Is Depression More Prevalent in People with Epilepsy?

Some people with epilepsy do have a greater tendency towards depression, which can easily be understood as a natural reaction to a difficult life situation. It would not be appropriate to call this kind of psychological reaction an illness, as anyone might feel the same given the particular circumstances.

However, some neurologists believe that, as well as this kind of 'reactive depression? some people with epilepsy may be more prone to 'endogenous depression', which may need drug treatment. This type of depression is thought by some doctors to be characterized by its sudden quality - that is, it tends to come suddenly and go suddenly.

Depression is potentially serious in people with epilepsy because of the risk of suicide, which is generally estimated to be around five times higher than that of the population in general. Although this is an unpleasant statistic, it is worth mentioning because medication can be so effective in treating depression, especially if started early in the depression. It may be a matter of adjusting the dosage or type of your anti-epileptic drugs, combined if necessary with small amounts of antidepressants - a mixture which has turned life around for many former sufferers.

'Having epilepsy?'-coming to terms with diagnosis
Coming to terms with epilepsy is similar to coming to terms with any other shocking major life event. There are a number of emotional responses to be gone through in the normal process of acceptance. Even if your epilepsy was diagnosed way back in childhood, you may still need to go through a grieving process in adulthood as you come to terms with the implications of epilepsy. Grief over diagnosis is very natural - in fact, it would probably be worrying if you did not grieve, as grief, including fear, anger and depression, is a necessary route to acceptance.

Fear is a normal response to hearing that you have epilepsy. This fear, which underlies much of the remaining public stigma around epilepsy, is largely fear of the unknown; hence the importance already mentioned of gaining as much information as possible about your condition on diagnosis, and about epilepsy in general. You may also need support from friends, family doctor, psychiatrist and support group.

Fear of losing control, a challenge to anyone, is one of the main anxieties of epilepsy. A diagnosis of epilepsy may also bring out the fear of death. This may hardly be likely or rational, but has to do with seizures that may make you feel very vulnerable. Fear of embarrassment or of appearing different may also be even stronger than fear of death for some!

People cope with grief in different ways. Some need a lot of time alone in which to cry, to feel sad, and to think. Sometimes, being aware of and letting out these emotions may seem as if you're being weak and not coming to terms with epilepsy at all. But, being in touch with and expressing these emotions is a necessary and healthy part of grieving -better than suppressing them.

Men may generally need more help in dealing with grief, in realizing that there are coping mechanisms such as talking to others, especially those in the same situation, perhaps via an epilepsy organization. Acknowledging and dealing with these feelings is important because it will help you eventually put them behind you and move on to a more positive and productive stance.

Depression is also a natural reaction to diagnosis, though it needs to be distinguished from long-term, ongoing depression, which is dealt with separately above. Depression is a natural reaction to the burden of having seizures and their brutal interruptions into everyday life, especially if you have to lay your normal activities to one side for several hours afterwards in order to recover.

Anger is another stage. You may be angry at yourself or at life events which you feel were responsible for your epilepsy, such as a car accident - angry perhaps at your parents for passing on a 'defective gene' or for drinking or smoking during pregnancy. Anger at the medical system is another common reaction, especially given the time often involved in diagnosis, and you may need to find ways of talking to your medical carers, as this is likely to be a long-term relationship.

You may also need to come to terms with how epilepsy may affect relationships with others, as well as the best way to solve the problem of how much to tell and how much to reveal.

Acceptance takes time and has many different stages and depends partly on how good your self-acceptance and esteem were beforehand. Essentially it means accepting yourself as a normal person who happens to have seizures.

Source: Epilepsy: A Behavior Medicine Approach to Assessment and Treatment by Joanne Dahl