How to Live Happily with Epilepsy

Many people with epilepsy complain of some distressing symptoms like being nervous, anxious, irritable, unhappy, sad etc. This is not uncommon, and are due to conditions like anxiety and depression. Depression and anxiety are known to co-exist with epilepsy. In the general population, depression and anxiety range from 5-15%, but in epilepsy it can go as high as 30-50%, which shows that it is quite common. This is thought to be because epilepsy is a disease of the neuronal networks in the brain, where there is abnormal excitation and alterations in the chemicals, which is similar to what happens in anxiety and depression. Hence it is very important to treat both anxiety and depression in epilepsy, as it will make the quality of life better as well as help in controlling seizures. 

What causes anxiety and depression in epilepsy?

1.  As mentioned before, the general risk of these diseases is higher in patients with epilepsy than the general population, and this is due to the nature of the disease itself and the imbalance of brain networks.
2. It could also be due to the side effects of some medications. A common example is Levetiracetam or “Keppra”. This drug is known to have anxiety and depression as psychiatric side effects; therefore, it can cause or worsen symptoms. Hence it is a good idea to consult with your doctor before taking Keppra, if you know you have anxiety or depression.
3. Another reason is that epilepsy is a chronic condition, and that itself is associated with anxiety and depression. Having a chronic disease can be a burden on anyone’s mentality, and this can predispose especially to depression. The stigma with epilepsy and the disability all can factor in as well.

So how do we treat?

Fortunately, treatment is straightforward and easily available. 

If you are on any drugs that could be causing depression or anxiety like Levetiracetam (Keppra) or Perampanel (Fycompa), stopping those drugs and switching to a different drug is a good option. Good drugs to switch to are Lamotrigine (Lamictal) and Valproic acid (Depakote), which are known to fight depression and cure them as well.

Psychotherapy is also a useful option. Here, you sit with a psychologist or a therapist, and you are helped to process the information in your brain. This will help to come to terms with your symptoms and understand why you may be anxious or unhappy, and can go a long way to overcoming these unpleasant thoughts. 

Another option is beginning treatment with antidepressant medication, like SSRI’s or SNRI’s. This stands for “Selective Serotonin Re-uptake Inhibitors” and Selective Serotonin and Nor-adrenaline Re-uptake Inhibitors”. Depression is an illness where certain chemicals like serotonin, noradrenaline and dopamine are reduced in the brain, leading to symptoms like sadness and worthlessness.  These antidepressant medications help by replenishing the deranged biochemistry in the brain and restoring the previous balance, thereby relieving the symptoms. These drugs are actually safe in epilepsy, even though the packaging may say beware of seizures. Do not be worried about this, as seizures occur with antidepressants only in toxicity, which means that the level has increased beyond the recommended amount in the body. Therefore, as long as toxicity is not reached, anti-depressant medication will not affect or cause seizures. Only antidepressant to worry about is Bupropion (Wellbutrin) which can lower the seizure threshold and better to be avoided in epilepsy. 

So in conclusion, identifying and treating anxiety and depression is extremely important in not only the treatment of epilepsy, but also to improve the quality of life in people with epilepsy. If you are a patient with epilepsy who is feeling sad, anxious or depressed, don’t hesitate to talk to your doctor, as there are many things which could be done to help you feel better and live a happy life.