. Some antiepileptic medications have mood stabilising properties, so it may be worth asking about this and considering changing the medication for epilepsy first.
Your doctor can prescribe antidepressant medication based on your specific symptoms and needs. You will start on the lowest possible dose and slowly increase it until it’s working at the lowest possible dose. Sometimes, you might need to try different medications and doses to find what works best for you. Don’t make any changes to your medications without discussing it with your doctor.
In addition to medications, lifestyle changes, psychological therapy, or other treatments such as Vagus Nerve Stimulation have proven benefits for both conditions.
Effective diagnosis and treatment of depression can not only affect the management of epilepsy but improves quality of life in people with epilepsy.
If you have epilepsy, you’re at higher risk of developing depression. If you have epilepsy and think you have depression, make an appointment with your doctor. They can recommend and discuss treatment that is best for you.
Anxiety often co-exists in people with epilepsy and, just like depression, anxiety can be seizure related. Some seizures cause feelings of anxiety as part of the seizure, but because seizures are unpredictable, many people have anxiety related to fear of having a seizure.
The combination of chronic physical illness, lost educational or employment opportunities, financial worries and the constant fear of seizures can also lead to anxiety developing.
Anxiety becomes a problem when you feel anxious most of the time and when it affects daily life such as eating, sleeping or being able to leave the house. If you are anxious, you may also feel unable to relax, or have no energy or be easily tired. You may panic in certain situations. You may sleep poorly or wake up too early in the morning. Your memory or concentration will be worse. You may feel easily irritated.
For more about signs and symptoms of anxiety click here
Medications used for epilepsy have benefits, but they also have side effects.
Possible side effects of antiepileptic medications include mood changes, depression, irritability, aggression, agitation or depression.
Think about when your mood changes started and if they correlate with any medication changes. If there is a direct correlation, then it is important to speak to your doctor and make necessary changes. You don’t need to live with intolerable side effects. However, it’s not always the medication effects. Some antiepileptic medications have also been known to improve mood.
The long lists of side effects that come with the antiepileptic medication can be alarming, but these are a list of possible side effects and often many of them don’t occur. If a listed side effect is labelled as common, this means that, at the most, 1 in 10 people will get it and 9 in 10 people will not.
What you can do
Initially, most people find managing epilepsy a real challenge. Until seizures are controlled with medication, the possibility of seizures in public can be a real concern. The effects of epilepsy extend beyond the seizures and often other issues such as driving, work and relationships are also affected. It may help to follow a few of these strategies:
- If you have recently been diagnosed with epilepsy, be gentle on yourself.
- Make sure you eat well, exercise regularly, get enough sleep and avoid alcohol and other drugs.
- Allow yourself time to relax and do what you enjoy.
- Think about how you have faced previous stressful situations in your life and what helped you cope (and what didn’t).
- Try to learn as much about epilepsy and its management as you can. You may find it helpful to connect with other people with epilepsy so you can learn from them and share your experiences. A good place to start is MyEpilepsyTeam
- Be aware of the symptoms of anxiety and depression and seek support at the earliest sign if you see them in yourself.
- Seek help from professionals. This may involve having counselling or attending a support group.
- Involve other family members and friends and accept offers of help.
- Keeping a diary of everything seizure and treatment related can really help you see the big picture. EpiDiary is a free online diary that you can track your moods, seizures and effects of your medication.
Read an interview and patient questions with Dr Tatiana Falcone from the Cleveland Clinic in the US. Dr Falcone’s specialty interests include: anxiety and mood disorders, epilepsy and behaviour, psychiatric issues in epilepsy, psycho-oncology, psychosis, and schizophrenia. https://my.clevelandclinic.org/health/transcripts/1200_mood-disorders-in-epilepsy