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Depression

Depression can be defined as a state of sadness or despair that has developed to the point of interfering with a person's social functioning and/or daily activities. When sadness is prolonged and impairs the person's ability to enjoy life, that person may be suffering from depression.

 

People who suffer from depression experience feelings of deep gloom and hopelessness. Among other symptoms, they often have appetite disturbances (constant eating or not eating at all), sleeping irregularities (sleeping too much or not being able to sleep), and are unable to concentrate. Many people suffer or have suffered from depression, but people who have epilepsy are more likely than the general public to have this problem.

 

 

Epilepsy and Depression

 

Numerous studies have found that depression is the most common psychiatric disorder in patients who have epilepsy. People suffering from epilepsy may feel depressed or be in a state of depression for a number of different reasons. Risk factors for epilepsy and depression include the following:

  • Seizure related factors
  • Psychosocial factors
  • Iatrogenic factors

 

 

Seizure-Related Factors

People who have epilepsy are more likely to suffer from depression if their seizures originate in the frontal and temporal lobes of their brain. People who have generalized seizures are less prone to suffer from depression. Occurrence of seizures is also a risk factor: people who have seizures frequently are more at risk of depression than people who have well-controlled seizures.

 

A change of mood or behaviour is common in the period before a seizure occurs. This is known as a prodromal stage. Depression may occur as part of an "aura" before a seizure. Depression is also common following a seizure. This is known as the post-ictal state and is usually brief.

 

 

Psychosocial Factors

 

People who suffer from epilepsy are prone to discrimination within society. People who have epilepsy may feel depressed due to the stigma associated with the disorder, lack of social support, and certain lifestyle adjustments that interfere with a person's independence. This includes: suspended driving privileges, restricted educational or employment opportunities, or having to change careers or jobs. Sexual dysfunction is also a prevalent problem for people who have epilepsy. All these factors diminish an individual's sense of control and independence, resulting in a decreased self-esteem and the development of depression.

 

 

Iatrogenic factors

 

Anti-epileptic drugs may cause psychiatric symptoms, especially depression. The cognitive side effects associated with anti-epileptic drugs are closely associated with depression.

 

 

 

Treatment

 

When treating depression in people with epilepsy, the initial steps should involve the optimization of seizure control, as people who are known to have controlled or fewer seizures are less likely to be depressed.

 

Several factors must be considered when contemplating anti-depressants for treating depression, including the effects of medication on the seizures and the interaction between antidepressants and the anti-epileptic drugs. People who have epilepsy should consult with their neurologist to discover the most effective forms of treatment.

 

Developing a support team is a very important part of treating depression in people who have epilepsy. This may include a counselor, social worker, or epilepsy nurse. These individuals may be able to aid in teaching coping skills that can help to improve mild depression or anxiety. Coping skills may help some people reduce the number of seizures they have. Support groups, where people can meet and share their experiences, also help people manage their depression. When depression is treated, there is a significant improvement after taking antidepressant medications or starting psychotherapy. Depression is best dealt with when detected and treated early on.