Epilepsy is a condition of the brain that causes seizures. If you have epilepsy, you’re more likely to develop depression and also anxiety. Depression is the most common mental health problem to affect people with epilepsy.[i] This is an important, and yet often neglected area of clinical practice in epilepsy.
There is no doubt that depression can have a negative effect on daily life and relationships, with or without epilepsy. It is also thought that there is a two-way relationship with epilepsy and depression. So for example:
- Depression can increase the risk of seizures by means of sleep deprivation,
- Medication adherence is poor in people with epilepsy who are depressed due to lack of motivation and memory issues
- Seizures can lead to depression both through biological mechanisms and the psychosocial impact that epilepsy has. [ii]
- A large study in the UK confirmed the relationship between depression and epilepsy, with each condition appearing to act as a risk factor for the other.[iii]
That’s why screening, assessing, and getting treatment for depression should be an integral part of epilepsy clinics and reviews with your doctor.
What is depression?
Depression is a common mood disorder. There are different kinds of depression.
We all have periods of feeling down from time to time. But with depression, the symptoms don’t usually go away unless they are treated. If you have depression, you may:
- feel sad, scared, angry, or anxious
- have trouble concentrating or paying attention
- sleep too much or too little
- lose interest in your usual activities
- be more or less hungry than usual
- have different aches and pains
Depression can interfere with your work or school and personal relationships and also make it hard to enjoy life. If you have symptoms of depression, make an appointment with your doctor or speak to someone. Don’t let it go on unchecked.
When does depression happen in people with epilepsy?
Depression may occur for a number of reasons, and often it is more than one.
- Some people with epilepsy report a low mood in the build up to a seizure and some may feel depressed after a seizure. These feelings can be short term or temporary and exclusively associated with seizures. There are also people whose mood improves after a seizure. [iv]
- People with temporal lobe epilepsy have higher rates of mood disorders than any other form of epilepsy.
- Others may have long term depression, and the depression may have even been present before the diagnosis of epilepsy.
- People with epilepsy may also experience depression because of the impact seizures and living with epilepsy have had on their life.
- Depression and mood changes can be a side effect of some antiepileptic medications.
Regardless of whether depression comes before or after an epilepsy diagnosis, depression can severely affect quality of life, even more than the seizures themselves.
These conditions together can also create a vicious cycle – just as poorly controlled seizures increase the risk of depression; untreated depression can make seizures more frequent and more severe.
An important thing to remember is that if you do experience mood changes, effective treatments are available, and recovery is possible. Epilepsy management becomes easier as depression lifts and treatments that tackle depression, such as psychotherapy, also reduce the frequency of seizures.
Diagnosis
Once diagnosed, depression (and anxiety) can be safely and effectively treated at the same time as epilepsy. Treatments for mental health conditions can greatly improve quality of life and can reduce the frequency and impact of seizures.
In people with epilepsy depression should be diagnosed early and reliably because successful treatment can have a great influence on outcome, quality of life and suicide risk. There are now simple reliable screening tools to help identify depression in epilepsy[v] or people at risk. These screening tools can improve detection of depression significantly.[vi]
You don’t need to see your neurologist to get diagnosed with depression, your GP should be able to help.
Treating depression
Treating depression is just as important as diagnosing it. Many general practitioners are reluctant to prescribe antidepressants to people with depression and epilepsy, fearing that they may exacerbate seizures, but this fear is largely unjustified. If needed, there are several antidepressants that are safe to use in people with epilepsy, however there are also a few that should not be prescribed because they are known to lower the seizure threshold. Your neurologist or psychiatrists should be aware of this.
To manage the depression, it is also important to optimise the epilepsy treatment – improve seizure control. Arguably, the ideal treatment outcome for people with epilepsy is to achieve complete seizure freedom through medical or surgical treatment of epilepsy.
Careful monitoring of medication side effects, especially of mood when starting a new medication or increasing the dose of a new or existing medication can be important for detection of early signs of mood changes which can prevent depression and suicidality. Reducing the dosage or even withdrawal of the drug in consultation with your doctor may be necessary.[vii]
Traditionally management of depression in people with epilepsy has been with medication, but some studies have shown psychotherapy to be effective as well and should be considered. There are also many online options – eTherapy – that may help if seeing a professional face to face is difficult. Read here about online therapy services. However, referral to a psychiatrist is mandatory in cases of severe and difficult-to-treat depression, or if there is evidence of suicidal intent.
Summary
Sustained mood changes or declining emotional well-being in people with epilepsy must be identified in a timely manner. In a busy medical clinic, symptoms of depression are frequently overlooked, mistaken, or not raised by the patient.
Depression risk can be lessened by optimising epilepsy treatment in terms of both seizure control and tolerating medication. For depression, psychotherapy has been shown to have beneficial effects, yet still appears to be underutilised by neurologists. Modern antidepressants are thought to be safe to use in epilepsy, however, due to the lack of appropriate studies the evidence is still inconclusive, particularly for mild depression.
Further information
Read a personal story here The parts of epilepsy people often don’t talk about
Listen to Dr Dan McLaughlin discuss Anxiety and Depression
Places that can help
- The MindSpot Clinic 1800 614 434 MindSpot is a free service for Australian adults who are experiencing difficulties with anxiety, stress, depression and low mood. They provide assessment and treatment courses, or can help you find local services that can help.
- MoodGym is an online self-help tool to help prevent and manage symptoms of depression and anxiety.
- THIS WAY UP™ provides online learning programs and CBT, education and research in anxiety, depressive disorders and physical health.
[i] https://indiana.pure.elsevier.com/en/publications/depression-and-epilepsy-epidemiologic-and-neurobiologic-perspecti Accessed Nov 2019
[ii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602262/ Accessed Nov 2019
[iii] https://www.medpagetoday.com/resource-centers/focus-on-epilepsy/understanding-bidirectional-link-between-epilepsy-and-depression/788 Accessed Nov 2019
[iv] https://www.mdedge.com/neurology/epilepsyresourcecenter/article/106256/epilepsy-seizures/mood-improves-following
[v] https://static1.squarespace.com/static/5b11943aaf20961cbb8f1315/t/5bb50d334192028ea0cbdd38/1538592051898/NDDI-E+Measure+and+Manuscript.pdf
[vi] https://www.sciencedirect.com/science/article/pii/S1059131109000661#fig1
[vii] https://www.seizure-journal.com/article/S1059-1311(16)30195-9/pdf
