Depression and Epilepsy.

[Annacrusis]

In May of last year, my last week of college, I tried to commit suicide. As I've said before, it's not that I wanted to die, I just want to sleep for a while. Lots of things were happening at once and I just didn't want to exist for a month or two.

Now how does this relate back to epilepsy, well my neuro said that just having epilepsy alone gives a person a 30% chance of some sort of mood disorder. Being female (like I am), adds 20%. I talked to him for a good two hours, told him everything about my life and such. In the end he diagnosed me with major depression. I wasn't surprised. I had already noticed the cycles and symptoms after my episode in May. But something did surprise me.

For my whole life, I've been taking Depakote ER, which not only treats epilepsy, but is also a mood balancer. So my whole life I was treating the depression I never knew I had. Until I switched to Keppra. Keppra has it's own problems, but it doesn't do anything for moods. So when I switched to Keppra, the depression came out in full force.

May was my lowest point in my life, and I will never go back to that, but I still suffer heavily from the depression, and I'd like to ask the forum a few questions.

1. What are the connections between Depression and Epilepsy?
2. How many people on the forum have both Depression and Epilepsy (not running in family)?
3. Should I get my neuro to formally diagnose me? (my parents don't really believe in depression)
4. Should I switch back to Depakote, even after my neuro has told me to get off of meds?
5. Do you have any advice?

I'm not afraid to give any more details of my life if anyone needs it.

 

[Fedup]

Annacrusis

You are having a hard time of it but never give up. You asked what is the connection between Depression and epilepsy, well as far as I know and my own experience depression goes hand in hand with epilepsy. I have found that for me depression is a side effect of some if not all the medication but I get depressed because of the seizures as well so to answer your second question YES I have both depression and epilepsy and depression does not run in my family.

Your parents may not believe in depression but it is real for you and yes talk to your neurologist about this. You do not change anything without talking to your neurologist or doctor, everybody is different so you need a doctor to answer this question.

 

[Mr.21T]

I took Depakote ER for the first 5 years after my diagnosis and I'm in nearly in tears reading your post, because I've been there.

A doctor (or Nakamova) will best answer most of your questions, but I can tell you what I've read and what my doctors have told me.

1. For me personally, my epilepsy stems from the temporal lobe. Paitents with TLE tend to have short tempers, paranoia, and fixation on things that bother them, which often exacerbates depressive symptoms. But my neurologist and neuropsychologists say that recovery from seizures and side effects from medication are big triggers for depression in paitents with epilepsy. Keppra is a drug known for causing emotional imbalance in some paitents.

We also deal with the struggle of not being fully in control of our lives and circumstances, as well as meeting family and society's expectation of where we should be in life. Depression is often a stage of grieving that comes when we fully accept what's going on with us.

2. *raises hand*.

3. I went to a neuropsychologist for a diagnosis. I went broke paying the three sessions necessary to receive a diagnosis, but it was somewhat worth it. The neuropsych sent my results to my neurologist and he referred me to a traditional psychiatrist. I never went, but that would be the way to deal with the depression directly (in the medical sense, at least.)

4. Only a doctor can tell you that...but the hardest thing about my personal struggle has been the period of new medication. I recently switched from Depakote to Tegretol, another mood regulating AE med, and it took a few months to feel normal. Remember the most important thing is seizure control. I would say talk to your doctor about everything you're feeling, listen to their judgement, and make your own decision. If you aren't taking antidepressants now, your neuro may be trying to spare you another medication.

5. If you're anything like I am, your self-destructive tendencies are based out of a real, and strong dissatisfaction with yourself and your circumstances.

I'm a guy so I deal with that by hitting stuff, lol. I bought a $40 heavy bag, some gloves, and handwraps and I hit the heck out the bag for an hour straight every time I feel that self-destructive anxiety rising (about 4 times a week). When money was tight and I was stranded at home, I'd wrap blankets around my biggest pillows and do the same thing until I was too tired to do anything hurtful.

