Recognizing Mood Disorders

How Do I Know if I Have a Mood Disorder?

Many patients experience problems with mood. You may have a mood disorder if you feel anxious, depressed, irritable, or have feelings of fear, panic, or pain that are not easily explained by your seizures or other medical causes. Depression is the most common mood disorder experienced by people with epilepsy and may affect more than half of people with uncontrolled seizures. Here is a list of some common symptoms of depression:

• Sadness
• Loss of interest or enjoyment of activities
• Excessive feelings of guilt
• Change in appetite and weight
• Trouble sleeping
• Tiredness

If you have mood symptoms that affect your usual activities, tell your doctor and consider seeing a mental health professional to be screened for depression.  Sometimes, AEDs and brain dysfunction can cause similar symptoms and mimic depression. A health professional can help you sort out the cause of your feelings. The impact of mood disorders on your life is at least as important as your seizures and should receive the same attention to treatment.  Do not hesitate to bring up this subject during an office visit.

How Might Mood Problems Affect Me?

You may notice that even though your seizures are controlled, or nearly so, you are having problems at work or getting along with your family or friends. Your mood may change for a few days before or after a seizure. You may be irritable or depressed without realizing it. You may get angry without reason. You may have physical symptoms such as headache, chest or stomach pain. Your mood may be affected by the reaction of other people to your epilepsy.

Your family and friends may be good observers of your behavior. You may wish to ask them if there are any behavior problems that you are not aware of (see Twelve Symptoms Suggestive of Depression table above).  Mood disorders such as depression may also contribute to sexual problems.

How Might Mood Problems Affect My Child Who Has Epilepsy?

Children who are depressed may be angry, cranky or irritable and be difficult to control. They may complain of not being loved, spend more time crying, or have trouble sleeping or eating. If your child has any of these symptoms of mood disorders, discuss them with your doctor who can make a diagnosis and determine whether treatment is needed.

Can Mood Problems Lead to Alcohol or Drugs?

Sometimes people resort to using drugs or alcohol in order to feel better. They may not even realize they are doing this. If you find you are drinking more alcohol than usual, or have started using recreational drugs, this may be a sign that you are suffering from a mood disorder related to your epilepsy. Ask your doctor to help you determine whether a mood disorder is responsible for your alcohol or drug use.  Alcohol or drugs provide only temporary relief from mood problems and may lead to increased seizures. Alcohol and drugs may also cause mood problems or make your mood problems worse.

Can Mood Disorders Result in Suicide?

Sometimes people with feelings of depression think about suicide. Feelings of hopelessness or helplessness may seem so severe that they will never go away. Suicide is more common in people with epilepsy than the general population. Even if you don’t think these thoughts are important, you should mention them to your doctor or other health care provider. If you or someone you know are thinking about suicide:

1. Seek immediate medical or mental health attention. Call 911 if necessary.
2. Do not let the person stay alone.
3. Prevent the person from access to guns, medication that may be used for overdose, or other dangerous items.

Can Epilepsy Surgery Cause Mood Problems?

Although epilepsy surgery will hopefully eliminate your seizures, it is not uncommon to experience depression after surgery. Even if you did not have a mood disorder before surgery, you may have psychological distress afterwards.  This appears to be related to the biological changes in your brain caused by the surgery. (An additional factor may be the adjustment you have to make to a life without seizures, which will be a big change.)

If the surgery cures your epilepsy, the mood disorder usually disappears. In the meantime, the mood problems may require treatment with medication and/or psychotherapy. It is important to continue to see your neurologist regularly after the epilepsy surgery, even if you are seizure free.  In most cases, the long term benefits of successful epilepsy surgery outweigh the risk of developing a mood disorder after surgery.  For most patients, mood symptoms improve after epilepsy surgery.

How Can My Doctor Tell if I am Having Mood
Problems?

It may be very difficult for your physician to notice that you are having mood problems because it is likely that you will only spend a few minutes in the office together. Mood problems can come and go, and you may feel fine the day that you see your doctor. You may also feel uncomfortable discussing your feelings and hesitate to bring up the issue, and your doctor may not ask. Consequently, it will help if you bring a member of your family or a friend to help discuss how you are feeling and behaving. 

A calendar of your feelings, just like your seizure calendar, will also be useful. You can write down the days that you are depressed or irritable, or any times you became excessively angry. Your doctor will listen to you and may ask you to complete a questionnaire. Questionnaires designed to detect mood problems are available both for adults and children with epilepsy.

If there is evidence that you have significant mood problems, your doctor may suggest treatment, usually with antidepressant medication. Your doctor may also refer you to a mental health specialist, such as a psychologist or psychiatrist.

How Can I Deal with Mood Problems When I Already Have Epilepsy?

It may seem unfair to have to manage more than one problem. Because seizures often occur in the same parts of the brain that affect the emotions, for many people mood problems are very much a part of having epilepsy. It is important to recognize mood problems because effective treatment is available that can improve your quality of life.  Doctors and other health care providers are becoming more aware of the importance of mood problems to people with epilepsy and are prepared to help. Various kinds of treatment are available, including counseling, psychotherapy, and medication (see Treatment of Mood Disorders). Your family may wish to participate in your treatment, as your epilepsy affects them as well.