Depression is a constellation or set of symptoms including:
Depression causes feelings of sadness, helplessness, hopelessness, and guilt, and makes the person unable to experience happiness. Other problems include difficulty sleeping (insomnia or sleeping excessively), decreased sexual desire, and appetite disturbances (loss of appetite or overeating). All people feel sad at some time in their life and the depth of sadness varies. The line between sadness and depression is not precise but at some point, when sadness is prolonged and impairs a person’s ability to enjoy life and to work, there is a problem.
Is depression a common disorder for those with epilepsy?
Depression is a common experience for many people. However, it is a much more common occurrence in those living with epilepsy. Studies reveal that 50% of those with epilepsy that is not controlled with medication suffer from depression as well.
Is the rate of suicide increased in those with epilepsy?
The most serious complication of depression is suicide. Just as the rate of depression is increased in people with epilepsy, there is also an increased rate of suicide. Patients, family members, and doctors often fail to recognize the presence or severity of depression. If there is any question, seek help. Anyone who expresses thoughts about hurting himself or herself should be taken extremely seriously. If someone who is depressed discusses a specific plan to hurt himself or herself or gives away treasured items, a psychiatrist should be consulted immediately and the person should be taken to an emergency room.
In persons with epilepsy, depression can result from:
The relative importance of each of these factors is controversial, and often several factors contribute. In some cases, the depression is related to loss of a job or a loved one, or to a flurry of seizures. Depression related to the psychological effects of living with epilepsy and other problems of life can be effectively treated in most cases by psychotherapy and counseling. Discussion of troublesome feelings with a psychiatrist, psychologist, or counselor can be extremely helpful.
Antiepileptic drugs, especially barbiturates (phenobarbital and primidone), can cause depression. This kind of depression is often dose-related; that is, the higher the dose, the greater the risk of depression. Taking one or more other antiepileptic drugs in combination with a barbiturate can also increase the risk. It is rare that only a barbiturate can control epilepsy, however, so if a person who is taking a barbiturate is feeling depressed, he or she should ask the doctor about a medication change. Other antiepileptic drugs, especially benzodiazepines, levetiracetam, topiramate and vigabatrin, can also occasionally contribute to depression.
Injury to the brain, whether from a stroke, oxygen deprivation, head injury, or infection, can cause depression. This is not surprising because the brain controls our emotions and moods. The role that epilepsy itself plays in directly causing depression remains controversial. As more information accumulates, however, it appears that epilepsy does contribute to the problem in some cases. In some patients, depression occurs hours or days before or after a seizure. More frequently, depression occurs between seizures (in the interictal period).
When possible, the cause or causes of depression should be treated. Serious depression requires antidepressant medication. Some psychiatrists and neurologists fear that antidepressants can aggravate the seizure disorder. Some evidence supports this fear, but most people with epilepsy who are treated with antidepressant medications do not experience more frequent seizures. Newer antidepressants such as the selective serotonin reuptake inhibitors (SSRIs) appear safe for almost all epilepsy patients. These drugs include:
Other new antidepressant drugs that are safe and well tolerated by most patients with epilepsy include nefazadone (Serzone), a serotonin antagonist and reuptake inhibitor as well as venlafaxine (Effexor) and duloxetine (Cymbalta), both are serotonin and norepinephrine reuptake inhibitors. All of these drugs that increase serotonin activity can also help treat obsessive-compulsive and anxiety disorders.
Buproprion (Wellbutrin), an antidepressant (especially in doses over 300 mg per day), should be avoided in people with epilepsy, as it can lower the seizure threshold and be associated with increased seizures.
Besides counseling and medications, very severe depression may be treated with electroconvulsive shock therapy. Patients with epilepsy can safely undergo this procedure.