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Depression and Epilepsy: What’s the Connection?

Updated on October 06, 2021
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Emily Brown

Depression and epilepsy share a strong connection. In fact, depression commonly occurs alongside epilepsy: Around 23 percent of people with epilepsy have or have had depression. By comparison, around 5 percent of the general population of U.S. adults have regular feelings of depression.

If you are living with epilepsy and experience or have experienced depression, know that you are certainly not alone. Understanding the causes and risk factors of depression, as well as ways to manage the condition, can help.

Causes of Depression

There are several potential causes of depression. Some are outside your control, such as neurological changes and medical conditions, which is the case for someone with epilepsy. Sometimes things change and depression passes, whereas sometimes it remains.

What’s the Difference Between Depression and Sadness?

Whereas sadness generally passes after a day or a week, depression is a mood disorder that sticks around and severely impacts everyday functioning. A depression diagnosis requires the presence of at least five symptoms of depression every day for at least two weeks. Common symptoms include:

  • Persistent feelings of sadness, anxiety, or emptiness
  • Loss of interest or pleasure in pastimes or activities
  • Fatigue or reduced energy
  • Trouble with sleeping, waking up early, or sleeping too much
  • Shifts in appetite or unintentional weight gain
  • Aches and pains
  • Digestive problems
  • Suicidal thoughts

Living with epilepsy can lead to disruptions in quality of life, which can lead to any one of these symptoms. If they linger, reach out to a doctor or mental health professional, such as one trained in psychiatry. It’s common to have depression or another mood disorder, such as anxiety, when living with epilepsy, and it’s OK to ask for help.

Risk Factors for Depression and Epilepsy

Research on the connection between epilepsy and depression as a comorbidity, or co-occurring condition, is ongoing. There is evidence to show a relationship between the conditions, but the risk of developing one from the other is not always clear.

One common risk factor between epilepsy and depression may involve genetics. However, the association between genes and epilepsy is complex, and researchers say genetic testing may not be sufficient to show a certain genetic predisposition. The jury is still out as to whether depression and epilepsy share a genetic component.

Learn more about genetics and epilepsy.

Does Epilepsy Cause Depression?

There is evidence to show that epilepsy connects to depression through both psychological and neurological pathways.

Can Stress from Epilepsy Cause Depression?

A review of clinical studies of epilepsy and depression have shown that living with epilepsy can cause stress, which can contribute to depression. The stress of living with epilepsy — for example, not being able to drive or having difficulty keeping a job — may cause someone with epilepsy to feel depressed. The same review noted that depression can be caused by changes in neurology that occur pre- and post-seizure, but that these depressed states are temporary.

Does the Type of Epilepsy or Seizure Increase Depression Risk?

According to the Epilepsy Foundation, certain types of seizures affect particular areas of the brain responsible for mood. However, other researchers reported that type of seizure is less important than seizure frequency in understanding how seizures increase depression risk. In other words, where the seizure occurs in the brain doesn’t matter so much. The conflicting evidence suggests that more research is needed on whether types of seizures directly increase risk of depression.

Can Antiepileptic Drugs Cause Depression?

Antiepileptic drugs (AEDs) are one course of treatment for epilepsy. Unfortunately, AEDs are known to have side effects connected with depression. For instance, common adverse effects of antiepileptic drugs include:

  • Drowsiness
  • Difficulty concentrating
  • Nervousness
  • Memory problems
  • Fatigue

Some side effects are even worse. The U.S. Food and Drug Administration (FDA) has found that some antiepileptic drugs are consistently associated with reports of suicidality.

A person who takes AEDs regularly may experience persistent depressive symptoms. If you are experiencing adverse side effects from antiepileptic medication, you should speak with your doctor. There may be another drug or a different dosage that won’t have the same effects.

Does Depression Cause Epilepsy?

Evidence from neurology researchers suggests that depression increases the risk for developing epilepsy, with more severe depression increasing the risk of epilepsy and worse seizure outcomes. An older study confirmed this link, saying that major depression is a risk factor for epileptic seizures — but that it’s more complicated than originally thought.

Both studies said more research is needed to look at the underlying links between depression and onset of seizures, including looking at family history of depression. Basically, the link between depression and risk of developing epilepsy is not a causal one; it’s important to remember that correlation is not causation.

How Does Depression Affect MyEpilepsyTeam Members?

More than 3,700 members of MyEpilepsyTeam report depression as a symptom. That’s about a quarter of all members. So, as ironic as it may seem to say you are in good company if you have depression, it’s true. There are thousands of others who know what you’re going through.

Being depressed can reduce quality of life and make everyday life feel harder, on top of the difficulties epilepsy brings. This double burden is common. One MyEpilepsyTeam member stated, “They believe my depression is made worse by my epilepsy.” Another member said, “I’ve gotten so down in the dumps about it that I wished I had gotten in a car accident that morning and lost my leg versus waking up and having my first of many seizures.”

Everybody’s story is different, however, and there is strength in numbers. One member said it well: “Try to remember that a lot of people, including people who have epilepsy, also have depression.” Another said, “Talk about it. That’s how I got through it in the beginning.”

It’s OK to speak up. Chances are you’ll virtually bump into someone who has felt the same way and can offer some support.

