Psychological Aspects of Epilepsy 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