This information is for you if you are worried that you might be depressed.

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1 Published on Epilepsy Action ( Page generated on 20/05/2014 Epilepsy and depression In this section Introduction About depression Causes of depression Epilepsy and depression Seizures and depression Epilepsy medicines and depression Treatments for depression Anti-depressant medicines for depression Managing epilepsy and depression Organisations for information and support Introduction Depression is common. It affects nearly one in six people in the UK. Anyone can experience depression. However, many studies show that it is more common if you have a long-term health condition like epilepsy. There is also some research which suggests that depression increases the risk of developing epilepsy. Everybody feels down from time to time and this is quite normal. If you have been feeling low for a long time, and this is affecting your daily life, you may be experiencing depression. Depression may also cause people to be more anxious, to have a short fuse or to develop problems with their memory. This information is for you if you are worried that you might be depressed. About depression We might feel unhappy from time to time with the normal ups and downs of life. Sometimes the things that happen in our day-to-day lives can make us feel fed up, worried or distressed. This is not the same as having depression. Depression becomes a medical problem when it gets in the way of your dayto-day life. The feelings usually last for several weeks, or they keep coming back.

2 Depression can show up in different ways. Because symptoms of depression can appear to be physical rather than emotional, they can be missed or put down to something else. When you are depressed you will probably have at least five or six of the symptoms below. Feeling unhappy most of the time (but may feel a little better in the evenings) Loss of interest in life and can't enjoy anything Finding it harder to make decisions Being unable to cope with things that you used to Feeling tired Feeling restless and agitated Loss of appetite and weight (some people find they do the opposite and gain weight) Taking longer to get to sleep, and then wake up earlier than usual Loss of interest in sex Loss of self-confidence Feeling useless, inadequate and hopeless Avoiding other people Feeling irritable Feeling worse at a particular time each day, usually in the morning Thinking of suicide Depression can be mild, moderate or severe. Not all periods of depression go on for a long time. But without help, it can last for months or even years. Causes of depression Sometimes there seem to be obvious reasons for developing depression. Here are some examples of reasons why some people become depressed. Bereavement Divorce A traumatic event Losing a job Family history of depression Some physical conditions Diet Street drugs and alcohol Seizures Side-effects of epilepsy medicines The reasons for becoming depressed will be different for different people. For example, not everyone who experiences a bereavement or traumatic life event will go on to become depressed. People who have a condition that affects the brain or nervous system may become depressed. Epilepsy is a condition that affects the brain.

3 Epilepsy and depression One in every three people with epilepsy will experience some form of depression during their lifetime. The links between epilepsy and depression are complicated. Having depression can be a risk for developing epilepsy. Many studies show that depression is more common in people with epilepsy than in people who do not have epilepsy. Living with epilepsy can affect people in different ways. Everyone reacts differently. You might find it hard to accept a diagnosis of epilepsy. And it might take time to adjust to the changes in your life. When you have epilepsy, there might be several things that could contribute to you becoming depressed. Here are some examples. Continuing to have seizures Being afraid of having seizures Having side-effects from epilepsy medicines Having problems at work Having social or relationship or family problems Seizures and depression For some people, depression is linked to seizures. It can be experienced before, during, or after a seizure. Depression might happen hours before a seizure. Some people with epilepsy also experience a sudden worsening of their mood as the first part of their seizures (during their aura). This is more common in people with temporal lobe epilepsies. When depression happens after a seizure, it might not start for several hours. It could be delayed for up to seven days afterwards. People whose seizures are not controlled by epilepsy medicines have a higher risk of experiencing depression. Evidence suggests that depression can also make epilepsy worse. Being depressed could cause your sleep patterns to be disturbed. Or it may cause you to miss doses of your epilepsy medicines. Both of these things can be a trigger for seizures for some people. Epilepsy medicines and depression Most people with epilepsy do not experience any problems with their mood or emotions as side-effects of taking epilepsy medicines. However, for some people, their epilepsy medicines can affect their mood, and cause depression as a side-effect. People who have a personal or family history of depression are more at risk of this.

