If you are living with epilepsy, you know that your symptoms include so much more than epileptic seizures. Psychiatric disorders, particularly mood disorders, are the most common coexisting medical conditions in people living with epilepsy. One MyEpilepsyTeam member asked, “Do epilepsy and mental health disorders such as bipolar, schizophrenia, depression, anxiety, etc. have a connection?”

One study found that more than one-third of people with epilepsy currently experience mental health issues — a significantly higher prevalence than the general population. These mental health disorders include depression and anxiety, as well as post-traumatic stress disorder (PTSD), and bipolar disorder.

In this article, we’ll look at these four mental health disorders, how they connect to epilepsy, and how they can be treated.

1. Major Depressive Disorder

Research studies and firsthand experiences from people living with epilepsy all show there’s a connection between the prevalence of depression and epilepsy. One member shared, “Stopped myself from committing suicide twice … so I’d say, yes, people with temporal lobe epilepsy may have mental health issues.”

A research study from 2021 looked at 493 people hospitalized for epilepsy. Researchers found that approximately 50 percent of them had symptoms of depression and 71 percent reported a low quality of life. But it is not clear exactly how epilepsy is associated with symptoms of depression or a low quality of life.

Findings from a 2008 research study lead researchers to ask if the relationship between epilepsy and major depression is bidirectional — meaning that epilepsy affects major depression and major depression affects epilepsy. The researchers found that people with preexisting mood disorders (such as depression) had more than twice the rate of epilepsy compared to people without mood disorders. On the other hand, they found that many people living with epilepsy experienced poor quality of life, which often led to symptoms of depression.

Depression and epilepsy may be connected by the fact that they’re both neurological disorders, or disorders that affect the brain. They’ve both been associated with dysfunction and abnormalities in levels of neurotransmitters (brain chemicals) including serotonin, norepinephrine, and glutamate.

It is also important to note that some epilepsy treatments, such as phenobarbital, have been associated with an increase in depression symptoms. Speak to your doctor if you believe your depression symptoms are associated with your epilepsy medication.

Drugs for major depressive disorder includes:

• Selective serotonin reuptake inhibitors (SSRIs), such as sertraline
• Serotonin norepinephrine reuptake inhibitors (SNRIs)
• Atypical antidepressants
• Tricyclic antidepressants
• Monoamine oxidase inhibitors (MAOIs)

Many people living with depression first seek counseling from a therapist, social worker, or psychologist before starting antidepressant drugs. They then continue counseling alongside taking medications. When considering treatment options, make sure to discuss your current epilepsy medications with your prescribing doctor.

2. Anxiety Disorders

Anxiety is one of the most common conditions associated with epilepsy. Psychologically, it is understandable that many people living with a seizure disorder may be worried about when and where their next seizure will occur.

The relationship between anxiety and epilepsy may also be neurobiological — that is, associated with the nervous system and brain. “I started having panic attacks,” one member explained. “Afterwards, I found out that I had a benign brain tumor that was causing my absence seizures.” After undergoing epilepsy surgery, this person’s epilepsy and anxiety symptoms were significantly improved.

For someone already living with epilepsy, managing anxiety can be difficult. “I don’t know why, but in the last two months, my anxiety has spiked to abnormal levels,” wrote one member. “After having a panic attack at work, I am now very depressed again. I’ve actually lost 10 pounds in the last two months from stress.”

Certain antiepileptic drugs have been shown to have antianxiety effects. These include GABAergic medications, which affect the gamma-aminobutyric acid (or GABA) neurotransmitter. Others, such as antiglutamatergic medications, can worsen anxiety. Make sure to report anxiety, and all other mood symptoms, to your neurologist. Ideally, your epilepsy treatment plan will not only reduce your seizure frequency but will help with your mental and physical wellness.

In addition to medical treatment, certain lifestyle adaptations can help you take back some control over your mental health. These include:

• Getting regular sleep
• Having social support
• Exercising
• Practicing meditation and other stress-management techniques

A counselor or therapist can help you find the strategies that work best for you.

3. Bipolar Disorder

Bipolar disorder is characterized by periods of depression (low mood) and mania (high mood). This mood disorder often co-exists with epilepsy, but many people wonder whether one condition causes the other. “The last time I was in the hospital, I was told I had both epilepsy and bipolar disorder. I have heard that one causes the other, but do not know which,” wrote one member.

Another member shared how their bipolar disorder impacts their job: “I have bipolar and haven’t told anyone at work (despite working in mental health), but I’m scared to discuss this with my managers.”

Bipolar and other mental disorders are often stigmatized conditions. Seeking social support from others going through a similar experience can be a good first step to getting help.

A 2018 study from Baylor College of Medicine found a relationship between bipolar and epilepsy. Researchers found that both bipolar disorder and epilepsy are related to an abnormal expression of a gene called ANK3, which is found in DNA. This imbalance causes brain signals related to both mania and seizures to overfire. These findings explain why bipolar disorder and epilepsy are so often seen together and can be treated with the same drugs.

Treatment for bipolar disorder includes a wide range of medications, such as:

• Antidepressant drugs
• Mood-stabilizing drugs
• Antipsychotic drugs
• Antianxiety drugs

If you take medications for bipolar disorder (or any mood disorder), it’s essential to stick to your treatment regimen as instructed by your doctor. Report any treatment side effects or worsening of symptoms to your psychiatrist to ensure your treatment is safe and effective for you.

4. Post-Traumatic Stress Disorder

Several MyEpilepsyTeam members live with PTSD in addition to seizures. PTSD is a mental health condition that can be triggered by watching or living through a frightening event — which could include seizures. According to Mayo Clinic, PTSD can lead to symptoms including flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event.

In some cases, members identify a strong link between the two conditions. There are many types of seizures, and people experience different seizure triggers. Psychogenic seizures are triggered by psychological stress and can be related to PTSD. For some members, knowing their seizures are psychogenic helped them find the right treatment. “I found out my seizures are caused by my PTSD,” wrote one MyEpilepsyTeam member. “It’s stress-induced, so I’m seeing a cognitive therapist.”

Other MyEpilepsyTeam members developed PTSD as a result of traumatic seizures. “Doctors got me on divalproex sodium (Depakote), diazepam (Valium), and medical marijuana to help with my epilepsy, but from the last seizure I had, I got severe anxiety and PTSD.”

Another member described the relationship between their PTSD and seizures: “As I understand my situation, I live in fear of the next seizure. When, where, how bad. Even worse anxiety after a simple partial (aura). In my case [that means] a grand mal is soon coming. That’s my PTSD.”

Treatment for PTSD includes various kinds of therapy. These include cognitive behavioral therapy (CBT), which aims to help you change the way you think about your trauma, and exposure therapy, which slowly and safely exposes you to the triggers in your life. Your doctor may also prescribe antidepressant and antianxiety medications. People living with epilepsy who are considering PTSD treatment should keep their neurologist informed if they start taking new medications or experience unexpected symptoms.

Your Mental Health Matters

If you are living with both epilepsy and a mood disorder, you are not alone. While the relationship between psychiatry and neurology in people living with epilepsy is highly observed, it is extremely complex for each individual. It is essential to treat your mental health as you would your physical health, listening to your mind and prioritizing mental health care as part of your epilepsy care plan.

Talk With Others Who Understand

MyEpilepsyTeam is the social network for people with epilepsy and their loved ones. On MyEpilepsyTeam, over 110,000 members come together to ask questions, give advice, and share their stories with others who understand life with epilepsy.

Have you ever experienced a mood disorder while living with epilepsy? How do you take care of your mental health? Share your experiences in a comment below or on your Activities page.