I also swim 5 days a week and exercise at about the same pace. I've had a destructive nature for a while, and overexertion helps quell my Hulkamania, lol.

When I was first diagnosed at 15, I became an avid writer. My feelings, life around me, current events were all scribbled into various notebooks I kept on me at all times. I work as a freelance journalist and do that to this day. Getting my feelings down on paper not only helped me control my emotions, but it also gave me perspective. Some days I'd write horrible things when I felt hopeless, and then I would look back on my words and be thankful I see more hope in life than I did then.


I hope that you'll stick around, look back on your post one day in the future and see how far you've come. I do have a few questions if you don't mind. How long have you had E? And what's the biggest thing you want to achieve/attain by May 2016?

 

[Belinda5000]

In May of last year, my last week of college, I tried to commit suicide. As I've said before, it's not that I wanted to die, I just want to sleep for a while. Lots of things were happening at once and I just didn't want to exist for a month or two.

Now how does this relate back to epilepsy, well my neuro said that just having epilepsy alone gives a person a 30% chance of some sort of mood disorder. Being female (like I am), adds 20%. I talked to him for a good two hours, told him everything about my life and such. In the end he diagnosed me with major depression. I wasn't surprised. I had already noticed the cycles and symptoms after my episode in May. But something did surprise me.

For my whole life, I've been taking Depakote ER, which not only treats epilepsy, but is also a mood balancer. So my whole life I was treating the depression I never knew I had. Until I switched to Keppra. Keppra has it's own problems, but it doesn't do anything for moods. So when I switched to Keppra, the depression came out in full force.

May was my lowest point in my life, and I will never go back to that, but I still suffer heavily from the depression, and I'd like to ask the forum a few questions.

1. What are the connections between Depression and Epilepsy?
2. How many people on the forum have both Depression and Epilepsy (not running in family)?
3. Should I get my neuro to formally diagnose me? (my parents don't really believe in depression)
4. Should I switch back to Depakote, even after my neuro has told me to get off of meds?
5. Do you have any advice?

I'm not afraid to give any more details of my life if anyone needs it.

Epilepsy drugs are CNS depressants which doesn't help because I've tried to commit suicide 4 times since I was 14 years old. When you look on the side effects of AEDs most of they have depression as a side effect.

It's not just epilepsy it's the drugs we take that put us in such a stupor.
I was feeling know one cared about in my family because of my epilepsy and I was just a burden was all.
My neuro has always told me to call him when I feel like I'm starting to get suicidal again, and he will drop everything talk with right away and he'll see me right away also. My neuro is a peach he's great.
You need someone you can cummicate with and who will listen to you.

 

[Annacrusis]

I do have a few questions if you don't mind. How long have you had E? And what's the biggest thing you want to achieve/attain by May 2016?

My first seizure was when I was five, and have been on prescriptions from then on. I'm not sure if it's temporal lobe or not...it might be.

What I want to do is be a police officer, seeing as how I got my BS in Criminal Justice, but that seems to be impossible now. I might have been able to even with the epilepsy, I've had one seizure in two years, but now with the possibility of depression, I fear it's not going to happen. Even my doctor was surprised that nobody at the college had stopped me.

 

[Bidwell]

Annacrusis, I think a rethink is in order about whether you can be a police officer or serve in another capacity in the criminal justice system if you have depressive tendencies. I would lay money on it that umpteen million policemen are depressed and doing their jobs well enough. Antidepressants are selling like hotcakes, only a little less than drugs for attention deficit disorder, which are the top sellers. Also remember something else. Being diagnosed with a major depression is not saying anything about you forever after. It is saying that the day you were diagnosed you did have a major depression. Depression IS physiological. I am so sorry you have been up against it and as FedUp says, NEVER give up! I hope we keep hearing from you.