4 These are the epilepsy medicines said to carry the highest risk of causing depression. Vigabatrin Phenobarbital (phenobarbitone) Levetiracetam Zonisamide Topiramate Tiagabine Clonazepam Depressive episodes may be dose-related with some epilepsy medicines but not others. This means that the higher the dose you are taking, the more likely you are to become depressed. People who take more than one type of epilepsy medicine may have an increased risk of experiencing depression. If you feel that your epilepsy medicines are affecting your mood or emotions, it is advisable to talk to your family doctor or epilepsy specialist. It is important that you do not just stop taking your epilepsy medicines. If you suddenly stop taking them, this could cause you to have more frequent and severe seizures. Treatments for depression Many people with mild depression will get better without treatment. However, some people need treatment for their depression. The treatment you are offered for your depression will depend on how seriously it is affecting you. Some people will need a combination of treatments, including psychological treatments or anti-depressant medicines. Psychological treatment is a general term. It is used to describe when you meet with someone trained to talk about feelings. It helps you to look at your thoughts and feelings and how these affect your life and your wellbeing. If you are very unwell, and treatments don t help, or you are considered to be at risk of suicide, you could be admitted to hospital. You might see different people for the treatment of your depression and the treatment of your epilepsy. If this is the case, there should be a care plan to say who is responsible for different parts of your treatment and care. Your treatment and care should take into account what you want and need. Below are some guidelines for the treatment of depression that are recommended by the National Institute for Health and Care Excellence (NICE). Active monitoring

5 This is for mild depression. It means monitoring you while waiting to see if your depression goes away without treatment, which mild depression often does. Cognitive behavioural therapy(cbt) This is a type of psychological treatment. It has been proven to help treat depression in people with and without epilepsy. The aim of CBT is to help look at and change any negative thoughts and feelings. It helps you to cope with life s challenges better. CBT cannot remove your problems, but can help you manage them in a more positive way. CBT has been shown to be very helpful at tackling problems such as depression. It is usually carried out with a therapist on a one-to-one basis, but can also take the form of: group therapy with others who wish to tackle a similar problem, or a self-help book where you carry out exercises from the book, or a computer program known as computerised CBT (CCBT). Counselling This is another form of psychological treatment. It gives you the chance to talk through everyday issues that may be causing your depression, and looks at ways to resolve them. Mindfulness-based cognitive therapy (MBCT) This involves taking time to see what is happening around you, rather than going over your problems again and again. It is a way that people can change the way they think and feel about their experiences, and involves techniques like yoga and meditation. Mindfulness-based cognitive therapy is often done in groups. Exercise Regular exercise can be very effective in lifting your mood and increasing your energy levels. Exercise is something you can do for yourself but it is also recommended as a treatment for depression in the NICE guidelines. Some family doctors will give you a prescription for exercise, referring you to a programme at a local gym or health centre. Complementary treatments Some people use complementary treatments to try and improve their quality of life. Treatments include acupuncture, massage, herbal treatments, homeopathy, and aromatherapy. Some people with depression find these treatments helpful.

6 It s really important to speak with your doctor or epilepsy nurse before you try any complementary or alternative treatments. This is because some treatments can trigger seizures for some people with epilepsy. And these treatments may interact with your epilepsy medicines. An example of this is St John s Wort, a herbal treatment that you can buy without a prescription at a pharmacy. It is used to treat people with mild depression. Information from the British National Formulary says that people who take epilepsy medicines should not take St John s Wort. This is because it can affect the way epilepsy medicines work. This could mean you have more seizures than usual. Anti-depressant medicines for depression Anti-depressant medicines can be useful for some people who find it difficult to deal with the normal tasks of day-to-day life. They work by increasing the activity and levels of certain chemicals in the brain that help to lift a person s mood. Anti-depressants do not change your life directly but can help you overcome depression. They may give you more energy to tackle the difficulties you are facing and make it easier to take an active approach to solving any problems you face. The choice of anti-depressant medicine will depend on a number of things including: what epilepsy medicines you are taking and any possible interactions the effect they may have on your seizures. Some anti-depressants have been linked to an increase in seizure frequency. This has led to an under treatment of depression in people with epilepsy. However, there is research to suggest that most anti-depressant medicines are safe for people with epilepsy, when used at the right doses. These types of anti-depressants are known as serotonin re-uptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Research also suggests that these types of anti-depressant medicines work well in people with epilepsy, regardless of how often they have seizures. Psychological treatments and anti-depressant medicines can work well together, but psychological treatments alone can also work well for some people. This is particularly true for people with epilepsy who feel that they are already taking enough medicines, and don t want to take any more. Managing epilepsy and depression You might think that it s normal to feel depressed because you have epilepsy. Many studies show that if you have epilepsy you are more likely to develop depression than someone who doesn t have epilepsy. However it doesn t

