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

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THE EPILEPSY REPORT OCTOBER 2008

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                          THE EPILEPSY REPORT OCTOBER 2008

epilepsy had depression, 19% had suicidal thoughts, 37% 

of patients were under- diagnosed and 17% of these patients 

were not treated for depression. Wiegartz and his associates 

(1999) in a study on comorbid psychiatric disorder in chronic 

epilepsy reported that 43% with a current major depressive 

disorder, 68% with a minor depressive disorder and 38% with 

a history of a life-time episodes of major depression were not 

treated. Ettinger et al (1998) reported that 26% of children 

with depression and epilepsy were not treated for depression. 

Although a substantial number of adolescents with epilepsy 

exhibit depression & anxiety, many are not diagnosed or 

treated. One of the reasons for under-diagnosis and under-

treatment might be that the manifestation of depressive 

symptoms is atypical in patients with epilepsy. 

The treatment for depression in epilepsy has been the usual 

antidepressant drugs that are prescribed for depression in 

patients without epilepsy. When prescribing antidepressants, 

it is important to rule out whether  the depressive episode 

followed the discontinuation of an antiepileptic drug with 

mood stabilising properties or that the depressive episode 

followed the introduction or dose increment of an antiepileptic 

drug with known negative psychotropic properties (Kanner, 

2003). While some clinicians are concerned about worsening 

the seizure frequency of patients who are treated with 

antidepressants, the risk of psychiatric drugs causing seizures 

is small. Tatum et al (2001) estimated that only 1 out of 100 

patients had worsened seizures after treating for depression 

with antidepressants. Although antidepressants are the 

major treatment for depression, as many as 30% to 35% of 

patients with major depression do not respond to treatments 

(Aldessarini, 1989). A recent meta-analysis by Kirsch et al 

(2008) found that antidepressant medications have reported 

only modest benefits over placebo treatment, and when 

unpublished trial data are included, the benefit falls below 

accepted criteria for clinical significance

Among the non-pharmacological treatments, a wide 

range of interventions such as psychotherapy, cognitive 

behaviour therapy, relaxation therapy, exercise therapy and 

counselling are used for treatment of depression in epilepsy. 

Research indicates that a combination of antidepressants and 

psychological treatments is far more effective than treatments 

in isolation and has the potential for more long-term results. 

As a group, patients with epilepsy tend to lack physical 

fitness and live sedentary lives compared with the population 

without epilepsy (Dubow & Kelly, 2003). The potential benefit 

of physical exercise as an alternative treatment for depression 

has received considerable attention in recent years. A growing 

body of literature shows that depressive symptoms are 

reduced with exercise (Singh et al, 2001). In a recent meta-

analysis, it was concluded that exercise was more effective 

compared to no treatment and as equally effective as cognitive 

behaviour therapy for depression (Lawlor & Hopker, 2001). 

Craft and Landers (1998) in a systematic review on exercise 

and depression found an overall mean effect size of .72. This 

seems to be a substantial effect that proves the effectiveness 

of exercise for patients with depression. Some studies have 

shown that patients with epilepsy too would receive similar 

benefits from physical activity. For example, Roth et al’s 

(1994) study found that active subjects had significantly lower 

levels of depression than inactive subjects, as well as better 

psychosocial adjustment. Similarly, authors like Erikson et 

al (1994) and Nakken et al (1990) have demonstrated that 

an exercise intervention improved mental health, quality of 

life and psychosocial functioning in patients with epilepsy. 

Incorporating exercise programs for depression into a regular 

lifestyle have also shown to be cost effective (Sevick et al, 

2000). 

Conclusion

Diagnosis and adequate management of depression is vitally 

important for a number of reasons in patients with epilepsy. 

It is well known that there is a strong correlation between 

major depression and suicides. Suicidal behaviour is a specific 

threat in patients with epilepsy as revealed by the suicide 

rate of persons with epilepsy being more than five times that 

of the general population. Patients with antidepressants and 

antiepileptic drugs need to be followed carefully and closely 

for side effects, particularly for suicidal ideation. Depression 

may severely impair daily functioning of people with epilepsy. 

Sleep deprivation can lead to, increased seizure frequency 

as can non-compliance with medication. Most crucially, 

depressed epilepsy patients may abuse their medication, both 

antidepressants and anti epilepsy drugs (AEDs) which may 

lead to fatal consequences. Quality of life can be poor in many 

patients with epilepsy, however for those patients with epilepsy 

whose depression remains untreated their quality  of life will 

be even more compromised. 