 

[Annacrusis]

I'm not sure I understand your post. Do you mean I should re-think my career choice, or that I should keep trying to achieve it? I don't really have suicidal tendencies anymore. I feel like back in May, it was just a perfect storm or changing to Keppra and a whole bunch of other stressors. If anything, I feel like my depression comes in cycles. I can function with all the symptoms, but I'd just like to be normal. I think that if I went back on the Depakote, my epilepsy and depression would be perfect. I got through my whole life with not even knowing I had depression and only having VERY MILD symptoms of it, to changing meds and falling to pieces.

 

[Bidwell]

Annacrusis, I was not clear. What I mean is that if you want to be a policeman, go for it! There are so many different paths for a person trained in law enforcement. Sounds like a really good career path. Don't let the depression piece of your situation stop you. Then in my post I got carried away with the amazing number of pills sold that seem to indicate that lots and lots of us are depressed, so don't let it stand in your way. I see how strange your situation is, having taken the Depakote and not had depression, and then this awfulness. I don't have anything to say about it except to keep going. Life is just so strange! And a lot of the time it does not make any sense as far as I can tell.

 

[Cint]

If anything, I feel like my depression comes in cycles. I can function with all the symptoms, but I'd just like to be normal. I think that if I went back on the Depakote, my epilepsy and depression would be perfect. I got through my whole life with not even knowing I had depression and only having VERY MILD symptoms of it, to changing meds and falling to pieces.

Falling to pieces doesn't sound MILD, IMO. Having mood swings is a very serious condition that needs to be dealt with, along with seizures.
I have suffered with major depression/mood swings and E for years. At one time I was seeing a neuropsychiatrist who specialized in the depression that goes along with epilepsy. Usually it is worse for those with Temporal Lobe Epilepsy. And it can be cyclical. Plus Depakote is a drug that is also used for bi-polar disorder, as are a few other AEDs. I take Topomax for seizures, and it is also prescribed for moods. I take Zoloft for moods, too. I had attempted suicide and thought about it several times, so I needed the anti-depressant + therapy.

Here is more on the subject:

http://www.epilepsy.com/learn/impact/moods-and-behavior/mood-and-behavior-advanced/depression

Interictal depression , occurs in 25% to 55% of people with epilepsy (1,2). Further, the suicide rate of persons with epilepsy is more than five times that of controls (1,3). Interictal depression has biological mechanisms (family history of depression, structural lesions, AEDs) and psychosocial-reactive mechanisms (1,2,4–6).
The burden of suffering depression causes is enormous. In one study of patients with medically refractory epilepsy, depression was by far the most significant predictor of poor quality of life, overriding seizure frequency and severity (7). Depression was common (54%), underdiagnosed, and largely untreated in this population (only 17% were taking antidepressants) (7).
Treating Depression
SSRIs and related drugs (e.g., venlafaxine and nefazodone) are the first line of therapy for most patients with depression. However, the efficacy and safety of any specific SSRI has not been proved (8). Drug interactions are more likely with fluoxetine, fluvoxamine, and paroxetine than with escitalopram, citalopram, or sertraline. Fluoxetine’s long half-life (>24 hours) is an advantage during tapering off, since it reduces the frequency of withdrawal symptoms. However, a long half-life is a disadvantage if the patient cannot tolerate the drug or experiences an adverse drug interaction.

 

[Elsie]

Your feelings are very real and you need to pay attention to them.

I've had some depression most of my adult life (plus the epilepsy t/c diagnosis). Last year I got so angry I finally went to dr. and asked for something...which we tried and which I couldn't tolerate. Looking back at what had happened in my life prior to that, I've come to the conclusion a nice calm stress-free vacation would have been better for me!

I do seem to have more anxiety than I used to. But, I do have a lot to worry about in my life, too. Some people are just able to let life "roll off their backs" easier than I am able.

Recent uptick in my trileptal (supposed to be a mood elevator - is that the word, smooth out moods) once I got used to it has helped me feel happier and more positive.

