Psychological Aspects of Epilepsy
Kami Marchese, Psy.D.
True or False?

It is normal to feel depressed
when you have epilepsy
True or False?

Suicide is a major cause of death
in epilepsy.
True or False?

Depression can be caused by
antiepileptic medication.
True or False?

Feelings of anxiety and/or
depression can be the manifestation
of a seizure.
Most Common Psychological
Conditions In Epilepsy




*Depression
Anxiety
Mania
Psychosis
Symptoms of Depression










Depressed mood most of the day
Loss of interest in activities
Feelings of worthlessness
Decreased concentration, indecisiveness
Increased irritability
Recurrent thoughts of death
Change in appetite, weight loss or gain
Sleep disturbance
Loss of energy
Psychomotor agitation or retardation
Types of Depression


Major Depressive Disorder (MDD)
Dysthymic Disorder
The difference between the two is
based on severity, persistence, and
chronicity.
Lifetime Prevalence of
Depression in Adults

10-20% - controlled epilepsy

20-60% - recurrent seizures

5.8%
- in general nonepileptic
population
Suicide


Suicide is 5-10 times higher in PWE
than in the general population
It is up to 25 times higher in people
with temporal lobe partial seizures vs
general population
What is Unique About Epilepsy?
Psychosocial
 Reaction to illness itself
 Lack of acceptance
 Poor adjustment to the diagnosis
 Individual’s adjustment
 Impact of epilepsy on the family
 Stigma and discrimination
 Lack of control and fear caused by random
seizure occurrence
Stages of Adjustment








Disbelief
Shock
Denial
Fear
Anger
Depression
Anxiety
Guilt
Why In Epilepsy?
Psychosocial


Lack of social support
Need to make significant adjustments in
lifestyle

Work limitations

Dangerous heights, operating machinery,
changing or cutting back on hours
Giving up driving privileges
 Childbearing concerns

Why In Epilepsy?
Physiological
(Directly Caused by Epilepsy)



Reaction to seizure medication
Brain regions are the same
Endocrine or metabolic effects
Antiepileptic Drugs (AED)
that can cause depression







Phenobarbital
Primidone (Mysoline)
Tiagabine (Gabitril)
Vigabatrin (Sabril)
Felbamate (Felbatol)
Topiramate (Topamax)
*Carbamazepine (Tegretol) and
Valproic Acid (Depakote)
*less frequent
Physiological Causes of
Mood Disorders

Overlap in brain regions involved in
epilepsy and depression
PWE who had temporal lobe scarring had
higher depression scores than other
patients
 Depression is more frequent in PWE of
temporal and frontal lobe origin


Comorbidity of epilepsy and migraine

Strong association between migraine and
depression
Depression Specific to Epilepsy

Classified according to the temporal
relation to seizure occurrence

Pre-ictal: Prior to seizure onset

Ictal: During the seizure and the expression
of seizure

Post-ictal: After seizure (includes up to 120
hours)

Inter-ictal: Unrelated to seizure occurrence
Inter-ictal Depression


Most common among PWE
Commonly presents as
dysthymic disorder with
waxing and waning course
Ictal Depression

Can be the clinical expression of a
simple partial seizure where
depression is the predominant or
only feature
Depression and
Quality of Life (QOL)


Studies have shown that
depression is the strongest
predictor of QOL
Even more than seizure frequency
and severity
Cognitive Functioning




Diminished attention and
concentration
Memory loss
Reduced processing speed
Difficulty making decisions
True or False?

It is normal to feel depressed when
you have epilepsy.
TRUE
True or False?

Suicide is a major cause of death
in epilepsy.
TRUE
True or False?

Feelings of anxiety and/or
depression can be the
manifestation of a seizure.
TRUE
True or False?

Depression can be caused by
antiepileptic medication.
TRUE
Next Steps



Seek treatment
Anti-depressant
medication
Individual or
group counseling