Types of Mood Disorders
The most common mood disorders in people with epilepsy are major depression and dysthymia. Some people have milder forms of depression that may also affect quality of life and respond to treatment. Anxiety, while not technically a mood disorder, is another common emotion that occurs more often in people with epilepsy. In order to improve the quality of life with people with epilepsy, it is important for both doctors and patients to be familiar with the commonly encountered problems of mood disorders.
Major Depressive Disorder
Although it is normal to feel sad sometimes, major depressive disorder (major depression) is a state of excessive depressive symptoms. These include sadness, lack of pleasure in activities, problems with weight and sleep, tiredness, difficulty concentrating and making decisions, feelings of worthlessness or guilt, and frequent thoughts of suicide and death. Five or more of these symptoms that last at least two weeks qualifies as major depressive disorder. More than 50 percent of individuals with epilepsy, especially those with uncontrolled seizures may experience significant depressive symptoms, and a number of them may meet the criteria for major depressive disorder.
(at least 5 symptoms for 2 weeks with at least one of the symptoms being either a depressed mood or loss of interest or pleasure)
- Decreased concentration, decision making
- Depressed mood most of the day
- Guilt or feelings of worthlessness
- Lack of pleasure in life
- Psychomotor agitation or retardation
- Recurrent thoughts of suicide or death
- Sleep difficulties
- Weight change of more than 5 percent in 1 month, decreased appetite
Adapted from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
Symptoms are similar to those of major depressive disorder, but tend to be present for at least two months at a time. They tend to be less severe, but last longer.
(depressed mood for more days than not over at least a two year period with two or more of the following symptoms)
- Feelings of hopelessness
- Inability to sleep or sleeping too much
- Low energy or fatigue
- Low self-esteem
- Poor appetite or overeating
- Poor concentration or difficulty making decisions
Adapted from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
Anxiety disorders are characterized by excessive feelings of fear, uneasiness or dread regarding something that is about to happen. Anxiety affects 10-50 percent of people with epilepsy. Physical symptoms, such as a rapid heart beat, stomach or chest pain, or feeling short of breath may accompany anxiety. It is common to have more than one type of anxiety disorder or anxiety plus a mood disorder, such as depression. (Sometimes feelings of anxiety or fear are actually part of a seizure, and this needs to be distinguished from an anxiety disorder.)
Bipolar disorder is characterized by two types of symptoms; depressive and manic. (Bipolar disorder is also known as manic-depressive illness.) Manic symptoms are characterized by excessive energy (agitation), excessive feelings of self importance (grandiosity), excessive interest in sex (hypersexuality) and inability to sleep (insomnia). Symptoms of bipolar disorder come and go. Usually people have depression or mania, but both can occur simultaneously. Depression can be very severe and lead to problems at work or at school, with relationships, and even to thoughts of suicide. Sometimes patients may lose touch with reality (psychosis). Bipolar disorder affects less than 1 percent of the adult population, but appears to be slightly increased in people with epilepsy.
Causes of Mood Disorders
There are many causes for mood disorders in people with epilepsy. Emotions arise from the brain and are influenced by many situations in our lives. Consequently, any brain injury underlying seizures such as head injury, brain infection, stroke or tumor may influence mood. Mood changes may also be related to seizures or actually be part of a seizure, such as a feeling of fear that may occur during a partial seizure.
Antiepileptic drugs (AEDs) may also be responsible for mood changes. For example, phenobarbital can cause depression. Other AEDs may also cause depression, but usually do not. Too many AEDs used together may also contribute to depression.
It may be difficult to determine whether it is a medication or an underlying brain problem that is responsible for an abnormal mood. When you start a new AED, pay attention to your mood and tell your doctor if it changes.
Mood disorders may also be a psychological response to having epilepsy. The challenges of living with epilepsy may lead to mood changes, which are a common problem for many people coping with a chronic illness like epilepsy. People with epilepsy may feel frustrated by the unpredictability of seizures, inability to drive or work, or being singled out by others as 'different' because they have seizures. These feelings should be addressed with your health care provider.
Another cause of mood disorders is substance abuse (alcohol or illicit drugs).
Mood Disorders and Children with Epilepsy
Mood disorders can also occur in children and may affect schoolwork and social functioning. The causes are similar to those in adults. However, children with depression may not have all the same symptoms as adults. For example, depressed children tend not to lose their appetites or complain of inability to sleep. They may not express feelings of sadness as easily as adults. Depressed children may be irritable, start to do poorly in school, spend less time with friends, take less pleasure in their activities, and express physical complaints, such as headache or stomach pain. Behavioral problems are very common symptoms of depression in children.
Depression and anxiety are often overlooked in children with epilepsy.
Need for Treatment
Everyone has occasional symptoms of depression or anxiety. These feelings become a 'disorder' when they last so long or are so intense that they interfere with a person's ability to function. It is important to share these feelings with your doctor, who can help you assess whether they are severe enough to require treatment.
Indications of a significant mood disorder include problems at work or at school, spending less time with friends, doing fun things or interacting with others or increased use of alcohol and recreational drugs.