Treating Depression

Managing seizures is one way to manage depression. Research shows that better seizure control protects people with epilepsy against depression. Besides managing seizures, there are other ways to help treat depression.

Therapy

Therapy is a great option for people with epilepsy and depression, and there are several therapies used to treat depression.

Cognitive behavioral therapy (CBT) is shown to reduce depression among people with epilepsy, according to the Epilepsy Foundation. CBT is based on the idea that some psychological issues are due, in part, to unhelpful patterns of thinking and behavior. The goal of CBT is to change these thoughts and behaviors.

However, one size does not fit all. Speaking to a mental health professional can help people with epilepsy determine the right kind of therapy for them. The added benefit of seeing a therapist, especially one with some knowledge of neurology, is that they can tailor the therapeutic approach to your unique background and circumstances.

Antidepressant Drugs

People with epilepsy have special considerations when it comes to antidepressant drugs because of their potential to increase seizure risk. The Epilepsy Foundation notes that certain classes of antidepressants carry more risk than others, with monoamine oxidase inhibitors (MAOIs) having the least risk, followed by selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants (TCAs).

According to the Epilepsy Foundation, several AEDs can also act as mood stabilizers, which means that epilepsy and depression may be managed with one drug. However, discontinuing some of these drugs may trigger depression.

People with epilepsy and depression should consult with their clinicians about managing their conditions with medication. It may be that both an antidepressant and antiepileptic drug are needed. For example, one MyEpilepsyTeam member noted, “I was put on Keppra and an antidepressant earlier this year and have had no more seizures — and my recent memories and thinking seem much improved.”

Lifestyle Changes

Some lifestyle changes may help with managing depression, but you should always check with your health care providers before trying any of these strategies:

  • Mindfulness/relaxation techniques — Growing evidence indicates that mindfulness improves mood. One example of a mindfulness practice is journaling — getting your feelings out on paper can help you sort through them.
  • Exercise — It’s generally good to exercise, and reports show exercise can improve seizure control. More research is needed, however, as some people with epilepsy report that exercise worsens their seizures.
  • Sleep — There’s a link between depression and sleep-cycle changes, which means that getting good sleep is important in managing depression.
  • Self-care time — As one MyEpilepsyTeam member stated, “Be able to say no, pace yourself, and work within your limits.” Another said, “Self-care is very important. I play music and it’s a lifeline for me.”
  • Social relationships — Social support improves well-being among people with depression. One member put it this way: “Let them help you but not take over for you. The decision to get better is yours.”

It’s about balance. Finding the right balance of therapy, medication, and lifestyle modifications might take some trial and error. Just remember there is a whole community of team members — thousands of them — who know what you’re going through.

Talk With Others Who Understand

MyEpilepsyTeam is the social network for people with epilepsy and their loved ones. On MyEpilepsyTeam, more than 98,000 members come together to ask questions, give advice, and share their stories with others who understand life with epilepsy.

Are you living with epilepsy and depression? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Links Between Epilepsy and Mood — Epilepsy Society
  2. Depression in Epilepsy — A Systematic Review and Meta-Analysis — Neurology
  3. Mental Health — Centers for Disease Control and Prevention
  4. Depression — National Institute on Mental Illness
  5. Depression — National Institute of Mental Health
  6. Epilepsy Causes — Johns Hopkins Medicine
  7. Depression in Epilepsy: A Critical Review from a Clinical Perspective — Nature Reviews Neurology
  8. Overview of Depression — Epilepsy Foundation
  9. The Impact of Depression, Seizure Variables and Locus of Control on Health Related Quality of Life in a Community Dwelling Sample of Older Adults — Seizure
  10. Severity of Anxiety and Depression are Related to a Higher Perception of Adverse Effects of Antiepileptic Drugs — Seizure
  11. Statistical Review and Analysis — Antiepileptic Drugs and Suicidality — U.S. Food and Drug Administration
  12. Association of Depression and Treated Depression With Epilepsy and Seizure Outcomes — A Multicohort Analysis — JAMA Neurology
  13. Depression and Suicide Attempt As Risk Factors for Incident Unprovoked Seizures — Annals of Neurology
  14. Epilepsy Coexisting With Depression — Pharmacological Reports
  15. Cognitive Therapies — Epilepsy Foundation
  16. What Is Cognitive Behavioral Therapy? — American Psychological Association
  17. Antidepressants — Epilepsy Foundation
  18. Stress, Anxiety, Depression — Epilepsy Foundation
  19. Lifestyle Medicine for Depression — BMC Psychiatry
  20. Exercise and Epilepsy: What Should I Do? — Epilepsy Foundation
  21. Circadian Rhythms and Treatment Implications in Depression — Progress in Neuro-Psychopharmacology & Biological Psychiatry
  22. Social Support and Social Negativity Findings in Depression: Perceived Responsiveness to Basic Psychological Needs — Clinical Psychology Review

A MyEpilepsyTeam Member said:

I've had Epilepsy since age 8, had Depression for only a few mths I notice I get dressed towards the end of each mth it's weird. Sometimes I can't sleep, I take a nap everyday. I have blackouts only… read more

posted about 2 months ago

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Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Emily Brown is a freelance writer and editor, specializing in health communication and public health. Learn more about her here.

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