Medication For Seizures And Depression

Whats The Difference Between Depression And Sadness

Whereas sadness generally passes after a day or a week, depression is a mood disorder that sticks around and severely impacts everyday functioning. A depression diagnosis requires the presence of at least five symptoms of depression every day for at least two weeks. Common symptoms include:

• Persistent feelings of sadness, anxiety, or emptiness
• Loss of interest or pleasure in pastimes or activities
• Fatigue or reduced energy
• Digestive problems
• Suicidal thoughts

Living with epilepsy can lead to disruptions in quality of life, which can lead to any one of these symptoms. If they linger, reach out to a doctor or mental health professional, such as one trained in psychiatry. Its common to have depression or another mood disorder, such as anxiety, when living with epilepsy, and its OK to ask for help.

Side Effects From Medications

Antiseizure drugs can also affect the mood centers in your brain, raising your risk of depression. Barbiturates may be more likely to contribute to depression than other antiseizure medications. These may also affect your mood:

If you suspect your epilepsy medication is affecting your mood, talk to your doctor. The symptoms may be temporary, while your body adjusts to the medication. But your doctor may also change the dose or switch you to another drug.

Does Medicine Used To Treat Depression Affect Seizures

A recent review describes what is known about when the two conditions happen together and how antidepressants may affect the brain of someone with epilepsy. The effects of antidepressants on epilepsy may be short-term or long-term. Some important findings:

• First-generation antidepressants could trigger seizures, which made clinicians a bit reluctant to prescribe these to people with epilepsy.
• Recent studies suggest that newer, second-generation antidepressants may be helpful in epilepsy by decreasing seizure frequency.
• There is much evidence that suggests that the use of antidepressants in epilepsy is beneficial, but the authors stress the need for caution.
• Until now, studies have only looked at the effects of antidepressants on seizures, but not on the mechanisms that cause seizures in the first place. This type of study would be difficult to do in people with epilepsy, but could be done with animal models.

Read Also: Anxiety And Depression Treatment Center Newport Beach

Antidepressant Choice For Patients With Epilepsy

This content was published in 2012. We do not recommend that you take any clinical decisions based on this information without first ensuring you have checked the latest guidance.

When depression is diagnosed, the first consideration should always be to check the patients antiepileptic regimen for potential drug-induced depression. Changing the antiepileptic to another drug with a more favourable effect on mood may be more beneficial than starting an antidepressant.

Although the risk of seizures with most antidepressants is low, before starting drug treatment patients should be made aware that there is still some degree of seizure risk.

Selective serotonin reuptake inhibitors are considered the first-line antidepressant option for patients with epilepsy. Fluoxetine is not recommended because it has a long half-life, potentially carries a greater risk of seizures and can interact with certain antiepileptics. Citalopram or sertraline are more appropriate options. They exhibit a better safety profile and have a lower likelihood of interacting with antiepileptics.

Moclobemide is a good alternative since it has a low risk of causing seizures .

Patients with epilepsy who respond poorly to, or are intolerant of, other antidepressants can be prescribed tricyclic antidepressants with caution, since they appear to lower the seizure threshold. If a TCA is needed, doxepin should be chosen because it is less likely to cause seizures.

Demographic Characteristics Of The Cohort

Table shows the baseline characteristics of the cohort. There were 146,028 females and 92,935 males. The mean age was 39.5 years .

The most common comorbidity at baseline was asthma and/or chronic obstructive airways disease , followed by hypertension . The most common medication at baseline was antihypertensives . There were 2672 patients on anticonvulsants at baseline.

Don’t Miss: Is It Normal To Get Depressed While Pregnant

How Can Research In Animals Help Us Understand Depression And Seizures In People

There are many animal models of epilepsy that scientists use in the lab. Some, like the maximal electroshock model can help study the new development of seizures in a rodent that is otherwise healthy. Chronic models of epilepsy take a longer time but help researchers study the circuits that underlie epilepsy in the brain.

