Mental Health and Epilepsy
Reviewed by: HU Medical Review Board | Last reviewed: November 2021 | Last updated: October 2021
Epilepsy is a brain disease. With epilepsy, groups of nerve cells in the brain (neurons) do not work properly and cause seizures. The types of seizures and how often they occur vary from person to person. One of epilepsy’s most common complications is issues with mental health.1
The mental health disorders found most often in people with epilepsy are:1
- Depression and thoughts of self-harm
- Interictal psychosis of epilepsy
- Postictal psychosis
Studies show depression is the most common mood disorder in epilepsy. A third to half of people with epilepsy have depression or other mood disorders. However, these numbers vary widely from study to study.2,3
What causes mood disorders in epilepsy?
Doctors know some reasons why mental health issues happen in people with epilepsy. One idea is that the same problems in the brain that cause epilepsy also cause mood disorders. This is supported by the fact that depression, bipolar disorder, or anxiety are often diagnosed before epilepsy.1
Another idea is that epilepsy causes quality-of-life issues that lead to depression or anxiety. It is common for people with epilepsy to lose their job or the ability to drive. This affects self-esteem and leads to isolation. Being unable to drive makes it harder to join friends or in-person support groups. Stigma and fear of seizures leads to avoiding exercise and social activities.1
Rates of depression are higher in people with uncontrolled epilepsy. Depression is also common before and after epilepsy surgery.1,4
Types of mental health disorders common in epilepsy
Several mental health disorders are common in people with epilepsy:1,5-9
- Depression – Depression is a common mood disorder with different levels of severity. It affects how you think, feel, and handle daily life. If symptoms last for a long time, it can make functioning hard. This is called major depressive disorder.
- Anxiety – Anxiety can be mild to severe. If worry and fear cause significant distress and impair daily life for a long time, it may be diagnosed as generalized anxiety disorder.
- Psychosis – This may be called interictal or postictal psychosis. Psychosis is a loss of contact with reality. The person may hear, see, or believe things that are not real. Some people have periods of psychosis between seizures or after a cluster of seizures. Some people have psychosis caused by schizophrenia or another psychiatric disease.
- Schizophrenia – This is a serious, disabling illness. It affects how a person thinks, feels, and behaves. People with schizophrenia are out of touch with reality and have disorganized behavior that does not allow them to participate in daily life.
Regular screenings are important because mental disorders are common with epilepsy. Guidelines say people with epilepsy should be screened often for depression, anxiety, and thoughts of self-harm. Screenings should happen upon diagnosis of epilepsy, at all routine follow-ups, and before and after any change of anti-seizure drugs.1
It is important to treat the mental health disorders linked to epilepsy. The time between seizures amounts to more than 99 percent of most people’s lives. That entire time is impacted by mental health.10
First, your doctor will look at what medicines you are taking. Changes in epilepsy drugs may play a role in making mental health worse, such as when:1
- Taking a new or much larger dose
- Withdrawing from a drug
- Mixing certain anti-seizure drugs and antidepressants
Many anti-seizure drugs may also improve anxiety and depression. Some people believe that all antidepressants increase the risk of seizures. However, many antidepressants are safe for people with epilepsy to take.1
A healthy lifestyle can help treat mood disorders and epilepsy. Suggestions include:1
- Take your anti-seizure drugs as prescribed
- Get counseling
- Avoid alcohol, smoking, and recreational drugs
- Get enough exercise and sleep
- Eat a well-balanced diet
Reducing stress may help people who find that stress triggers seizures. Choices include:
- Cognitive behavioral therapy
- Relaxation training
While mental health issues are often seen with epilepsy, some other complications are also common. These include:
- Unwanted drug side effects
- Learning and memory problems
- Injuries due to accidents
- Sleep issues
- Status epilepticus or seizure clusters
- Sudden unexpected death in epilepsy (SUDEP)