Sharing the vision epilepsy: life’s turning point Gavin Dimitri

26

THE EPILEPSY REPORT OCTOBER 2008

27

                          THE EPILEPSY REPORT OCTOBER 2008

Depression in epilepsy: 

prevalence, causes and 

treatments

J

aya Pinikahana PhD

Principal Social Researcher

Epilepsy Foundation of Victoria

Prevalence of depression

It has long been recognised that depression is common 

among people with epilepsy. Depression is the most common 

comorbid psychiatric condition in epilepsy and it is more 

common and severe in patients with epilepsy than it is in other 

chronic medical or neurological conditions  (Mendez et al, 

1993). The lifetime prevalence of depression in epilepsy has 

been estimated at between 6% and 30% in population based 

studies and up to 50% among patients in epilepsy treatment 

clinics (Kanner, 2003). There is no controversy among 

researchers that the prevalence of depression in people with 

epilepsy is higher than the general population. The estimates 

of depression in epilepsy range from 20% to 55% in patients 

with recurrent seizures and from 3% to 9% in patients with 

controlled epilepsy. Anxiety is even more common, occurring 

in 25% of people with epilepsy (Jacoby et al, 1996). 

Why it occurs?

Depression can occur just before a seizure or following a 

seizure or it can happen at any time after the diagnosis.  While 

some anticonvulsant drugs may cause depression, depression 

can also be a psychological reaction to having the condition 

and the social response to it. The link between depression 

and epilepsy has been noted since around 400 BC when 

Hippocrates expressed that ‘melancholics ordinarily become 

epileptics and epileptics melancholics’. The last ten years have 

witnessed an interest in depression in all chronic illnesses 

including epilepsy. Recent research shows that depression 

in epilepsy is not a result of a single causal factor but rather 

a combination of neurological, neurobiological, genetic and 

psychosocial factors. Forsgren & Nystrom (1990) found that a 

history of depression was 6 times higher among patients than 

among normal controls. When it comes to partial seizures, the 

history of depression was 17 times higher among patients than 

controls. In a study by Hersdorffer et al (2000), it was found 

that patients were 3.7 times more likely to have had a history 

of depression preceding their initial seizure. They also found 

that a depressive disorder occurred closer to the date of the 

first seizure in patients than in controls. However, the evidence 

does not constitute that depression causes epilepsy. The two-

way relationship between these two conditions could mean that 

some common pathogenic mechanisms are involved during the 

process. 

Some studies show that people with a history of depression 

have a higher risk of developing epilepsy (Forsgren & 

Nystrom, 1990). Most depressive disorders in young adults 

may be preceded by depression in adolescence (Pine at al, 

1998). Some studies show that high seizure frequency and 

drug resistance may lead to depressed mood in patients with 

epilepsy (Robertson, 1991; Schmitz et al, 1999). However, 

the role of epileptic seizures in the development of depressive 

symptomatology has not been fully explained (Kanner, 2003).  

Because the impact of biological variables is less clear, authors 

like Hermann et al (1990) suggest that psychosocial factors are 

better predictors of depression than biological factors. 

Psychosocial aspects

Although the literature remains inconclusive on gender 

differences, some studies report women to be at higher risk of 

developing depression than men. There is no clear evidence 

to suggest that age at onset or duration of epilepsy are factors 

associated with depression. Some studies show that depression 

is common among low income earners and young people and 

that depressed epilepsy patients have worse social and family 

functioning. An additional burden is the fact that they are 

more likely to be unemployed. The suicide rate of persons with 

epilepsy is more than five times that of controls (Mendez et al, 

1986; Mathews & Barbaras, 1981). The burden of depression 

in patients with epilepsy is considered to be a major area of 

attention in recent investigations. While some studies have 

shown a correlation between seizure frequency and quality 

of life (Baker et al, 1997; Leidy et al, 1999), Boylan and his 

associates (2004), found that depression was by far the most 

significant predictor of poor quality of life, overriding the 

significance of seizure frequency or severity of seizures.

 

Treatment of depression in epilepsy

Depression is largely under-diagnosed and under-treated 

in this population. Although depression in epilepsy has been 

fairly consistently established, very little research has been 

done on treatment of depression in epilepsy.  Boylan et al 

(2004) found that 54% of his adult sample of patients with 

P

eople with epilepsy often ask 

whether it is safe or not for them to 

drink alcohol.  While current research 

indicates that adults with epilepsy may 

have one or two alcoholic drinks a day 

without any worsening of their seizures 

or changes in the blood level of their 

antiepileptic medication, the effects of 

alcohol can vary between individuals 

and their specific medication.

The following information is a guide 

to help people with epilepsy assess the 

risks associated with the consumption of 

alcohol.

Interactions of AEDs and 

alcohol

 

AEDs and alcohol interact in 

specific ways. AEDs can make you 

more sensitive to the sedating effects 

of alcohol while alcohol can reduce 

the effectiveness of AEDs making 

seizures more likely. Alcohol can also 

exaggerate the side effects of some 

AEDs. This means it will take fewer 

drinks to "get drunk" than if you were 

not taking medication. The results of 

mixing alcohol with AEDs also depend 

on which medication you are taking, 

and this should be discussed with your 

doctor.

It is also important to bear in mind 

that taking drugs which act on the brain 

is likely to make you more sensitive 

to the effects of alcohol.  This means 

that rather less than the recommended 

amounts of alcohol for activities such 

as driving might well affect your 

competence.  

Alcohol and seizures

The risk of seizures for many people 

with epilepsy is greatly increased after 

consuming three or more alcoholic 

drinks, however there will be those 

who are more sensitive to the effects of 

alcohol after fewer drinks. Generally 

alcohol does not provoke a seizure while 

the  person is drinking, the seizure is 

more likely to occur 4 to 72 hours after 

the drinking has stopped.

The risk of binge drinking

Binge drinking can cause a seizure, 

even in people who do not have 

epilepsy. Such seizures can be due 

to the toxic effects of alcohol, too 

much fluid, alcohol withdrawal and 

metabolic changes in the body and can 

occur within 4 to 72 hours of stopping 

drinking.

Recent studies have shown that the 

chronic abuse of alcohol is associated 

with the development of epilepsy 

in some people, as repeated alcohol 

withdrawal seizures may make the brain 

more excitable. Therefore, people who 

have experienced seizures brought on 

by binge drinking may begin to have 

unprovoked epileptic seizures whether 

alcohol is consumed or not.

Withdrawal seizures

Withdrawal seizures are most common 

among persons who have abused alcohol 

for years. When alcohol consumption is 

stopped suddenly or is markedly reduced 

over a short period of time, a seizure 

may occur. 

To drink or not to drink?

Socializing and relaxing with friends 

can often involve drinking alcohol, 

whether it be at a pub, nightclub or that 

lazy Sunday BBQ.

 To drink alcohol is always an 

individual decision and many people 

with epilepsy will have decided that 

alcohol is not for them, perhaps because 

they don’t want to take the risk, or 

experience has taught them that even 

moderate drinking can make their 

epilepsy worse. 

alcohol and epilepsy

Binge drinking has been getting some media of late and we have been asked 

a lot of questions about the risks associated with alcohol and epilepsy from the 

general community as well as from people with epilepsy. Mark Francis from The 

Epilepsy Centre in SA prepared this update for The Epilepsy Report.

 If you decide to drink alcohol the 

following guidelines will help you 

minimize the risks:



  Drink in moderation. This means 

having one or two standard drinks a 

day. A standard drink is equal to:

one small glass of wine 

 

ƒ

(100ml)

one glass of full strength beer 

 

ƒ

(285ml)

or 30ml of spirits.

 

ƒ



  Stick to your limits and do not allow 

anyone to persuade you to drink more.

  

Avoid excessive drinking. This can 

result in poor seizure control due to 

late nights, missed meals, or forgotten 

doses, while withdrawal seizures are 

likely to occur as the alcohol level in 

the blood falls.



  Do not deliberately miss your dose, 

take extra medication or alter the time 

you regularly take your medication 

before drinking. This will not alter any 

reactions and may cause additional 

side effects or seizures. You are 

far more likely to have a seizure by 

missing your AEDs than by having an 

occasional drink. 



  Do not drink and drive, the possible 

interaction with AEDs can greatly 

affect your competence.

  

And most importantly, ask your 

doctor about the effects of drinking 

alcohol with the medication you have 

been prescribed.  

---