By Cong Zhi Zhao, MD
As a neurologist I am often the bearer of bad news, and some of the most frequent bad news I deliver is the diagnosis of epilepsy. This is a potentially devastating diagnosis and I often see patients return with symptoms of depression. Depression is one of the most common associated disorders in people with epilepsy and the risk of suicide is also higher when both epilepsy and depression are present.
For these reasons, it is important to assess people with epilepsy for depression. This is especially true for those patients whose seizures are treatment resistant.
As an article in 2004 issue of Neurology® shows, in these patients depression is a better predictor of quality of life than seizure frequency.
What causes depression?
Depression in people with epilepsy can be caused by a combination of factors. These include medications, decreased mobility and isolation, social stigma, and their reaction to the diagnosis. The seizures, especially those that originate in the limbic part of the brain, an area involved in emotions, can themselves cause depressed mood. Finally, if not complicated enough already, some antiepileptic medications can worsen mood disorders, whereas others may act as mood stabilizers.
In 2008, the FDA issued an alert on the increased risk of suicidal behavior or thoughts in patients taking antiepileptic drugs. They encouraged patients to discuss this with their physicians but NOT to stop taking the medication before that discussion. In people with both epilepsy and depression, the foremost goal is still to achieve seizure freedom with medication, surgery or VNS (vagus nerve stimulation). However, in people who cannot achieve seizure freedom, the quality of their lives may depend more upon adequate treatment of depression. While the most popular antidepressants, selective serotonin reuptake inhibitors or SSRIs, can lower the threshold for seizures, in most patients this is usually not a barrier to adequate depression treatment.
Talk to your neurologist
If you suffer from epilepsy and have a history of feeling down, hopeless or depressed or develop those symptoms while being treated for epilepsy, speak with your neurologist right away. Let your neurologist know if you have a history of mood disorder before starting medication, as this may affect the choice of which antiepileptic is the best option for you.
Your neurologist should ask you about depression, anxiety and suicidal thoughts at each visit and consider treatment for the mood disorder or refer you to a behavioral health provider as needed. You are not alone if you have depression after receiving the diagnosis of epilepsy, and treating the depression is just as important for your wellbeing and life quality as is treating the seizures.
For more information on epilepsy and depression:
Whether you have epilepsy or not, if you have thoughts of hurting yourself there are people to help you: