Epilepsy and depression are both significant health concerns that often overlap with each other. Epilepsy involves recurring seizures that disrupt brain function, while depression is a mood disorder characterised by continuous feelings of sadness and a lack of interest in daily activities. Despite their differences, these conditions are closely connected. Research shows that people with epilepsy are more likely to experience depression, and those with depression may have an increased risk of seizures.¹

In this article, we'll explore how epilepsy and depression are connected and discuss treatment options to manage both conditions.

What is epilepsy?

Epilepsy is a neurological condition that causes frequent seizures due to sudden bursts of electrical activity in a group of brain cells. These seizures can differ greatly in how they appear in different people and in their intensity.²

Symptoms of epileptic seizures:^2,3

• Brief episodes of involuntary vigorous body movements, often referred to as a "fit"
• Intense, prolonged shaking of the entire body
• Muscle rigidity or minor muscle twitches
• Zoning out and gazing into space without awareness
• Odd physical sensations, such as a "fluttering" in the stomach, peculiar smells or tastes, or tingling in the limbs
• Increased heart rate or rapid breathing than normal 
• Momentary confusion slowed cognition, or difficulties with speech and comprehension
• Suddenly losing consciousness
• Losing control over bladder or bowel functions
• Feelings of fear, anxiety, or déjà vu.

What is depression?

Depression is a mental health condition that can significantly disrupt your emotional well-being and daily life. It causes persistent sadness and a disinterest in activities you once used to enjoy.⁴

While it's normal to feel down occasionally, if these feelings hang around for two weeks or more, you might be facing depression. This condition affects how you think, feel, and perform everyday tasks like eating, sleeping, and working. Depression can impact many areas of your life, such as your relationships, school or work performance, and even your physical health.⁴

Depression may be described as mild, moderate, or severe depending on how much impact it has on your daily life activities.⁵ The symptoms of depression can vary from person to person. 

Symptoms of depression^4,5

• Feelings of deep sadness, anxiety, or emptiness
• A sense of hopelessness or a consistently negative outlook
• Constantly feeling irritated, frustrated, uneasy, or restless
• Persistent feelings of guilt, worthlessness, or helplessness
• Chronic fatigue, low energy, or a sense of sluggishness
• Changes in appetite or unintended weight gain or loss
• Difficulty focusing, remembering, or making decisions
• Sleep disturbances, such as trouble falling asleep (insomnia), waking up too early or sleeping too much
• Unexplained aches, pains, headaches, or digestive problems
• Repeated suicidal thoughts, or attempts
• Withdrawing from social interactions, becoming negative or detached
• Increased consumption of alcohol or drugs
• Reduced interest in sexual activity.

How are epilepsy and depression connected?

Epilepsy is linked with an increased risk of several mental health conditions, including anxiety, psychotic disorders, bipolar disorder, and depression. Among these, depression stands out as the most prevalent mental health condition associated with epilepsy. Research indicates that approximately 1 in 3 individuals with epilepsy develop depression, significantly impacting their quality of lives.¹

There are several key points that demonstrate the connection between epilepsy and depression which will be explored in this section.

A bidirectional relationship

The relationship between epilepsy and depression is bidirectional. As per research, individuals with epilepsy are more likely to experience depressive symptoms compared to the general population. In fact, various studies have found that up to 55% of people with epilepsy suffer from depression.⁶

Similarly, depression worsens the symptoms of epilepsy. It can trigger seizures by disrupting sleep patterns; and seizures, in turn, can bring on depression because of the physical effects and the emotional toll of living with epilepsy. Moreover, studies have also revealed that extreme stress in people with epilepsy can increase the frequency of seizures in them.⁷

Living with epilepsy may lead to depressive symptoms

The psychosocial challenges of living with epilepsy can contribute significantly to depression, mainly because of the unpredictable nature of seizures. This may happen in the following ways:^8,9