• The effects of antidepressants on epilepsy should be studied in chronic animal models of epilepsy to give us a better understanding about the long-term effects of antidepressants in an epileptic brain.
• Although antidepressants have positive effects in epilepsy, more studies should be done in animal models to understand how this works.

Mood Problems As A Side Effect Of Medication

Possible side effects of anti-epileptic drugs include mood changes, irritability, agitation or depression. However, with some people AEDs can improve their mood. The risk of you having a side effect may be lower than you think. If a side effect is listed as common, this means that at the most, 1 in 10 people will get it and 9 in 10 people will not. The lists of side effects that come with AEDs may make you expect to have side effects, increasing your anxiety or low mood.

You could keep a diary of your mood, along with a record of any medication changes, so that you can see whether there are any links. This may help discussions with your doctor or nurse, especially when you are new to taking medication. Download a PDF seizure diary or get a .

Some feelings should not be ignored, especially if you are having thoughts about suicide, or about death generally. Telling someone how you feel is the first step to feeling less alone. Telling your doctor or nurse how you feel means that they can help.

Don’t Miss: How To Claim Depression With Va

Additional File : Table S1

List of Read codes included in the definition of the epilepsy/seizures outcome. Table S2. Read codes used for identification of patients with depression and their assigned severity. Table S3. Baseline characteristics of patients according to the class of antidepressant first prescribed. Table S4. 5-year hazard ratios for epilepsy/seizures by antidepressant class, dose and individual drug, with SSRIs, mid-dose SSRI and citalopram as the reference categories respectively. Table S5. 5-year hazard ratios for epilepsy/seizures by antidepressant class, dose and individual drug, with untreated patients excluded from the cohort. Table S6. 5-year hazard ratios for epilepsy/seizures by antidepressant class, dose and individual drug, with patients on anticonvulsants at baseline excluded from the cohort. Table S7. 1-year hazard ratios for epilepsy/seizures by antidepressant class, dose and individual drug. Table S8. 1-year hazard ratios for epilepsy/seizures by antidepressant class, dose and individual drug, with SSRIs, mid-dose SSRI and citalopram as the reference categories respectively.

Implications Of Our Findings

Whilst we acknowledge our results need further confirmation via future studies, there are possible implications of our findings for the treatment of depression.

We have found that treatment with all antidepressants is associated with an increased risk of epilepsy/seizures, with some types of antidepressant being associated with a much higher risk than others. This suggests there is a need to inform patients and their doctors about the increased risks of continued antidepressant therapy that accumulate over long periods of treatment. Consideration of each patients individual circumstances must be taken into account, allowing discussion between the clinician and the patient, enabling a shared decision to be reached on future treatments.

Due to the increased absolute risks of epilepsy/seizures that occur under long term use, there is a need for an individual clinical risk-benefit assessment for any patient facing antidepressant treatment over a period of five or more years, bearing in mind the absence of evidence supporting longer term treatment with antidepressants. This may be of particular importance to people with mild and infrequently recurring depression, or those with additional risk factors for seizures such as evidence of cerebrovascular disease.

Recommended Reading: Can Depression Make You Lightheaded

Depression And Epilepsy: Whats The Connection

Depression and epilepsy share a strong connection. In fact, depression commonly occurs alongside epilepsy: Around 23 percent of people with epilepsy have or have had depression. By comparison, around 5 percent of the general population of U.S. adults have regular feelings of depression.

If you are living with epilepsy and experience or have experienced depression, know that you are certainly not alone. Understanding the causes and risk factors of depression, as well as ways to manage the condition, can help.

What Is The Best Seizure Medication

The best seizure medication is one that treats the particular type of seizure a patient is experiencing.

• Some seizure medications work best on generalized tonic-clonic seizures . These are the kind of seizures typically seen with epilepsy.
• Others are more effective at controlling partial or absence seizures.

Some seizure medications are considered first-line therapy, while others are approved as “add-ons” when further seizure control is needed.