I don't know if mine stems from something associated with having epilepsy, or not. I know as a kid I had a tendency to be melancholy. And from an early age I had SAD (seasonal affective disorder) and noticed I was "down" in the cloudy winter months. And this was years before any diagnosis of E.

Annacrusis, I hope you will go easy with yourself and try to remember often black moods pass and life feels better later. Make sure your drs. are aware of this because our meds can contribute.

 

[Nakamova]

Hey Annacrusis, great advice from everyone above.

Depression and epilepsy definitely go hand-in-hand, but it can be a complicated relationship at times. Both disorders can stem from similar or co-occurring genetic or neurochemical issues in the brain. And both can be exacerbated by external factors (such as stigma or medication) as well as by seizure-related and/or med-related fatigue.

You mentioned that your neuro wants you to go off meds -- is that because you have been seizure-free for two or more years while on meds? (Apologies if you've already addressed this). Either way, I hope you let your neuro know about the mood issues -- that's one of the first things my neuro asked about, since it's an important factor when choosing medications. Definitely ask for a referral from your neuro or GP to a therapist. Mr.21T mentioned seeing a neuropsychiatrist, a good choice if it's one available to you.

(my parents don't really believe in depression)

Lack of support at home can make everything harder. All the more reason to get your doctors on your side, advocating for treatment and therapy.

If you haven't read them already, you might find these CWE threads of interest. The first thread below is a poll asking about specific kinds of depression that folks may have experienced.
http://www.coping-with-epilepsy.com/forums/f27/do-you-have-depression-your-epilepsy-if-yes-one-9783/
http://www.coping-with-epilepsy.com/forums/f23/depression-epilepsy-13773/
http://www.coping-with-epilepsy.com/forums/f20/epilepsy-depression-24582/
http://www.coping-with-epilepsy.com/forums/f23/epilepsy-anxiety-depression-7928/
http://www.coping-with-epilepsy.com/forums/f23/im-depressed-2231/
http://www.coping-with-epilepsy.com/forums/f36/drugs-depression-22365/
http://www.coping-with-epilepsy.com/forums/f23/seizures-major-depression-24724/
http://www.coping-with-epilepsy.com/forums/f20/tegretol-depression-15095/

 

[Joseph]

Hi Annacrusis,
I'm not the right person to answer 1, 3 or 4 nor do I have any proper advice. I too have depressions with suicidal tendencies in cycles (and epilepsy). I just wanted to let you know that you're not alone!

 

[Cint]

I just wanted to let you know that you're not alone!

No, she is NOT ALONE!

 

[Matthew74]

I don't technically qualify to answer your question, since both my parents seemed to have some issues with depression. However, I have had at least 2 major depressive episodes (probably a lot more, but those were the worst.) I attempted suicide my junior year of high school, sort of. I changed my mind and went to the hospital. I have been diagnosed with anxiety NOS (Keppra probably had something to do with that.), but I probably have something more like dysthymia. I read somewhwere (textbook or something) that some doctors think there is an epilepsy specific depression syndrome. Apparently a lot of people with epilepsy score differently on the various depression inventories.

Basically I never feel like doing anything. It's like walking through jello your whole life. I have to force myself to do things I enjoy. It's fine if I can get started.

I have wondered about mood stabilizers and depression. This is just a conjecture, but it seems to me that if you tend to get depressed anyhow, a mood stabilizer would make you depressed all the time - unless you know by trial that it actually makes you feel better, as you said about Depacote. I think it's interesting that psychiatrists use AEDs a lot, but the psychological side effects don't seem to be taken very seriously by neurologists.

 

[Bidwell]

You inspire me to post, Matt,even though I am seeing stars since I am so pooped. But I do know about when life is like walking through jello. And that is interesting about how people with epilepsy score differently on some depression scales. I believe it. I have more to say when I can say it -- maybe tomorrow!

 

[George__]

I think the two go hand in hand.

Epilepsy causes you go to into depression -> the depression worsens your epilepsy -> you fall further into depression

 

[Mr.21T]

I can also attest to the "walking through jello" feeling of life with e.

