Depression and Anxiety

People with epilepsy are more likely to experience depression and anxiety than the general population. This section will explain what what anxiety and depression are and how they are related to epilepsy. It also includes a starting point for treatment.

Anxiety and depression can happen together.

Expand Anxiety SectionAnxiety

What is anxiety?

Everyone experiences feelings of anxiety such as worry, stress, and nervousness from time to time. For people with epilepsy, it’s normal to worry about the possibility of having a seizure or to find it stressful coping with the impact of epilepsy. These experiences become problematic when the feelings are frequent or intense, are produced by trivial things or nothing at all, and interfere with our functioning.

Anxiety can also affect memory, the experience of medication side effects, and seizure control. Despite this impact, anxiety is often under-recognized and under-treated in people with epilepsy.

There is a range of anxiety symptoms that vary based on the type of anxiety disorder a person has. These include:

Cognitive

Anxious thoughts, predictions, and beliefs (E.g. “I’m going to have a seizure at the party, everyone will laugh at me, so I won’t attend”)

Physical

Pounding heart, sweating, nausea, dizziness, muscle tension, shortness of breath. It’s possible for these physical symptoms to be mistaken for a seizure, or for a seizure to be incorrectly identified as anxiety.

Emotional

Feelings of fear, stress, nervousness.

It’s important to talk to your healthcare provider if feelings of anxiety or stress are interfering with your ability to work, study, socialize, or manage daily tasks.

Why are people with epilepsy more likely to experience anxiety?

It isn’t well understood why anxiety is more common in people with epilepsy, who can experience a complicated mix of anxiety symptoms. Anxiety related to epilepsy may be caused by a variety of factors:

  • Anxiety can be a part of seizures themselves. This may occur at the start of a seizure, during aseizure, or immediately afterwards. For example, some people who have focal seizures feel sudden fear at the start of a seizure.
  • Anxiety may result from the psychosocial impacts of having epilepsy, including the stress of an epilepsy diagnosis or the worry or fear of having a seizure.
  • There may be associated neurological or psychiatric disorders.
  • Genetics may play a role.
  • Underlying brain mechanisms related to epilepsy may also influence anxiety.
  • Effects of medication.

What are the treatments for anxiety?

There hasn’t been a lot of research showing what treatments are most effective for people with epilepsy and anxiety. Generally, many psychological treatments, such as relaxation training, meditation, biofeedback, and stress management, can help with anxiety disorders. Many people also benefit from supportive counselling or couples or family therapy. One of the most common forms of treatment for anxiety disorders is cognitive-behavioural therapy (CBT). Medications may also help, and many people receive CBT and medication in combination.

For help in finding mental health services in your community, call the Mental Health Helpline at 1-866-531-2600 or visit www.mentalhealthhelpline.ca

Strategies for coping with anxiety:

There are many strategies to try when you are feeling anxious or stressed. These ideas may work best if you do them regularly.

  • Try relaxation techniques such as muscle relaxation or breathing exercises. Try taking steady breaths that are not too deep or too fast. Do this several times to feel calmer.
  • Regular exercise helps keep you fit and can improve sleep. It can contribute to a sense of well-being by providing a break from day-to- day worries and by giving a sense of control and achievement. Gentle movement, such as simple stretching, can relax and calm the body.
  • Eat a healthy, well-balanced diet. Limit caffeine, alcohol, and nicotine.
  • Plan small, achievable tasks for each day.
  • Talk to someone. Tell friends and family how you’re feeling, and let them know how they can help you. Talk to a physician or therapist for professional help.

Expand Depression SectionDepression

What is depression?

Most people feel sad or down from time to time. Although we may casually refer to this as “being depressed”, it is not clinical depression. When someone experiences certain symptoms almost every day for at least two weeks, they may be clinically depressed. These symptoms include:

  • Depressed mood
  • Weight gain or loss
  • Insomnia or hypersomnia
  • Restlessness or lethargy
  • Worthlessness or feeling guilty
  • Decreased interest or pleasure
  • Difficulty concentrating or making decisions
  • Recurrent thoughts of death and suicide.

These symptoms may be so debilitating that they interfere with a person’s quality of life. Being depressed can impact a person’s ability to care for themselves, perform their job, and maintain healthy relationships. When experiencing depression, some people with epilepsy will have difficulty coping, feeling motivated to get out of bed, remembering things, concentrating, or taking anti-seizure medications.

Why are people with epilepsy more likely to experience depression?

Some people experience depression after a seizure. This is called post-ictal depression.

  • People with temporal lobe epilepsy may be more likely to experience depression because the seizures begin in the area of the brain that primarily regulates mood.
  • The abrupt change in lifestyle and traumatic loss of control over one’s life after receiving an epilepsy diagnosis can also trigger depression.
  • Depression can be a side effect of some anti-seizure medications (Phenobarbital, Vigabatrin,Lamotrigine, and Phenytoin). However, other anti-seizure drugs such as Carbamazepine and Valproic Acid can improve one’s mood.

If you think you are depressed:

Talk to a health care provider about your depression. They may refer you to a psychiatrist, neuropsychiatrist, or a psychologist with experience treating depression.

  • Seek support from friends, family, and health care workers such as nurses, social workers, and counsellors.
  • Avoid isolation.
  • If you are in crisis, contact your health care provider and go to your nearest hospital emergency room.

What are the treatments for depression?

Therapy

There are a number of forms of therapy that can help people with mild depression, including psychotherapy, supportive therapy, cognitive therapy, interpersonal therapy, group therapy, or family therapy. A health care provider can help a person with epilepsy and depression decide which form of therapy best suits them

Medication

People with epilepsy and depression may benefit from a combination of therapy and antidepressants. Some newer antidepressants are even associated with increased seizure control

Lifestyle Changes

Along with therapy and medication, doing things you enjoy, eating well, exercising, and avoiding alcohol and non-prescription drugs can help improve your mood.

 

The information in this page was adapted from the Spark sheets “Epilepsy and Anxiety” (2017) and “Epilepsy and Depression” (2015). Download a pdf version of Epilepsy and Depression here. A pdf of Epilepsy and Anxiety will be available by Fall 2017.