Viewpoint: Dr. John Barry discusses the impact of mood disorder in the life of "Victor Newman"

By John Barry, M.D.
Special to EpilepsyUSA
Posted: August 29, 2006

John Barry, M.D., is an associate professor of Psychiatry and Behavioral Sciences at Stanford University Medical Center. After reading a section of the script for episodes of The Young and the Restless dealing with epilepsy, EpilepsyUSA spoke to him about the changes in mood of Victor Newman, the character diagnosed with temporal lobe epilepsy.

What can you tell us about mood disorder as it relates to epilepsy?

There are a number of people with epilepsy who experience disagreeable changes in their emotions. In fact, while the link between mood disorders and epilepsy has been observed for more than 2,000 years, the relationship between seizures and mood disorders has not been well understood. Today, we don't have all the answers, but we do know mood disorders occur more often in people with epilepsy than in the general population.

Unfortunately, mood plays a critical role in the ability of people to perform a variety of daily activities. People with epilepsy may be experiencing a mood disorder when feeling anxious, depressed, irritable, or have feelings of fear, panic, or pain that are not easily explained by seizures or other medical causes. Depression is the most common mood disorder experienced by people with epilepsy and may affect up to a third of people with uncontrolled seizures.

While some people become depressed, others may become irritable. Some people have milder forms of depression that may also affect quality of life and response 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 for people with epilepsy, it's very important for both doctors and patients to be familiar with the commonly encountered problems of mood disorders.

For a lot of people with refractory seizures, the impact of mood disorders on their lives is at least as important as their epileptic events. Therefore, they should receive the same attention to treatment. If someone has a mood symptom affecting their usual activities, they should tell the doctor and consider seeing a mental health professional to be screened for depression. It's important to realize that antiepilepsy drugs (AEDs) and brain dysfunction can sometimes cause similar symptoms and mimic depression. A health professional should be able to sort out the cause of the feelings, however.

What can you say about the epilepsy symptoms associated with the character, Victor Newman?

The doctor in the television program diagnosed the character with epilepsy as having a simple partial seizure. However, because he has experienced periods of unconsciousness, he may very well have complex partial seizures instead.

Regardless of the character's diagnosis, I am concerned that viewers of the program could believe that epilepsy creates a heightened sense of well being. This is not what I see every day with people who are experiencing the kind of mood disorders that are associated with epilepsy.

While some of the firstaid information presented in the program appears quite accurate, the character's condition is not very realistic and is certainly not very common. People with some forms of epilepsy may experience auditory hallucinations, such as hearing sounds as well as visual experiences. This may occur as an ictal event or more commonly as a post-ictal phenomena, especially after a flurry of seizures.

Could the character's mood disorder improve with his treatment for epilepsy and seizures?

Seizures are the most obvious part of having epilepsy, but they may not be the only part. A brain injury – such as a head injury, meningitis, stroke, or brain tumor – that is causing the seizures may also cause mood problems. A mood disorder, like depression, is likely to decrease someone's quality of life. For example, symptoms that occur with depression such as irritability and sadness may interfere with social relationships, and trouble sleeping may even make seizures worse. Depression can sometimes be very severe, leading to thoughts of death or suicide. So, it's important for people experiencing these symptoms to share their feelings with a health care provider because there are many effective treatments for mood disorders associated with epilepsy.

Some AEDs may help to improve mood, but their primary purpose is to control the seizures. Other AEDs, however, may be associated with depression or worsen an underlying depression. Unfortunately, it's difficult sometimes to determine whether the medication or the underlying brain dysfunction is responsible for abnormal mood. Often times the temporal relationship of starting an AED and the onset of a mood disorder will give a helpful hint. Psychotherapy and medication are the mainstays of treatment. The goal is to completely eliminate the symptoms.

If you were writing the story, how would you have portrayed the character?

The portrayal of the character is unfortunate since a rare or unusual appearance of a seizure disorder is being portrayed as the norm. First, I would want the viewers to realize that having epilepsy is not a desirable condition. Secondly, I see people with epilepsy every day and many of them have very fascinating, admirable and interesting stories that deserve to be told and do not require such a stretch of imagination. For example, I might describe someone who has had a severe head injury and developed epilepsy and their subsequent depression and personal and family struggles to get care and find employment. The very common and typical experiences of people with epilepsy are often dramatic and display the immense concern and sacrifice that families freely extend to one another. You don't have to make up such an unusual symptom complex to find a fascinating story line. It's not necessary. The real lives of people with epilepsy are often very dramatic without any exaggeration. Alternatively, the major character could have developed epilepsy in a more common fashion and sustained a steep decline in his overall functioning that was ameliorated by effective treatment.

What could happen next to the character?

If the character continues to have seizures and refuses his medication, he could have a generalized convulsion. In addition, if his mood symptoms are a post ictal phenomena, certainly they may worsen and cause more of a functional difficulty for both the character and his family. The symptoms that he is having may not be so desirable at that point and treatment may become more obviously necessary and agreed upon by the character.

Unfortunately, if the character decides to start taking his medication as prescribed and then reverts back to his less-desirable personality, we're really sending the wrong message about people with epilepsy. It's just not what happens in the real world. Most of the initial seizures experienced by people who develop epilepsy are neutral in their presentation and may be even "invisible" to most others. They are certainly not associated with such an enviable sense of calm and peacefulness that is being portrayed here.