• Ongoing anxiety about when the next episode of seizure might occur in public often leads to withdrawing from social situations, resulting in loneliness and isolation.
• Misunderstanding and discrimination from others can lead to shame, lowered self-esteem, and further isolation.
• The stigma surrounding epilepsy can create obstacles in employment, education, and social opportunities, increasing the risk of depression
• Managing medication, appointments, and treatment side effects altogether can be overwhelming for epilepsy patients, adding to the stress.
• Family members' anxiety about the condition can create a tense home environment. Overprotectiveness from them can limit the person's independence, causing frustration and helplessness.
• Medical costs, potential job loss, and the inability to work full-time can cause financial stress, contributing to depression.

Shared biological mechanisms between epilepsy and depression

Several studies have shown that epilepsy and depression may share common underlying biological mechanisms, including:^9,10

• Brain structure changes: Both conditions can involve similar changes in brain structure, especially in cases of temporal lobe epilepsy (TLE).
• Serotonin dysfunction: Problems with serotonin, a neurotransmitter (brain chemical messenger) that affects mood, are found in both depression and some types of epilepsy. These issues can also disrupt other important neurotransmitters.
• HPA axis deregulation: Both epilepsy and depression are associated with a hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis in the brain. Excess stress hormones produced in depression, such as cortisol, can increase the excitability of nerve cells in the hippocampus in the brain, triggering seizures.

Epilepsy medication may have depressive side effects

Some epilepsy medications, called Antiepileptic drugs (AEDs) are known to cause mood changes that might lead to depression or depressive symptoms in epilepsy patients, such as:⁸

• Sleepiness
• Trouble focusing
• Nervousness
• Issues with remembering stuff
• Feeling tired all the time.

In 2008, the U.S. Food and Drug Administration (FDA) issued a warning stating that antiepileptic drugs may raise the risk of suicide or suicidal thoughts in patients.⁸

However, not all anti-epileptic drugs (AEDs) have negative effects on mood; many have been reported to positively influence mood. Therefore, if you feel that your epilepsy medication is causing depressive symptoms, you must contact your doctor immediately. They can then suggest alternative medications and dosages that may be more suitable for you.⁸

Management and treatment for epilepsy and depression

If you are dealing with both depression and epilepsy, your treatment will aim to prevent seizures and lessen the intensity of your symptoms.

This approach includes surgery, medication, behavioural therapy, and lifestyle changes. Surgical options, such as amygdalohippocampectomy have been shown to improve both seizure control and depressive symptoms in patients. Anti-epileptic drugs also help control seizures and reduce related stress and depression, although some may have depressive side effects, so your doctor will closely monitor and adjust your treatment as needed.⁹

Behavioural therapies like cognitive-behavioural therapy (CBT) provide strategies to manage depressive symptoms effectively. Regular physical activity and a healthy diet boost mental health, as exercise releases endorphins, natural mood enhancers. Reducing alcohol consumption is also beneficial.^9,11

Support groups and therapy offer emotional support and practical advice, reducing feelings of isolation and empowering you to manage your conditions. Combining these treatments with professional guidance can significantly improve your quality of life while managing both epilepsy and depression.^9,11

Summary

Although epilepsy and depression are two different conditions, they often occur together and can aggravate each other's symptoms, significantly impacting one's overall well-being. Epilepsy can increase the risk and severity of depression, while depression can worsen epilepsy symptoms, such as seizure frequency and medication effectiveness. 

Getting diagnosed with epilepsy, depression or both can be quite overwhelming, but there are ways to manage and address the impact of these conditions on your life. Detecting and treating depression early is crucial to minimise its negative impact on epilepsy management. However, treatment can be complex due to the potential for some depression medications to worsen seizures. Your healthcare providers need to consider both conditions when planning your treatment. Certain medications, therapy, and support groups can help you manage symptoms and improve your quality of life. 

Don't hesitate to reach out for support as you navigate these challenges. Remember, you're not alone, and there are people and resources ready to guide you through this journey with empathy and understanding.