Depression and epilepsy

What is depression?

Everybody feels down from time to time. This is quite normal. You might feel sad, fed up, anxious or worried. These feelings can be difficult to deal with. But they normally pass quite quickly on their own. Making some small changes are often enough to improve your mental health or low mood. But if you’ve been feeling down for more than two weeks, or it’s affecting your daily life, you might be depressed.

Depression affects people in different ways. You might:

• Feel sad or low much of the time
• Feel hopeless or helpless
• Lose interest in things you normally enjoy
• Feel guilty or worthless
• Feel restless, irritable or frustrated
• Feel tired all the time, with no energy
• Sleep more or less than usual
• Have no motivation or be unable to concentrate
• Lose interest in sex
• Eat more or less than usual
• Think about harming yourself or suicide

It’s common to have anxiety at the same time as depression, too.

What is the link between epilepsy and depression?

There is a strong link between epilepsy and depression. Around a third of people with epilepsy also get depression. This is nearly three times as much as the general population. This connection seems to work both ways.

• People with epilepsy are more likely to develop depression
• People with depression have a higher risk of developing epilepsy

If you have epilepsy, depression can make your epilepsy worse. It can also mean epilepsy treatments are less effective. You might notice symptoms of depression before getting a seizure. Or you may feel depressed after a seizure, or have depression that isn’t related to seizures at all.

There are several possible reasons for the link between epilepsy and depression:

They could be caused by similar change in the brain and nervous system

Some people who had depression before having temporal lobe surgery seem more likely to continue having seizures afterwards. The people who had epilepsy without a history of depression were more likely to become seizure free after surgery.

Aspects of living with epilepsy can be hard to deal with and may make depression more likely.

These include coming to terms with a diagnosis, coping with seizures and stigma of epilepsy.

Depression can also be a side effect of some epilepsy medicines.

Side effects can be worse if you start at too high a dose, or the dose is increased too quickly.

There has been concern that epilepsy medicines may trigger thoughts of suicide too. This seems more likely to be due to a combination of factors, rather than the medicines alone. If you develop mood changes or distressing thoughts, speak to your doctor or epilepsy specialist. They should be aware of this possible link, and will be able to offer advice and organise support.

If you are having thoughts about hurting yourself or suicide, get help straight away.
Call NHS 111 or the Samaritans on 116 123. You can also text ‘Shout’ to 85258 – 24 hours a day.

Self-help for low mood and depression

Looking after your mental health can help you cope better with your epilepsy.

There are lots of things you can do yourself to look after your mental wellbeing. Here are a few tips.

• Stay connected with people to avoid feeling isolated
• Talk to people you trust about how you feel
• Try to have a regular good night’s sleep
• Eat a healthy, balanced diet
• Don’t drink too much alcohol
• Try to keep active. Exercise releases chemicals called endorphins into your body. These are natural antidepressants

Try our epilepsy and wellbeing course to help understand how mental illness and emotional wellbeing can be linked with your epilepsy. This is a two hour course that you can do in your own time.

We have more tips on looking after your mental health on our Epilepsy and wellbeing page.

Treatment and support for depression

Talk to your GP, epilepsy specialist or epilepsy nurse if you have been feeling low. They will ask you some questions to find out how long you have been feeling this way, and how it’s affecting you.

If you have mild symptoms of depression, they may offer advice on things you can try. This may include self-help programmes you can do by yourself or with support from a therapist. Other treatments include talking therapy and antidepressants. We discuss these below.

Talking therapies

Talking therapies involve talking with a therapist about how you’re feeling. Your doctor may suggest this option first, if your symptoms are mild. There are different types of talking therapy that can help with low mood and depression. You may be able to see a therapist by yourself, or as part of a group therapy session.

In England you may be able to refer yourself to an NHS talking therapies service without having to see your GP.

We have more information on talking therapies and how to access them. See our page on mental health support in epilepsy.

Antidepressants

Your doctor may offer antidepressant medicines if you:

• Have more severe depression
• Have tried talking therapies and you still have symptoms of depression
• You prefer this option to talking therapies

Some people may benefit from a combination of talking therapy and antidepressants. Antidepressants work by increasing chemicals in the brain linked to mood. They help increase the level of a natural chemical in your brain called serotonin, which is thought to be a “good mood” chemical. Some antidepressant medicines can interact with epilepsy medicines, affecting how well they work. Your doctor will talk to you about which antidepressant is best for you. You usually need to take them for at least 6 months. If your medicine doesn’t help, your doctor may suggest trying a different type.

St John’s Wort is a herbal antidepressant. It can interact with some epilepsy medicines. It’s not recommended for most people with epilepsy. You should only take it if your doctor agrees and is closely monitoring you.

If you are having thoughts about hurting yourself or suicide, get help straight away. 
Call NHS 111 or the Samaritans on 116 123. You can also text ‘Shout’ to 85258 – 24 hours a day.