7 mean that it s your fault that you are depressed or that you just have to live with it. It s important to get good treatment and care for your epilepsy. But it is also important that we all look after our emotional health and wellbeing too. Our bodies and mind are connected. Being diagnosed and living with epilepsy might affect how we feel emotionally. How we feel emotionally can affect the way we cope with epilepsy as well as how we cope with our day-to-day lives. There are things that you can do. Here are some things that might help. Seek help We all need help sometimes. If the negative feelings you are having don t go away, or they are affecting your everyday life, you might need some support. This could be from a family member, a friend, your family doctor, epilepsy specialist or epilepsy nurse. If you are feeling that life is too much, it is important to get help straight away. Either see your family doctor or call NHS Direct on (This service is gradually being replaced by NHS 111 service.) You can also contact the Samaritans. They offer 24 hour confidential emotional support for people who are experiencing feelings of distress or despair, including those which may lead to suicide. The Samaritans Tel: jo@samaritans.org [1] Website: samaritans.org.uk Learn about your condition Try to learn about your epilepsy. You could speak to your family doctor, epilepsy specialist or epilepsy nurse about any questions you have. You could also contact Epilepsy Action s freephone helpline number and speak to an Advice and Information Officer. You may want to overcome any feelings of isolation by going out and talking to other people about your epilepsy and your feelings. Epilepsy Action has an extensive network of branches, coffee and chat groups and volunteers throughout the UK. They provide local support to people with epilepsy, their family and friends and carers. For more information about any of these services, contact the Epilepsy Helpline or visit epilepsy.org.uk/about/local-services [2]

8 You may be interested in our online community, forum4e [3]. This is for people with epilepsy and carers of people with epilepsy. Hopefully, you will be able to talk to others in a similar situation. Be actively involved in your treatment and care The National Health Service (NHS) run self-management programmes. They aim to help increase your confidence, improve your quality of life and show you how to manage your condition better. For more information about self-management programmes visit the NHS choices website: nhs.uk [4] Manage your condition as effectively as possible Research shows that people with long-term conditions who take more control of their health have a much better quality of life. Try to focus on the things you can control. Take your epilepsy medicines on time. Have a good sleep routine. Take regular exercise. Eat and drink sensibly. Take time out regularly to relax or do something you enjoy. Epilepsy action has more information about epilepsy and stress [5]. Organisations for information and support Counselling Directory Has details of qualified counsellers and psychotherapists. Website: counselling-directory.org.uk [6] Depression Alliance A charity for people affected by depression. Runs self-help groups. Tel: (UK only) information@depressionalliance.org [7] Website: depressionalliance.org [8] Mind Helps people to take control over their mental health. They offer advice and support. Tel: (UK only) info@mind.org.uk [9] Website: mind.org.uk [10] NHS choices The country's biggest health website and gives all the information you need to

9 make choices about your health. Website: nhs.uk [4] Rethink Mental Illness Provide expert, accredited advice and information to everyone affected by mental health problems. Tel: (UK only) [11] Website: rethink.org [12] Saneline A national out-of-hours telephone helpline, offering emotional support and information for people affected by mental health problems. Tel: (UK only) san @sane.org.uk [13] Website: sane.org.uk [14] If you would like to see this information with references, visit the Advice and Information references [15]section of our website. See Depression and epilepsy. Code: F Last Updated: August 2013 Review Due Date: August 2015 Our thanks Epilepsy Action would like to thank Markus Reuber, Professor of Clinical Neurology at the University of Sheffield and Honorary Consultant Neurologist at the Sheffield Teaching Hospitals NHS Foundation Trust, for his contribution to this information. Dr Reuber has declared no conflict of interest. This information has been produced under the terms of The Information Standard [16]. Source: Links: [1] mailto:jo@samaritans.org [2] [3] [4] [5] [6] [7] mailto:information@depressionalliance.org [8]

10 [9] [10] [11] [12] [13] [14] [15] [16] About this publication This information is written with input from people with epilepsy and professionals. Epilepsy Action makes every effort to ensure the accuracy of information but cannot be held liable for any actions taken. If you want to know our sources, or give us feedback, contact us. Your support We hope you ve found the information helpful. As a charity, we rely on donations. If you would like to make a donation visit You can become a member of Epilepsy Action from as little as 1 a month at or call Epilepsy Helpline Freephone , text , helpline@epilepsy.org.uk, Contact details Epilepsy Action, Gate Way Drive, Yeadon, Leeds LS19 7XY, UK, +44 (0) A registered charity (No ) and company limited by guarantee (No ) in England. Copyright Epilepsy Action