Some seizure medications are potentially dangerous to administer to young children such as valproic acid .

Sometimes, certain medications work better than others for unusual seizure situations. For example, women who develop an increase in seizure activity around menstruation can benefit from using acetazolamide .

Also to be considered is whether the patient is, or might become, pregnant during therapy. Some seizure medications, including phenytoin and valproic acid, can harm the developing fetus.

Some seizure medications should only be used when other options run out as they carry significant potential for serious side effects.

You May Like: Male Depression And Anxiety Symptoms

How Does Depression Affect Myepilepsyteam Members

More than 3,700 members of MyEpilepsyTeam report depression as a symptom. Thats about a quarter of all members. So, as ironic as it may seem to say you are in good company if you have depression, its true. There are thousands of others who know what youre going through.

Being depressed can reduce quality of life and make everyday life feel harder, on top of the difficulties epilepsy brings. This double burden is common. One MyEpilepsyTeam member stated, They believe my depression is made worse by my epilepsy. Another member said, Ive gotten so down in the dumps about it that I wished I had gotten in a car accident that morning and lost my leg versus waking up and having my first of many seizures.

Everybodys story is different, however, and there is strength in numbers. One member said it well: Try to remember that a lot of people, including people who have epilepsy, also have depression. Another said, Talk about it. Thats how I got through it in the beginning.

Its OK to speak up. Chances are youll virtually bump into someone who has felt the same way and can offer some support.

What Are Common Seizure Medication Side Effects

Because seizure medications work in the central nervous system, most cause some degree of drowsiness or dizziness, at least at the beginning of therapy. Also, most anti-seizure medications can induce suicidal thoughts or actions, and/or bring on or worsen depression.

Seizure medications have a variety of possible side effects. The following is a list of potential side effects of different classes of seizure medications.

Acetazolamide :

Benzodiazepines :

• Changes in heartbeat with possible fainting
• Drug dependence

• Severe changes in mood and behavior, including hostility, aggression, suicidal thoughts

• Swelling of hands and feet
• Trouble concentrating

Valproic acid and derivatives :

• Irreversible visual problems, including reductions in acuity and color differentiation

Zonisamide :

Read Also: Blood Test To Determine Depression

Lexapro For Major Depression In Patients With Epilepsy

The primary objective will be to pilot the use of escitalopram for the treatment of major depression in patients with epilepsy. The secondary objectives will be to determine effect sizes on scales measuring depressive symptoms, physical symptoms, psychosocial function and quality of life, and to evaluate safety in the population of patients with epilepsy.

These results will be used to evaluate the possibility of a future double-blind, placebo controlled RCT of escitalopram for the treatment of major depression in patients with epilepsy.

Rationale:

Escitalopram may be an ideal SSRI for patients on antiepileptic medications because of the lack of pharmacokinetic drug interactions, which can be expected, for example, with fluoxetine or paroxetine.

Study Hypothesis:

Primary and Secondary objectives:

Study design:

Treatment:

Safety Monitoring:

Safety monitoring for seizure worsening during the study will consist of the following:

Anticipated findings:

Life Mood And Epilepsy What Affects You

Here are some common issues related to having epilepsy and some suggestions for how to manage them.

• Fear of seizures is understandable. Seizures can be frightening, unpredictable and risky. Learning about what happens during your seizures or talking about your fear, may help to reduce your fear.
• If your employment or education is disrupted by epilepsy, learning more about epilepsy may help, and we can provide training for colleges and employers which may help improve understanding of your individual situation and avoid any unnecessary restrictions.
• Safety is important but so is being able to live as fully as possible. Learning about your epilepsy may help you get a balance between keeping safe and being independent.
• Losing your driving licence can be hard in both practical and psychological terms. However, some people find that travel alternatives lead them to get fitter or to meet new people.

If some of these links are true for you, focusing on one or two may be easier than trying to deal with several at once. Think about what affects you the most.