References

Aldessarini RJ (1989) Current status of antidepressants: clinical 

pharmacology and therapy. Journal of Psychiatry. 50(4) 117-26

Baker GA, Jacoby A, Buck D, Stalgis C, Monnet D (1997) Quality of life 

of people with epilepsy: a European study. Epilepsia, 38, 353-62

BaldessarinI RJ. Current status of antidepressants: clinical pharmacology 

and therapy Journal of Clinical Psychiatry. 50(4):117-26, 1989

Boylan LS, Flint LA, Labovitz DL et al (2004) Depression but not seizure 

frequency predicts quality of life in treatment-resistant epilepsy. Neurology, 

62, 258-261

Craft L & Landers D (1998) The effect of exercise in clinical depression 

and depression resulting from mental illness. Journal of Sports and Exercise 

Psychology, 20, 339-357

Dubow JS & Kelly JP (2003) Epilepsy in sports and recreation, Sports 

Medicine, 33 (7), 499-516

Eriksen HR, Ellertsen B et al (1994) Physical exercise in women with 

epilepsy. Epilepsia, 35, 1256-64

Ettinger  A, Weisbrot DM, Nolan, EE (1998) Symptoms of depression and 

anxiety in pediatric epilepsy patients. Epilepsia, 39, 595-9

Forsgren L & Nystrom, L (1990) An incident case referent study of 

epileptic seizures in adults. Epilepsy Research, 6, 66-81

Hermann BP, WhitmaN S, Wyller AR (1990) Psychosocial predictors of 

psychopathology in epilepsy. British Journal of Psychiatry, 156, 98-105

Hersdorffer DC, Hauser WA, Annegers JF, Cascino G (2000) Major 

depression is a risk for seizures in older adults. Ann Neurol, 47, 246-249

Jacoby A, Baker GA, Steen N et al (1996) The clinical course of epilepsy 

and its psychosocial correlates: findings from a UK community study. 

Epilepsia, 37, 148-61

Kanner  AM (2003) Depression in epilepsy: Prevalence, clinical 

semiology, pathogenic mechanisms and treatment. Biological Psychiatry, 54, 

388-98

Kanner AM (2003) Depression in epilepsy: a frequently neglected multi-

faceted disorder. Epilepsy & Behaviour, (Suppl 4) 11-17

Kirsch I, Deacon BJ, Huedo M et al (2008) Initial severity and 

antidepressant benefit: a meta-analysis of data submitted to th Food and Drug 

Administration, Public Library Sciences, 5(2) :e45

Lawlor D & Hopker S (2001) The effectiveness of exercise as an 

intervention in the management of depression: Systematic review and meta-

regression analysis of randomised controlled trial. BMJ, 322, 1-8

Leidy NK, Elixhauser A, Vickrey B et al (1999) Seizure frequency and the 

health related quality of life of adults with epilepsy. Neurology, 53, 162-166

Mathews WS, Barbaras G (1981) Suicide in epilepsy: a review of the 

literature. Psychosomatics. 22, 515-24

Mendez MF, Doss RC, Taylor JL, Salguero P (1993) Depression in 

epilepsy: relationship to seizures and anticonvulsant therapy. J Nerv Ment 

Disorders, 181, 444-7

Mendez MF, Cummings JL, Benson DF (1986) Depression in epilepsy: 

significance and phenomenology. Arch Neurol. 43, 766-70

Nakken KO, Bjorholt, PG, Johannessen SL et al (1990) Effect of physical 

training on aerobic capacity, seizure occurrence and serum level of 

antiepileptic drugs in adults with epilepsy. Epilepsia, 31,88-94

Pine DS, Cohen P, Gurley D (1998) The risk of early adulthood anxiety and 

depressive disorders in adolescents with anxiety and depressive disorders. 

