What is anxiety and depression?

Worry, fear and panic are words that are often used to describe anxiety. While low mood, unhappiness and sadness are words that describe depression. Symptoms of anxiety and low mood are normal human experiences that affect everyone on occasion. But, when these symptoms become too severe or occur too often, they can start to have a big impact on our emotional and physical wellbeing and daily life.

Some symptoms of depression and anxiety overlap, such as problems with sleep, irritability, and difficulty concentrating. But there are some key differences that help distinguish between the two.

Anxiety

Anxiety usually occurs when we fear the consequences of certain events, situations, or symptoms and when we have concerns about being able to manage or cope with the consequences of these. For example, people with epilepsy often have anxiety about having a seizure in public and losing control and being embarrassed, which is understandable. But, for some this anxiety can become increasingly worse and lead people to avoid going out in public or leaving the house altogether and becoming socially isolated. Ongoing, long-term anxiety can be debilitating and lead to irrational thoughts and fears that interfere with your daily life.

Depression

Low mood or feeling sad or down is normal from time to time and can occur in response to significant challenges, stressors and losses and when we find it hard to get enjoyment or pleasure out of things. For example, people with epilepsy often face challenges to their independence (e.g., loss of driving license) and maintaining a job as well as difficulties with their memory. These challenges, if unmanaged, can increase the risk of people experiencing depression.

The symptoms of anxiety and depression can classified into one of three types – Physical, Behavioural and Thought Symptoms:

Anxiety and depression not only affect the way people feel about themselves and their future, but can also negatively impact their physical health, quality of life,  those around them, and their ability to self-manage their epilepsy.

Why do people with epilepsy get anxiety and depression?

Anxiety and depression are very common in the general community and affect about 1 in 5 of Australians every year. We know that anxiety and depression are even more common in people with chronic health conditions, like epilepsy, and as many as 1 in 2 people will experience anxiety or depression at some point in their lives. Research also shows that more than half of people who have anxiety and depression will experience both together.

Anxiety and depression are influenced by a whole range of things, including biological factors, medications, social supports and coping skills. For example:

• Biological: Some scientists believe that depression and epilepsy share common brain pathways that mean people with epilepsy are at greater risk of depression and vice versa. Some people with epilepsy experience low mood and anxiety in association with seizures, so either before, during and/or after seizures.
• Medications: There is some evidence that some antiseizure medications can also affect mood.
• Social: Research indicates that people who have good social supports (family, friends and community), and who stay as active socially, do better.
• Coping: Plenty of research shows that how we think and what we do can have a very big impact on whether we experience anxiety and low mood, especially when we have a long term health condition. For example, people who try to maintain the different areas of their life as much as possible (stick to usual routine, be active, connect with peers, think positively) often do best.

Managing Depression and Anxiety in People with Epilepsy

While some people believe depression and anxiety are an inevitable consequence of living with epilepsy or a consequence of the medications. The good news is that this isn’t true and that both depression and anxiety can be treated. The two most common types of treatment include:

• Medication: People with epilepsy are sometimes prescribed antidepressant or anti-anxiety medications by a doctor – either their  GP, neurologist, or psychiatrist. If symptoms are mild, then medication may not be needed.
• Psychological Treatments: Are usually provided by psychologists and involve learning good information about emotional wellbeing and practical skills and strategies for managing anxiety and low mood alongside your epilepsy.

It is common for people with epilepsy to be unsure and hesitant when to seek treatment for symptoms of depression and anxiety.

If you are interested in a brief online assessment designed to measure your recent symptoms of anxiety and depression go to the e-CentreClinic online assessment. These are confidential and no-one else will see or receive your results.

Importantly, while these measures can provide good general information about your symptoms, only a health professional can properly assess your symptoms and make a diagnosis. So, if you are concerned about your symptoms or emotional wellbeing, please consult your GP or a health professional as soon as possible.

If you are feeling suicidal or in crisis, please act immediately by contacting:

• Lifeline on 13 11 14
• Suicide Callback Service on 1300 659 467
• Emergency services on 000.

Epilepsy Action Australia and the eCentreClinic at Macquarie University Australia are working towards improving access to online treatment courses for people with epilepsy experiencing symptoms of anxiety and depression. If you would like to find out more about these internet-delivered courses please visit the eCentreClinic. They also run a Well-being Neuro Course specifically aimed at people with neurological conditions.

Psychosis

Psychosis is a condition that affects the way your brain processes information. Psychosis can involve seeing or hearing things that aren’t real (hallucinations), loss of touch with reality (delusions) and disordered thoughts. People with psychosis may feel a lack of or inappropriate emotions and may display decreased drive and motivation, social withdrawal, paranoia, or extreme levels of physical activity, becoming either hyperactive or immobile.

A small percentage (0.2%) of people with epilepsy experience psychotic symptoms. For some people their psychosis is no different to that found in people without epilepsy. For others psychosis can be directly related to seizures and is sometimes known as post-ictal (after seizure) psychosis.

Post-ictal psychosis usually occurs a few hours or days following a cluster of seizures. These psychotic episodes can involve disordered thoughts, confusion, delusional ideas and aggressive behaviour. Importantly, these episodes are usually brief and can be effectively prevented or treated with medication. Some people may have repeated episodes of post-ictal psychosis after a cluster of seizures, so this can be managed or even prevented with early administration of antipsychotic medication after a seizure cluster.

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