Read Also: Difference Between Apathy And Depression

Does The Type Of Epilepsy Or Seizure Increase Depression Risk

According to the Epilepsy Foundation, certain types of seizures affect particular areas of the brain responsible for mood. However, other researchers reported that type of seizure is less important than seizure frequency in understanding how seizures increase depression risk. In other words, where the seizure occurs in the brain doesnt matter so much. The conflicting evidence suggests that more research is needed on whether types of seizures directly increase risk of depression.

What Are The Different Types Of Depression

There are many types of depression. There also are many terms used to describe different types of depression. Diagnosing depression can be complicated.

Following are the medical terms used. Do not use these descriptions to diagnose your own symptoms or those of your loved ones. Seek help from your primary care provider or mental health specialist if any of these problems are present.

There are other mental health disorders that can have similar symptoms to depression. Read about diagnosing depression to learn more.

Read Also: How To Stop Being Depressed

Risk Factors For Depression And Epilepsy

Research on the connection between epilepsy and depression as a comorbidity, or co-occurring condition, is ongoing. There is evidence to show a relationship between the conditions, but the risk of developing one from the other is not always clear.

One common risk factor between epilepsy and depression may involve genetics. However, the association between genes and epilepsy is complex, and researchers say genetic testing may not be sufficient to show a certain genetic predisposition. The jury is still out as to whether depression and epilepsy share a genetic component.

Learn more about genetics and epilepsy.

When Does Depression Affect People With Epilepsy

For some people with epilepsy, symptoms of depression act as an aura. An aura is a warning sign that a seizure is coming.

You might also feel depressed for several days after a seizure. Or you may experience long-term depression. Depression can potentially affect you at any time.

The possible causes of depression in people with epilepsy include:

Also Check: How Bad Is Depression And Anxiety

Duration And Monitoring Of Treatment

No clinical trials in depressed patients with epilepsy have studied duration of treatment as it pertains to remission and time to relapse. As such, no evidence exists as to how long a patient with depression and epilepsy should remain on antidepressant treatment. Of the few antidepressant efficacy studies, most use the HAM-D to measure depressive symptomatology.46 Further, given the lack of current evidence in treating and measuring depression in epilepsy, it stands to reason to follow the primary depression model. As such, the HAM-D, Montgomery Asberg Depression Rating Scale ,47 the Patient Health Questionnaire ,48 the 30-item Inventory of Depressive SymptomatologySelf-report ,49 and the 16-item Quick Inventory of Depressive SymptomatologySelf-report 50 have all been validated to monitor depressive symptoms on an ongoing basis. However, as mentioned above, depressive symptoms in epileptics may manifest differently from primary depression, and commonly used depression measuring scales need validation in this population. Again, this underscores the need for further controlled clinical trials in this understudied population.

Treatment Of Depression In Patients With Epilepsy

Mebanga Ojong, PharmD CandidatePhiladelphia College of Osteopathic Medicine School of PharmacySuwanee, Georgia

Assistant Professor of Pharmacy PracticePhiladelphia College of Osteopathic Medicine School of PharmacySuwanee, Georgia

US Pharm. 2012 37:29-32.

ABSTRACT: Depression is more prevalent in patients with epilepsythan in the general population. The condition remains underdiagnosedbecause of underreporting of signs and symptoms. Another reason for lackof treatment is the belief that antidepressants have proconvulsanteffects. Many antidepressants are known to lower the seizure threshold however, data indicate that, at low doses, antidepressants possessanticonvulsant properties. Evidence also suggests that when anantidepressant is used within its therapeutic dosage range, the risk ofseizure activity is low. When selecting an antidepressant for use in apatient with epilepsy, the clinician should carefully consider drug-druginteractions between antiepileptics and antidepressants. In general,selective serotonin reuptake inhibitors are considered first-linetherapy. The efficacy of antidepressants in epilepsy patients may beenhanced with supportive therapy or psychotherapy.

Also Check: Apps That Help You With Depression