Arch Gen Psychiatry, 55, 56-64\

Robertson MM (1991) Depression in epilepsy. In: Trimble MR, editor, 

women and epilepsy. Wiley: Chichester; 223-42

Roth DL, Goode KT, Williams VL et al (1994) Physical exercise, stressful 

life experience, and depression in adults with epilepsy. Epilepsia, 35, 1248-55

Schmitz EB, Robertson MM, Trimble MR (1999) Depression and 

schizophrenia in epilepsy: social and biological risk factors. Epilepsy 

Research, 35, 59-68

Sevick M, Dunn A, Morrow et al (2000) Cost-effectiveness of lifestyle and 

structured exercise intervention in sedentary adults. American Journal of 

Preventive Medicine, 19, 1-8

Singh N, Clements K, & Singh M (2001) The efficacy of exercise as a long-

term antidepressant in elderly subjects; A RCT. Journal of Gerontology, 56A, 

M497-M504

Tatum WO, French JA, Faught E, Morris GL (2001) Post marketing 

antiepileptic drug survey. Epilepsia, 42, 1134-1140

Wiegartz  P, Seidenberg M, Woodard A. et al (1999) Co-morbid psychiatric 

disorder in chronic epilepsy: recognition and etiology of depression. 

Neurology, 53, 3-25

The Epilepsy Foundation of Victoria (EFV) invites you to become an 

occasional participant in the Epilepsy Foundation’s ongoing research 

programme into the social effects of living with epilepsy and caring for those 

with epilepsy. We need people to tell us about their experiences and views of 

living with epilepsy. 

What is EFV Research Participant Register (RPR)?

The Epilepsy Foundation of Victoria’s  Research Participant Register is an 

ongoing  initiative created in 2006 to establish a unique research source 

from which we can learn much valuable information about epilepsy  that can 

be used to improve the lives of people affected by this condition. This is the 

only register of its kind in Australia and we have not so far learned of another 

anywhere else in the world.

Why is it important to join in this register?

The World Health Organisation has stated that: the social consequences of 

epilepsy are often more difficult to overcome than the seizures themselves. 

They are talking about issues like finding and keeping a job, transport and 

driving and the attitudes of other people towards epilepsy. Yet in Australia, 

there is hardly any reliable research into these social consequences. If the 

Epilepsy Foundation of Victoria gathers detailed factual evidence of this kind, 

we will be even more successful in lobbying governments for a better deal and 

a fairer go for all those living with epilepsy.

Who is eligible to join in RPR?

Following individuals are eligible to join the register.

Individuals who have epilepsy/seizure disorder

o 

Carers who look after someone with epilepsy/seizure disorder

o 

Are there risks to me as a research register participant?

This is not a medical or clinical research register. From time to time, we might 

contact you and ask if you would be prepared to answer some questions 

over the phone or fill in a mailed questionnaire. Sometimes there will be small 

group meetings of participants at the Foundation’s office in Camberwell or a 

regional centre to which you might be invited. 

Does putting my name in the RPR obligate me to 

participate in future research projects?

Putting your name does not obligate you in any way. You may be too busy 

or just not feel like participating at that time – that’s fine! But if you do, any 

information you provide will be confidential, anonymous, safeguarded and 

only used for specified research purposes. 

How would I benefit by joining the register?

There may be opportunities to talk with people living with epilepsy and those  

who work with them.  Most importantly, this is an opportunity to be part of a 

longitudinal study of living with epilepsy – the first of its kind.

 

Epilepsy Foundation 

of Victoria

If you are interested in learning more about this 

research contact: 

Dr Jaya Pinikahana 

Principal Social Researcher

Phone: [phone] Fax: [phone]

[e-mail]

Megan O’Donoghue 

passed away suddenly in 

February 2007.

Megan’s friends and 

family were left trying to 

fathom the loss. A gifted 

and creative amateur cook, 

passionate about food 

and wine, energetic social 

organiser – Megan was a 

girl who ‘ate’ life. 

Inspired by Megan’s 

culinary passions, the 

concept of a ‘Megan cookbook’ – a way for her friends and family to 

honour her memory – was born. 

Now, 

Megan Meals Memories written and edited by Andrea Neilson 

is a reality and contains over 60 of Megan’s recipes – food she loved and 

shared with friends and family. Food you will cook over and over again. All 

the recipes, along with their accompanying stories, were contributed by

Megan’s friends and family, or leapt from the stained pages of her own 

cookbook collection, demanding to be included.

   “Andrea has brought all of the material together in a way which lets 

Megan herself shine through, in the voices of the many contributors (and 

sometimes in her own words), and which also movingly expresses Andrea’s 

own love for a very dear friend.” – Jessica Ramsden (friend).

Copies can be purchased from EFV for $25 plus $4.95

postage & handling. Tel: [phone] or email:[e-mail].

I

n m em ory of a friend

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