Depression and Epilepsy
Judi Burrill (Epilepsy Kingston)
Depression occurs in 20% of people with epilepsy. This can result from psychological reactions such as fear and from the side effects of medications. The acceptance of a diagnosis often involves grief reactions such as denial, anger and depression. There are adjustments to be made to seizures, effects on self-esteem and confidence.
Medications can sometimes be a double-edged sword: effective in bringing the seizures under control but at the same time contributing to psychosocial problems. Carbamazepine (Tegretol®), phenobarbital, phenytoin (Dilantin®) and vigabatrin (Sabril®) can contribute to depression and memory impairment. Depression can also be part of the postictal phase several days following seizures.
Depression affects the total person: body, feelings, thoughts and behaviours. It can interfere with a person's ability to work and interact with people, including family members. Depression is a deep intense feeling that never lifts. Some describe it as "being in a black hole, unable to get out." The most persistent mood is sadness, but anxiety and irritability may also be present. The depressed person gets no relief from favourite pass-times. The ability to experience pleasure is gone. At times, intense feelings of fear appear for no apparent reason. There is a sense of hopelessness; insignificant events can be experienced as irritating.
Not everyone can acknowledge or verbalize the sense of feeling depressed. It is important to remember that children and teens can suffer with depression: although they can exhibit the same signs of depression as adults, they can also mask their feelings with aggressive and inappropriate behaviour.
Knowing the signs of depression and developing coping strategies is a must!
One of the first signs of depression is an obvious lack of attention to one's appearance. Depression can lead to loss of motivation, drive and ambition. Decision-making becomes an endeavour in itself and normal activities are burdensome. Social interaction becomes a difficult task, and the depressed person often prefers solitude.
Sleep disturbance is a common feature. Early morning awakening [2 or 3 hours earlier] is most typical of depression. Initial insomnia or trouble falling asleep and multiple waking throughout the night are other features. Food loses its taste and appetite decreases. Appetite can also increase. Loss of energy and fatigue are also common. If a person experiences a combination of these symptoms for a period of 2 to 3 weeks with no change, a doctor should be consulted.
Depression is treatable! If you know someone who is depressed try not to criticise, push, patronise or lose your temper. The depressed person cannot "just pull themselves up and get on with it!" What helps is listening, validation and understanding.
It is important to remember also that, among persons with epilepsy, suicide rates are five times higher than the average. Untreated depression and anxiety disorders can lead a person to a point of feeling lost, with no hope, and suicide seems a viable option. Suicide is about stopping pain. Accessible treatment, support and coping strategies are preventative measures that can help the depressed person find hope and develop a will to live!
Postictal psychosis can follow a series of closely spaced seizures. It usually occurs after a 24-48 hour latency from 2 days to a week or more. Recognising the characteristics can be crucial in care management. Personality changes occur and paranoid delusions are often present. Depression is common, as is suicidal ideation.
Postictal psychosis can be managed with better seizure control and with coping strategies to help deal with the fears, anxiety and frustration.
A panic or anxiety attack may include the following: shortness of breath, heart palpitations, trembling, shaking, sweating, nausea, dizziness, hot flashes, fear of dying/going 'crazy'/going out of control. The following are some hints when dealing with panic attacks.
Don't Fight Panic. Remember, panic attacks are time limited and will pass.
Face the Symptoms. "OK, here it is again. I can allow my body to go through its reactions and handle this. I've done it before." Allowing the body to have its reactions such as heart palpitations, sweaty palms and so on will enable you to move through panic much more quickly.
Breathe. Deep abdominal breathing, done slowly and steadily, can relax the body. Anti-anxiety medication is sometimes prescribed.
Be aware of what you need, what helps and which coping strategies work for you. Epilepsy can often cause significant alteration to an individual's lifestyle, socially, psychologically and vocationally. This, compounded with the side effect of medications or with seizures, can lead to panic, anxiety, depression and/or suicidal ideation.
The toll that untreated depression can take is great, not only in terms of personal happiness and fulfilment, but also in its impact on family, work and psychological health. With treatment, about 80% of depressed persons improve dramatically within 3-4 months of starting psychotherapy and/or antidepressant medication. The best hope for recovery and management of depression comes from early detection and treatment.
If you believe you may be suffering from depression, talk to your doctor, counsellor or contact your local branch of the Canadian Mental Health Association.
More information about depression
