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Depression and stress in epilepsy: Management strategies Lorna Myers, Ph. D. Director of Clinical Neuropsychology Northeast Regional Epilepsy Group Chronic epilepsy and psychiatric disorders 50-60% of patients with chronic epilepsy have depressive or anxiety disorders

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depression and stress in epilepsy management strategies

Depression and stress in epilepsy: Management strategies

Lorna Myers, Ph. D.

Director of Clinical Neuropsychology Northeast Regional Epilepsy Group

chronic epilepsy and psychiatric disorders
Chronic 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
chronic epilepsy and psychiatric disorders3
Chronic epilepsy and psychiatric disorders

* Changes in neurotransmitters or folic acid deficiencies can worsen depression

* Suicide: 5 times higher than in the general population and 25 times higher in complex partial seizures (temporal lobe)

in epilepsy
In Epilepsy
  • Inter-ictal: Depression that occurs between seizures-not during an active seizure
  • Peri-Ictal: Depression just before or after (hours or days) a seizure
  • Ictal: the seizure co-occurs with depressive symptoms
characteristics of depression in epilepsy
Characteristics of depression in epilepsy
  • Peri-ictal depressions tend to be associated to psychotic or paranoid symptoms
  • They tend to respond to changes in anti-epileptic or antidepressive medications
  • These patients tend to be more irritable and emotional
  • Many have dysthymia between seizures
types of depression
Types of depression?
  • Major Depression
  • Minor Depression (dysthymia)
  • Bipolar Disorder (manic-depressive)
important facts about depresison
Important Facts about depresison
  • Over 80% of those treated for depression improve.
  • Depression can affect people of all ages, races, SES, and genders. However, the ratio of women to men is 2:1
  • 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
what is major depression
What is major depression?
  • 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
minor depression
Minor Depression
  • Feeling depressed almost every day for at least 2 years
  • Having 2 or more of the following:
    • Changes in appetite
    • Insomnia/hypersomnia
    • Low self esteem
    • Fatigue
    • Concentration problems
    • Hopelessness
bipolar disorder
Bipolar Disorder
  • Manic cycles (hyperactivity, agitation, insomnia, hypersexuality, grandiosity, sometimes, psychosis, racing thoughts, pressured speech) lasting one week or more
  • Intense depressive cycles
gad and epilepsy
GAD and epilepsy
  • GAD: disabling and free floating anxiety that lasts for at least 6 months (+poor sleep, appetite, concentration).
  • In epilepsy: it can present with a fear of future seizures/of medical complications
panic attacks and epilepsy
Panic attacks and epilepsy
  • Sudden and severe panic on a frequency of more than one attack per week for a period of at least 1 month
  • Patients with epilepsy have panic attacks up to six times more frequently than control populations
why depression and anxiety in epilepsy
Why depression and anxiety in epilepsy?
  • Psychological reaction to epilepsy (sadness, hopelessness)
  • Social factors (lost driver’s license, job, loss of control)
  • Secondary medication effects (eg. polypharmacy, high doses, sudden discontinuation)
  • The effect of electrical discharges in or near the limbic system
treatments for clinical range depression anxiety
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
treatments for clinical range depression anxiety15
Treatments for clinical range depression/anxiety
  • Biofeedback
  • Family therapy and psychoeducation
  • Vagal Nerve Stimulator (FDA approved for mood disorders)
  • For refractory major depression: Electro shock (ECT) or Transcranial magnetic stimulation (TMS)
alternative treatments
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.
what can i do to help myself
What can I do to help myself?
  • Exercise: yoga, pilates, non-aerobic 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
  • Get treatment for my sleep disorder
  • Attend epilepsy support group and activities
what can i do to help myself18
What can I do to help myself?

Strategies to support treatment or work on small mood shifts:

  • Apply positive psychology principles
  • Use a diary
  • Learn and use relaxation techniques
  • Watch out for Worry Words
how can you become more optimistic
How can you become more optimistic
  • In your diary, write down a bad event that happened to you:
    • how will I know when I start to bounce back from this, how will this have limited effects on the rest of my life?
  • Reframe an event, finding a hidden blessing or strength (cognitive restructuring)
optimism
Optimism
  • Write a Future diary (“It is now 6 months since I … and now I am ….”)
  • Gratitude (Which three people in your life have most helped you. Write them a letter, call them, write about them)
  • Savoring life (enjoy each moment)
how to achieve greater happiness
How to achieve greater happiness

Practice acts of kindness, volunteer

  • Learn to forgive/ Forgiveness is a way of healing yourself
  • Take time for yourself (walk, massage, facial, read a book, go to the gym, watch a movie, etc.
  • Focus on what you can control and let go of the rest.
  • Try not to judge yourself or others (should, could)
how to achieve greater happiness22
How to achieve greater happiness?
  • Commit to your goals and pursue them (even small ones)
  • If finding yourself in an unhappy situation, start planning how you will change this.
  • Use humor
  • At times you may need to avoid unhappy people
how do i work on my stress levels
How do I work on my stress levels?
  • Breathing exercises (when nervous, we breathe fast, shallow. When calm, we breathe slow and deep)
  • Autogenic training
  • Deep muscle relaxation
track your worry words
Track your worry words
  • Tune into your self-talk
  • Get a small notepad and carry it with you for a few days.
  • Listen to what you say to yourself when stressed and write down the internal chatter.
  • Then check your monologue for worry words
what are worry words
What are worry words?

Extremist: Horrible, awful, dreadful, etc.

All-or-none: All, always, completely, never, none, etc.

Judging, commanding, and labeling: bad, wrong, must, should, idiot, jerk, pig, etc.

Victim: I Can’t, impossible, overwhelmed, worn out, etc.

correcting worry words to reasonable alternatives
Correcting worry words to reasonable alternatives
  • Extremist example: That presentation in front of people was torture.
  • Reasonable alternative: That was difficult but not unbearable.
  • All or none example: “You always criticize me”.
  • Reasonable alternative: “Right now, I feel that you are being critical of me”.
practice makes perfect
Practice makes perfect
  • Keep your diary on daily basis
  • Practice relaxation techniques daily (at least 2 months running)-30 minutes
  • Establish self-care activities in your regular schedule (e.g. hair stylist appt, watch a favorite show, facials)
  • Watch your diet regularly but allow yourself some pleasures.
  • Physical exercise
thank you
Thank you!

Be well

references and resources
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 )