Depression

Depression is a common experience for many people, but it is known to occur more often in people with epilepsy.

What is depression?

Most people feel sad from time to time. The difference between sadness and depression is not clear but, at some point, when sadness is prolonged and impairs a person's ability to enjoy life, that person may be considered to be depressed.

Depression can cause feelings of deep gloom and hopelessness. Other problems include difficulty in concentrating, in sleeping (either not being able to sleep or sleeping too much), decreased sexual desire and appetite disturbances (such as overeating or loss of appetite).

Psychological/social factors

In people with epilepsy, depression can be a psychological reaction to having the condition or to being treated differently because of it. Symptoms of depression can also be triggered by the social problems related to a diagnosis of epilepsy (such as losing one's driving licence) or to an increase in the number of seizures being experienced. And of course depression can be triggered in people with epilepsy by all the same things as for anybody, such as the death of someone close, divorce or redundancy.

Drug-related factors

Depression can sometimes be a side effect of medication such as some barbiturates. The depression associated with barbiturates such as phenobarbital and primidone is often dose-related, which means that the higher the dose of the drug, the greater the risk of depression. Taking one or more other anti-epileptic drugs in combination with a barbiturate can also increase the risk of developing depression.

Factors related to the underlying cause of the epilepsy

Depression can be related to the cause of the epilepsy. Injury to the brain can occur for many reasons, including stroke, a difficult birth, head trauma or a past infection such as meningitis or encephalitis. Because the brain controls our emotions and moods, it is not surprising that any disruption to normal brain functions can cause depression. Studies suggest that people with damage to the frontal and temporal lobes of the brain are more prone to depression than those with damage to other parts of the brain. However, many people with brain damage do not become depressed.

Seizures causing depression

Although it is unclear exactly how epilepsy as a condition can directly cause depression, it is known that some people have changes in mood or behaviour in the period before a seizure occurs. This is known as the prodromal stage. Depression may occur as part of a warning or "aura" before a more recognisable seizure. Equally, depression and confusion are very common following a seizure. This is known as a postictal state. Usually, postictal states are brief.

Treatment options - benefits and risks

It is always important to seek medical advice before starting any kind of treatment. Generally, treatments for depression include antidepressant drugs and counselling. In very severe cases, electroconvulsive therapy may be needed.

When dealing with depression in people with epilepsy, the doctor and patient must carefully balance any benefits and risks of treatment. For example, some antidepressant drugs may trigger seizures in some people with epilepsy. However, as the most serious complication of depression is suicide, the issue of risk versus benefits needs to be considered very carefully by the doctor.

Where depression is related to seizure activity, this usually needs to be treated by trying to control the seizures themselves, usually with anti-epileptic medication.

Alternative/complementary therapies

It is particularly important to seek medical advice before trying complementary or alternative treatment as some herbal remedies, for example St John's Wort, can interact with anti-epileptic medication.

Links of interest:

• Depression Alliance
• Samaritans

Further advice and suggestions for further reading about epilepsy and depression can be obtained from Epilepsy Action by using the Email Helpline, or for UK callers through the freephone helpline 0808 800 5050.