Depression in epilepsy: recognition and treatment

1. Depression in epilepsy: recognition and treatment Lorna Myers, Ph. D. Director of Clinical Neuropsychology Northeast Regional Epilepsy Group

2. Epilepsy and psychiatric disorders 50-60% of patients with chronic epilepsy have depressive or anxiety disorders • No known association between depression and seizure type, frequency, duration, or age of seizure onset • Left temporal or frontal lobe epilepsy exhibits a greater association to depression

3. Epilepsy and psychiatric disorders • Suicide: 5-10 times higher than in the general population and 25 times higher in complex partial seizures (temporal lobe) • Depression in epilepsy impacts quality of life more than other medical issues • Depression can worsen seizure control and treatment success

4. Why so much depression in epilepsy? • Psychological reaction to epilepsy (sadness, hopelessness, change in life) • Social factors (lost driver’s license, job, loss of control) • Secondary medication effects (eg. polypharmacy, high doses, sudden discontinuation)

5. Why depression in epilepsy The effect of electrical discharges in or near the brain structures and systems that control emotion Severity of seizures Medically refractory seizures

6. Depression in children Depression rates are higher in children with epilepsy-even in more benign epilepsies (i.e. Absences, benign rolandic) Sometimes there are important discrepancies between parental and child ratings Bullying Academic difficulties

7. Depression in women Considerably higher rates of depression than in men Specific differences in hormonal activity Internalizing tendencies

8. Depression in men with epilepsy Side effects of medications can sometimes affect mood Sexual dysfunction (erectile dysfunction, lower libido) Impact on “male identity” bc of driving restrictions, work

9. Depression in different ethnicities Hispanics with epilepsy have a higher rate of depression than American born patients with epilepsy Other ethnic groups may be similarly inclined: future studies needed

10. Facts about Depression Depression can affect people of all ages Depression can affect all SES Depression can affect all races and ethnicities (although it may be expressed differently) Genders: the ratio of women to men is 2:1

11. Important Facts about depresison • Over 80% of those treated for depression improve. • Nearly half of all people who are depressed do not receive the appropriate treatment because they are not correctly diagnosed • Severe depression is associated to decline in mental function as time passes

12. What should I be looking for? • Depressed mood almost all day long • Reduced interest in activities or people • Weight change (5% in one month) • Insomnia/hypersomnia • Motor retardation or activation • Fatigue • Guilt or low self worth • Concentration problems • Suicidal thoughts or acts

13. What should I be looking for? Unreasonable feelings of guilt Feeling “less than” compared to others Irritability Feelings of hopelessness Decrease in sexual desire

14. Treatments for clinical range depression/anxiety • Prescription of psychiatric meds with the epileptologist’s blessing • Talk-therapy with a psychologist/social worker • Close monitoring by the epileptologist especially if there is a connection between epilepsy and mood

15. Treatments for clinical range depression/anxiety • Family therapy and psychoeducation • Vagal Nerve Stimulator (FDA approved for mood disorders)

16. Psychotherapy • An objective listener • Problem solving • Learn: • that what we think affects our feelings • to detect negative thoughts and defuse them • Positive psychology exercises • Mindfulness approaches • Relaxation exercises

17. Alternative treatments • Must consult with doctor prior to taking any of the following herbs/supplements: St. John’s Wort, Echinacea, Valerian-they have the potential to interact with AEDs • Careful with some hands on techniques (thai massage, cranio sacral massage, chiropraxis). Consult your doctor.

18. What can I do to help myself? • Exercise: yoga, pilates, non-intense physical exercise, weight lifting under supervision). 30’ per day improves mood • Diet: consult with nutritionist: proper calorie intake, fruits, vegies, whole wheat, low fat meats • Treatment for sleep disorder • Attend epilepsy support group and activities

19. Achieving Optimism • Gratitude (Which three people in your life have most helped you. Write them a letter, call them, write about them)

20. How do I work on my stress levels? • Breathing exercises (when nervous, we breathe fast, shallow. When calm, we breathe slow and deep)

21. Thank you! Be well

22. References and resources • Psychiatric Issues in Epilepsy, Edited by Ettinger, A & Kanner A (2001). Lippincott, Williams & Wilkins • http://www.nimh.nih.gov/publicat/spdep5122.cfm • 1-866-615-NIMH (6464) • Autogenic training (http://www.youtube.com/watch?v=t05S6O6YWgw) • Deep muscle relaxation (http://www.youtube.com/watch?v=KxQJIiu9tK0&feature=related )

23. References and resources Depression in elderly patients with epilepsy (2010) Olgica Laban-Grant, E. Fertig, J. Kanter, H. Husaini, L. Myers and M. Lancman