Understanding Epilepsy and Depression

Depression, also called major depressive disorder (MDD), commonly occurs in people with epilepsy and contributes to a lower quality of life, increased time in hospitals, and less control over seizures. Though the two illnesses often occur together, depression is frequently overlooked and undiagnosed.

This article will discuss the connection between epilepsy and depression, the complications of having both disorders, and how to diagnose them. It will also provide treatment options for epilepsy and depression and ways to cope with them.

The Connection Between Epilepsy and Depression

Depression is the most common mental illness in those who have epilepsy.In fact, people with epilepsy are three times more likely to be diagnosed with depression than those without epilepsy. Having depression with epilepsy can be highly disruptive when left untreated, and it often affects a person's quality of life more significantly than seizures do.

While the connection may be due to various reasons, managing and coping with epilepsy has been found to impact mood and cause depression symptoms.

Latest Research

Recent data shows that the prevalence of depression in people with epilepsy is actually higher than once thought, and whether a person develops depression is not dependent on the severity of epilepsy or how controlled it is. About 23% of people with epilepsy are also diagnosed with depression.

Complications of Epilepsy and Depression

Depression has been shown to worsen epilepsy. It can lead to negative outcomes following surgery for epilepsy and can also interfere with medications used to treat epilepsy symptoms. Depression is also associated with suicide and can severely impact a person with epilepsy's life.

Diagnosis of Epilepsy and Depression

Early diagnosis of depression in those with epilepsy is extremely important for successfully managing both illnesses. If depression is suspected, you should contact a mental health professional as soon as possible.

Diagnostic Criteria for Depression

The Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5) requires you have at least five of the following symptoms for two weeks for a diagnosis of major depressive disorder:

• Depressed mood
• Loss of interest or pleasure
• Weight loss or gain
• Sleeping too much or too little
• Slow psychomotor movements
• Fatigue
• Feeling worthless or excessive/inappropriate guilt
• Decreased concentration
• Thoughts of death or suicide

In addition, the following four criteria must be present:

1. The symptoms cause significant distress or impact functioning.
2. The symptoms experienced are not caused by substance use.
3. The symptoms are not due to a psychotic disorder.
4. The person does not have a history of mania or hypomania.

Common Depression Symptoms in People With Epilepsy

In people with epilepsy, the most common depression symptoms include:

• Poor frustration tolerance
• Loss of interest or pleasure
• Helplessness
• Irritability
• Feelings of self-deprecation
• Feelings of guilt
• Crying bouts
• Hopelessness

As some of these symptoms don't meet the formal criteria for MDD, depression is often missed in those with epilepsy.

Depression Screening Tools

Depression can only be diagnosed by a mental health professional. Screening tools are often used to help identify depression symptoms and help with making a diagnosis. There are many tools to screen for depression, including:

• The Patient Health Questionnaire 9 (PHQ-9)
• Hospital Anxiety and Depression Scale (HADS)
• Mini-International Neuropsychiatric Interview (MINI)
• Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)

All of these tools have also been validated for those with epilepsy.

Treatment of Epilepsy and Depression

Depression can affect the effectiveness of epilepsy medications, especially for those who were diagnosed with depression prior to developing epilepsy. Therefore, it's essential to be in regular communication with your healthcare provider to monitor symptoms and ensure treatment efficacy.

Medications

Some medications that are used to treat depression can worsen seizures. Therefore, people with epilepsy should work closely with a healthcare provider specializing in treating epilepsy and a psychiatrist. Antidepressants should be started in low doses and increased as needed and tolerated. Medications that are recommended to treat depression in people with epilepsy include:

• Selective serotonin-reuptake inhibitors (SSRIs)
• Norepinephrine-reuptake inhibitors (SNRIs)

Both of these families of medications are shown to have little effect on seizures and to have fewer side effects. Medications from other families of drugs that are used to treat depression should only be used if SSRIs and SNRIs are not effective and only under the guidance of your healthcare provider.

Psychotherapy

Psychotherapy can be an effective way of treating depression in people with epilepsy. Though therapy is unlikely to improve seizure management, it can help improve depression symptoms. Of the available therapeutic interventions, cognitive-behavioral therapy (CBT) may be the best option. This is because CBT can be adapted to meet the individual needs of the person seeking treatment to support their biggest concerns and symptoms. In some people with epilepsy, CBT can help reduce depression symptoms over a three to four-month period.

The kinds of skills and techniques taught in psychotherapy may include:

• Behavioral change
• Social interaction support
• Goal setting and problem solving

A therapist will work with each client to determine the most-needed behavioral and social skills.

Coping With Depression and Epilepsy

Depression significantly impacts a person with epilepsy's quality of life. People with epilepsy and depression often experience more resistance to medication, worse outcomes after surgery, and higher rates of suicidal thoughts. However, finding ways to cope through lifestyle changes and peer support can improve the quality of life.

Coping Strategies

Though not a replacement for medical intervention, there are many coping strategies that can help reduce symptoms of depression in people with epilepsy. Some include:

• Learning about the illnesses and how they impact you. Having an understanding about how depression and epilepsy symptoms impact one another can help when trying to prevent episodes. For example, for many people, a depressed mood tends to be worse in the 24 hours leading up to a seizure. In some people, however, depression symptoms don't occur until several days after a seizure.
• Seeking support from friends and loved ones. Sharing thoughts and feelings with others can reduce feelings of isolation and provide a safe place to talk when things feel overwhelming.
• Using relaxation techniques. Meditation, yoga, breathing, and other relaxation exercises can help reduce stress.

Support Groups

Support groups can offer connection, a safe place to ask questions, and an opportunity to find resources and help others. There are two types of support groups:

• Peer-run support groups are led by non-professionals who share the same condition(s). These kinds of groups can often be found by searching online for epilepsy or depression support groups. Some places to find support groups include FND Hope and Mental Health America.
• Clinical support groups. These groups are run by licensed mental health professionals. Usually, a mental health professional will start a support group with current individuals facing similar challenges. Ask your mental health professional about available clinical support groups.
  

Summary

Depression is the most common mental illness in people with epilepsy and can worsen epilepsy symptoms by increasing seizures, interfering with the efficacy of medications, and worsening a person's quality of life. Therefore, early diagnosis of depression in people with epilepsy is an important way to reduce its negative effects. A mental health professional can use a depression screening tool like the Patient Health Questionnaire 9 (PHQ-9) or the Hospital Anxiety and Depression Scale (HADS) along with the diagnosis criteria from the DSM-5 to determine whether someone has depression.

Treatment for depression in people with epilepsy can be complex, as some medications can worsen seizures. Therefore, all medical professionals must know about a epilepsy and/or depression diagnosis before forming a treatment plan. Some medications, like selective serotonin-reuptake inhibitors (SSRIs) and norepinephrine-reuptake inhibitors (SNRIs) have been shown to be particularly safe and effective for treating depression in people with epilepsy. In addition, psychotherapy and support groups can also help with treating depression symptoms.

A Word From Verywell

Depression can have a significant impact on a person's life. For people with epilepsy, depression can be even worse. If you are coping with depression symptoms along with epilepsy, get help right away. It may feel isolating and scary to manage both illnesses, but there is support. Talk to a mental health professional, especially a psychiatrist, as well as your healthcare provider, to ensure your medications are working well. It often helps to talk to others with the same illnesses. Try finding a support group where you can make connections and find resources. Depression is the most common mental illness for people with epilepsy; others can support you as you learn to cope with symptoms.