Psychological Aspects of Epilepsy Kami Marchese, Psy.D.

True or False? n It is normal to feel depressed when you have epilepsy

True or False? n Suicide is a major cause of death in epilepsy.

True or False? n Depression can be caused by antiepileptic medication.

True or False? n Feelings of anxiety and/or depression can be the manifestation of a seizure.

Most Common Psychological Conditions In Epilepsy n *Depression n Anxiety n Mania n Psychosis

Symptoms of Depression n Depressed mood most of the day n Loss of interest in activities n Feelings of worthlessness n Decreased concentration, indecisiveness n Increased irritability n Recurrent thoughts of death n Change in appetite, weight loss or gain n Sleep disturbance n Loss of energy n Psychomotor agitation or retardation

Types of Depression n Major Depressive Disorder (MDD) n Dysthymic Disorder The difference between the two is based on severity, persistence, and chronicity.

Lifetime Prevalence of Depression in Adults n 10-20% - controlled epilepsy n 20-60% - recurrent seizures n 5.8% - in general nonepileptic population

Suicide n Suicide is 5-10 times higher in PWE than in the general population n 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 n Need to make significant adjustments in lifestyle u Work limitations F Dangerous heights, operating machinery, changing or cutting back on hours u Giving up driving privileges u Childbearing concerns

Why In Epilepsy? Physiological (Directly Caused by Epilepsy) n Reaction to seizure medication n Brain regions are the same n Endocrine or metabolic effects

Antiepileptic Drugs (AED) that can cause depression n Phenobarbital n Primidone (Mysoline) n Tiagabine (Gabitril) n Vigabatrin (Sabril) n Felbamate (Felbatol) n Topiramate (Topamax) n *Carbamazepine (Tegretol) and Valproic Acid (Depakote) *less frequent

Physiological Causes of Mood Disorders n Overlap in brain regions involved in epilepsy and depression u PWE who had temporal lobe scarring had higher depression scores than other patients u Depression is more frequent in PWE of temporal and frontal lobe origin n Comorbidity of epilepsy and migraine u Strong association between migraine and depression

Depression Specific to Epilepsy n Classified according to the temporal relation to seizure occurrence u Pre-ictal: Prior to seizure onset u Ictal: During the seizure and the expression of seizure u Post-ictal: After seizure (includes up to 120 hours) u Inter-ictal: Unrelated to seizure occurrence

Inter-ictal Depression n Most common among PWE n Commonly presents as dysthymic disorder with waxing and waning course

Ictal Depression n Can be the clinical expression of a simple partial seizure where depression is the predominant or only feature

Depression and Quality of Life (QOL) n Studies have shown that depression is the strongest predictor of QOL n Even more than seizure frequency and severity

Cognitive Functioning n Diminished attention and concentration n Memory loss n Reduced processing speed n Difficulty making decisions

True or False? n It is normal to feel depressed when you have epilepsy. TRUE

True or False? n Suicide is a major cause of death in epilepsy. TRUE

True or False? n Feelings of anxiety and/or depression can be the manifestation of a seizure. TRUE

True or False? n Depression can be caused by antiepileptic medication. TRUE

Next Steps n Seek treatment n Anti-depressant medication n Individual or group counseling