Understanding Anxiety and Epilepsy

Epilepsy can be a stressful or challenging condition. After a diagnosis, a person may naturally feel anxious about their health or about having a seizure. It has been estimated that about 20% of people with epilepsy also show anxiety symptoms.

Clinical anxiety is a mental health disorder different from mild, fleeting anxiety. Anxiety can overlap with epilepsy symptoms and even be a symptom of epilepsy, so the two conditions are associated in various ways. Appropriate treatment for both conditions should be part of your treatment plan.

Read on to find out more about epilepsy and anxiety, their diagnosis and treatment, and how to cope.

The Connection Between Anxiety and Epilepsy

Epilepsy has connections and associations with stress and anxiety, both as part of the disease process and as things that can worsen the condition. Certain anxiety symptoms can occur with seizures or before a seizure starts, as part of the aura. The exact cause or link between brain abnormalities and anxiety is unknown, but there is an association.

Approximately 20% of people with epilepsy also show symptoms of anxiety. This is a significant number of people, yet the relationship between the two conditions remains understudied.

Complications of Anxiety and Epilepsy

Sometimes panic attacks are mistakenly diagnosed as a seizure. Some symptoms can be present in both, like rapid heartbeat, sweating, skin flushing, and hyperventilation (overbreathing).

If the panic attack is severe, hyperventilation can sometimes cause convulsions (uncontrollable muscle contractions), which further adds to the confusion with a diagnosis.

Chronic stress, which can include anxiety, can increase seizures in people with epilepsy. More research needs to be done to explore this further, but stress has been associated with increased seizures, and anxiety is a commonly co-occurring disorder with epilepsy.

Diagnosis of Anxiety and Epilepsy

While a neurologist (a specialist in conditions of the nervous system) is usually the one who diagnoses epilepsy, a mental health professional typically diagnoses anxiety. However, a neurologist may notice clinical signs of anxiety and provide a referral. The symptoms of the two are very different.

Along with taking a medical and family history and doing a physical exam, the neurologist might:

• Perform a neurological exam and ask questions to assess mental functions and test reflexes, muscles, and senses
• Perform an electroencephalogram (EEG) to look for changes in brain electrical patterns related to seizures
• Order brain scans like computed tomography (CT) scans or magnetic resonance imaging (MRI) to detect changes in the brain that might lead to seizures

Healthcare providers and mental health professionals use the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5,) when they evaluate a person for an anxiety disorder and make a diagnosis.

Self-Test for Anxiety

If you’re concerned that your symptoms are more than the adjustment to a new diagnosis or epilepsy symptoms, a self-test can be a good motivator to seek professional help. A self-test should not be used in place of a professional clinical diagnosis.

Self-tests to screen for anxiety include:

• GAD-7 (General Anxiety Disorder-7), which can be printed to bring to an appointment
• Psychology Today
• Mental Health America

Treatment of Anxiety and Epilepsy

There is no cure for epilepsy, but there are ways to treat and manage it. Epilepsy may be treated with various options, including medications, surgery, seizure devices, and special diets.

What works for one person may not work for another, so you and your treatment provider will develop a management plan for your specific symptoms and needs.

Anxiety is typically treated with a combination of medication and psychotherapy. That being said, studies on anxiety disorders in epilepsy are lacking, and there is no knowledge of the response and remission rates of anxiety disorders in people with epilepsy compared to those without epilepsy.

Anxiety may affect epilepsy treatment because medication interactions may cause serious side effects, but more research is needed.

Medications

For people without epilepsy, many studies have focused on drugs known as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Although there is no evidence that SSRIs are associated with an increased risk of seizures, more research is needed to explore how these drugs fare in those with epilepsy.

For people with anxiety and epilepsy, the two drugs that are often used include:

• Buspar (buspirone): This is a serotonin receptor agonist, which means it inhibits the release of serotonin, a chemical messenger that facilitates communication between cells in the nervous system.
• Lyrica (pregabalin): This anticonvulsant calms damaged or overactive nerves that trigger pain or seizures.

Pregabalin is the only antiepileptic drug licensed to treat both anxiety and epilepsy. If you are taking medication for anxiety, talk with your healthcare provider about any possible interactions between the anxiety medication and epilepsy medications or if it is an appropriate drug for someone with epilepsy.

Psychotherapy

Psychotherapy is often used alongside medication to treat anxiety. There are different kinds of psychotherapy for anxiety, and what works for one person may not work for another.

A mental health professional will conduct a detailed evaluation to determine the most effective treatment for you. Different types of therapy for anxiety can include:

• Cognitive behavioral therapy (CBT): In this therapy, problematic patterns of thoughts and behaviors are explored so they might be changed.
• Acceptance and commitment therapy (ACT): This therapy focuses on mindfulness, identifies problematic thoughts or feelings, and teaches skills to accept and contextualize them.
• Dialectical behavioral therapy (DBT): This therapy combines CBT techniques with concepts from mindfulness, balancing emotions, and changing thought patterns.

Coping With Anxiety and Epilepsy

Living with a chronic condition as well as a mental health disorder can be stressful, and developing good coping techniques is important to manage your conditions and stay as healthy as possible.

Lifestyle Changes

A 2021 study found an association between chronic stress and seizures in people with epilepsy. Better coping techniques like participating in mindfulness-based stress management, cognitive-behavioral therapies, and relaxation techniques might help reduce the overall stress load. This may help reduce seizure risk and anxiety.

Diet can also be helpful in both managing epilepsy and anxiety. When used with seizure medications, dietary therapy can help manage epilepsy. Dietary changes can include:  

• Ketogenic diet: A very high-fat, low-carbohydrate diet
• Medium-chain triglyceride diet (MCT diet): A ketogenic diet using a fat supplement that consists only of MCT fats
• Modified Atkins diet (MAD): A high-fat, low-carbohydrate diet with unrestricted amounts of protein
• Low glycemic index treatment (LGIT): Focuses on carbohydrates that have less effect on blood sugar levels (such as fiber or consuming fats with carbohydrates)

Diet can also help with anxiety. Low-carbohydrate, high-fat diets (such as the ketogenic diet, MCT diet, and MAD) can sometimes help reduce anxiety. This may be due to the anti-inflammatory effects of the diet or the effects on gut microbiology. More research is necessary to state any associations definitively.

These lifestyle changes are not a replacement for medical treatment but can be used in conjunction with your treatment plan.

Support Groups

Support groups for epilepsy can be helpful in interacting with others living with similar circumstances. They can be online or in-person and can include:

• The Epilepsy Foundation
• Epilepsy Alliance America

Anxiety support groups can also be beneficial. Ones to look at include:

• Anxiety & Depression Association of America: You can search for in-person support groups near you or online groups.
• Mental Health America: They have online support message boards, and you can find local associates in your area.

Summary

Epilepsy is intertwined with stress and anxiety, as both a reaction to the diagnosis and as aspects of the condition, and also as a comorbid (co-occurring) condition. It’s important to get accurate diagnoses of both conditions in order to get the most appropriate treatment.

While lifestyle modifications like diet and stress management can help, these are best used in conjunction with the treatment plans your healthcare providers put in place for epilepsy and anxiety. This can include seizure medication, anxiety medication, surgery, seizure devices, psychotherapy, and dietary therapy.

A Word From Verywell

Having one chronic condition can be overwhelming; when you have two, like epilepsy and anxiety, it can be even more so. It’s natural to need help coping, and this can include support groups and a therapist.

Tell your treatment team if you are feeling overwhelmed and anxiety is disrupting your life. You don’t have to do this alone. They can provide resources to help reduce anxiety and improve your quality of life.