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While researchers agree that there is frequently a link between chronic illnesses and depression, for people with epilepsy the link appears to be especially significant. One reason may be that epilepsy and depression are affected by the same neurotransmitters (the brain's chemical messengers that tell the rest of the body what to do).
The National Epilepsy Foundation puts it this way: "Dealing with the physical aspects of a seizure disorder is only half the battle. A diagnosis of epilepsy can bring a wide range of feelings such as shock, disbelief, denial, anger, fear and worry."
Dr. John Barry of Stanford University's Neuropsychiatry Clinic has conducted considerable research on the topic of epilepsy and depression. "A link between epilepsy and mood disorders has been noted for more than 2,000 years," said Dr. Barry. Since depression adversely affects the lives of people with epilepsy Dr. Barry maintains that it is important for people in the medical profession to be alert to mood disorders and be prepared to offer appropriate treatment when it is indicated.
In a recent study 775 people with epilepsy were compared to 395 people with asthma and 395 healthy people. The results revealed that 26.5 percent of the epilepsy group had severe depressive symptoms compared to 20.2 percent of the asthma group and only 5.2 percent of the healthy group.
While there are physiological reasons why people with epilepsy are prone to depression, it can also be associated with a psychological response to having epilepsy. The challenges of living with epilepsy may lead to mood changes. People with epilepsy may feel frustrated by the unpredictability of seizures, the inability to drive to work, or being singled out by others as "different."
The most frequently prescribed antidepressants for both adults and children with epilepsy and depression are in the same class as Prozac. When antidepressants are prescribed it is important that the patient is carefully monitored for any side effects. Mood disorder medications may require dose adjustments and may take several weeks to become fully effective. Just like antiepileptic drugs, sometimes more than one antidepressant may need to be tried. Fortunately, most people with epilepsy respond very well to depression treatment.
Children with epilepsy may be particularly vulnerable to depression symptoms, according to Dr. Signita Pliopls, a pediatric neuropsychiatrist in the department of adolescent psychiatry at Children's Hospital in Chicago. "There's an enormous stigma associated with epilepsy, and they may feel ashamed of their condition. Because mental disorders have a profound stigma attached to them in the eyes of young people, many kids will tend to downplay their depressive symptoms, which only makes them worse." By the same token, parents are often hesitant to ask for a referral to a psychiatrist. The problem can be compounded by the fact that the family's health insurance may not pay or may pay very minimal amounts for mental illness care.
One thing is very clear. The more seizures a child has, the more likely they are to experience depression. About nine percent of teens who have occasional seizures experience depression but for those with frequent seizures, the number jumps to 20 percent. Parents and medical professionals need to be alert to the fact that depression and an increased risk of suicide are common among teens with epilepsy. "These children are vulnerable and at risk," according to Dr. Plioplys. "Depression can go unnoticed for months and years and the very high risk of suicide is a very dangerous condition."
Medicines prescribed for children with seizures may mask depression because one of the common side effects of some drugs is sleepiness. Fatigue and excessive sleeping are also hallmarks of depression. But in a child on seizure medication, it can be hard to determine what is a side effect of the medication and what is a sign of depression. Irritability, learning problems, regressive behavior and anger can all be signs of depression in children.
Adolescent psychiatrists warn that if your child is sullen, angry, withdrawn, spending less time with friends and school grades are declining, don't just write it off as a moody child and something that will pass. Talk to your child's neurologist about a psychiatric referral.
Epilepsy surgery is sometimes recommended for patients who cannot control their seizures with medication. A study of 360 patients found that rates of anxiety and depression disorders declined more than 50 percent after up to two years following epilepsy surgery. Patients who were seizure free found that their depression symptoms had significantly decreased or gone away completely.
For more information about epilepsy and depression, contact your local chapter of the Epilepsy Foundation or visit the web site at http://www.ef.org.
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