Epilepsy and Mood Disorders

Many people with epilepsy experience disagreeable changes in their emotions, and the link between mood disorders and epilepsy has been observed for more than 2,000 years. While this link has been noticed for many years, the relationship between seizures and mood disorders has not been well understood until recently. Now, although we do not have all the answers, we do know that mood disorders occur more often in people with epilepsy than in the general population.

Importance of Mood Disorders

Mood disorders in people with epilepsy are very important and can greatly impact a person's daily activities and quality of life. These feelings may be present most of the time, or appear just before, during, or after a seizure. Some people become depressed, others may be irritable. 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.

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 Do I Know if I Need Treatment?

At times, everyone experiences some feelings of anxiety, irritability, or depression. However, if these symptoms last a long time, are severe, or interfere with your relationships or job, they probably require treatment. Start by telling the physician who treats your seizures, whether it is a family doctor, internist, or neurologist, about your feelings. Explain how often these symptoms occur, how they make you uncomfortable, and how long they last. If you can, bring in a calendar that tracks these symptoms, just like a seizure calendar. Ask your doctor whether these symptoms might be related to your epilepsy and what to do about them. Together, you and your doctor can decide whether you need treatment for a mood disorder.

Isn't Treatment for the Seizures Enough?

Seizures are the most obvious part of having epilepsy, but they may not be the only part. If you have had a brain injury such as a head injury, meningitis, stroke, or brain tumor that is causing the seizures, it may be causing mood problems as well. A mood disorder, like depression, is likely decreasing your quality of life. Symptoms that occur with depression such as irritability and sadness may interfere with your social relationships, and trouble sleeping may even make your seizures worse. Depression can sometimes be very severe, leading to thoughts of death or suicide. It is important to share your feelings with your health care provider because there are many effective treatments for mood disorders associated with epilepsy. Some antiepileptic drugs (AEDs) may help your mood, but their primary purpose is to control the seizures. For the treatment of a mood disorder, you may need an antidepressant.

Are There Treatments for Mood Disorders?

Many types of treatment are available for mood disorders. Psychotherapy and medication are the mainstays of treatment, which may be used separately or together. The goal is to completely eliminate your symptoms. The most common type of medication treatment is called an antidepressant, of which there are several kinds (see the Commonly Used Antidepressants table below). Your doctor is most likely to prescribe a selective serotonin reuptake inhibitor (SSRI). It is important to remember that medications for mood disorders may require dose adjustments and may take several weeks before becoming fully effective. Just like AEDs, sometimes more than one antidepressant may need to be tried before getting good results. For most individuals with epilepsy, depressive symptoms usually respond very well to low doses of medication.

Can AEDs Cause Depression?

Some AEDs may cause depression or worsen an underlying depression. For example, phenobarbital and primidone have been associated with depressive symptoms. All AEDs may be associated with changes in mood. It is difficult sometimes to determine whether the medication or the underlying brain dysfunction is responsible for your abnormal mood. Tell your doctor if you have noted a change in your mood since you have started a new seizure medication. It may be worthwhile to change to another AED to see whether your symptoms improve.