It seems like recently my emotions about the day range from "dangerously self-destructive" to "numb".

I have wondered about mood stabilizers and depression. This is just a conjecture, but it seems to me that if you tend to get depressed anyhow, a mood stabilizer would make you depressed all the time - unless you know by trial that it actually makes you feel better, as you said about Depacote. I think it's interesting that psychiatrists use AEDs a lot, but the psychological side effects don't seem to be taken very seriously by neurologists.

It's because all they care about is stopping seizures. If they do that, they feel like successes even though the medicine makes the patient feel like they're not alive.

The only time I felt alive was when I quit my AED drugs cold turkey. I was seizure free for nearly two years but crashed hard and now am as depressed as I've been for most of my life.

You're not alone.

 

[Cint]

I read somewhwere (textbook or something) that some doctors think there is an epilepsy specific depression syndrome. Apparently a lot of people with epilepsy score differently on the various depression inventories.

That is based on where the seizures are coming from in the brain. As in determining what type of seizures one has by locating where they are starting, they can determine the severity of depression based on the same info.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1783479/

Impact of the Bidirectional Relationship Between Depression and Epilepsy

That epilepsy is a risk factor for depression is no longer questioned. Similarly, data from three population-based control studies indicate that people with a history of depression have a 4- to 7-fold higher risk of developing epilepsy (17–19); in one of these studies, a prior history of suicidality was associated with a 5-fold increased risk of developing epilepsy (19). The bidirectional relationship does not imply causality but rather suggests that common pathogenic mechanisms are operant in both conditions, with the presence of one disorder potentially facilitating the development of the other.

A review of this topic previously published in Epilepsy Currents (20) listed the following pathogenic mechanisms shared by depression and epilepsy:

-Abnormal CNS activity of several neurotransmitters, particularly serotonin (5-hydroxytryptamine, 5-HT), norepinephrine, dopamine, GABA, and glutamate.

-Structural changes, presenting as atrophy of temporal- and frontal-lobe structures (identified by high-resolution MRI and volumetric measurements), in the amygdala, hippocampus, entorhinal cortex, temporal lateral neocortex, as well as in the prefrontal, orbito-frontal, and mesial-frontal cortex, and to a lesser degree, of the thalamic nuclei and basal ganglia.

-Functional abnormalities (identified by positron emission tomography [PET] and single-photon emission computed tomography [SPECT]) in temporal and frontal lobes, consisting of decreased 5-HT1A binding in the mesial structures, raphe nuclei, thalamus, and cingulate gyrus.

-Abnormal function of the hypothalamic–pituitary–adrenal axis.

I have wondered about mood stabilizers and depression. This is just a conjecture, but it seems to me that if you tend to get depressed anyhow, a mood stabilizer would make you depressed all the time - unless you know by trial that it actually makes you feel better, as you said about Depacote. I think it's interesting that psychiatrists use AEDs a lot, but the psychological side effects don't seem to be taken very seriously by neurologists.

How could a mood stabilizer make you depressed all the time? If one is not stabilized, then time to move on to something else. There is a fine line between neurology/psychiatry. That is why I was seeing a neuropsychiatrist at one time. I was very, very depressed and only a dr. of this caliber could find the right combo of meds to treat me for the depression. IMO, people with epilepsy who also suffer from mood disorder, should be able to see a neuropsychiatrist. But unfortunately there are not enough to serve everyone and they are TOO expensive, unless one's insurance will cover that.

 

[Steven]

Hi I am from Boston. I have been treated for complex partial seizures. It has been written that if you have epilepsy , on the left side, you will have depression. I have been told that if you have epilepsy you must be depressed. There is no way around this. What are your symptoms: Do you feel strange to yourself, out of body, anxiety attacks pick at clothing, feel like a ghost or feel numb. Things seem to far away? Perception problems?

 

[Bidwell]

Whoever wrote that certainly was one to spread good news. Who was it?