Ask the Expert with Alan Ettinger, MD – Mood Disorders, an Introduction

What should a person do when they are feeling really down (suffering mood swings) from epilepsy?

First of all, please be aware that this is very common in epilepsy and that many individuals are facing similar issues. The most important thing to do is to spend time with your doctor discussing openly what you are experiencing. You should insist on getting the proper comprehensive treatment of this issue and it would advisable to get a referral to a good mental health professional.



Why does epilepsy appear to cause depression? Is it because of the medications?

This is an excellent question and the answer is very complicated. Medications are just one of many potential causes. While many used to simplistically believe that depression was simply a reaction to having a chronic illness, in fact there are likely many biological causes and the conditions that give rise to epilepsy may in fact also produce depression.



I had bad mood swings that lasted for about 4 weeks straight last month (1 hour happy, 1 really sad or depressed, very random). They have stopped now, but I remember it happening at the university and school. I'm on 1800mg of Epilim and often wonder are my mood swings supposed to be this bad.

While depression has been widely recognized in epilepsy, there has been surprisingly little research into the specific entity of mood swings in epilepsy. Only recently have reports begun to come out on this entity. In any event, it would be advisable for you to see a qualified mental health professional to evaluate these symptoms and recommend treatment which is likely to be of help.



Can epilepsy affect the mood and can the mood affect epilepsy? Is it any different in men and woman? What are the best anti-seizure medications to use with depression in men and woman or is it still depends on each individual?

Only your doctor could tell you what is the most optimal antiepileptic drug for your condition. However, there are some that are felt to be less risky for worsening depression and even some evidence for some therapies that could address both epilepsy and depression. I have been involved in some studies involving lamotrigine and the vagal nerve stimulator both of which I believe may have some antidepressant properties.



About 5 years ago, I was diagnosed schizoaffective bipolar type and in the beginning of this year with epilepsy. However, I had seizures years before diagnosis. I'm on what seems to be double epilepsy/bipolar medications (Lamictal and Klonopin) but I'm having severe rages of anger to the point that I'm physically violent. I also believe I'm having seizures that I have no memory of due to new sore bumps on my head at random times. My psychiatrist has me on a strong dose of seroquel and my neurologist wants me completely off of it (but I really need to be on the seroquel). My question is is this: Beside psychotherapy and the pill cocktail I have are there any more things that I can do to soften the mood characteristics so they are not as out of control? I have no way to go to therapists and am barely able to make my regular appointments due to lack of transportation. The transportation I qualify for (shuttles, etc.) does not allow me to bring my children. Also, are there programs for parents with epilepsy that help aid in transportation issues? My current situation does not allow me to have access to buses and to take a cab. From where I live I would eat up my disability funds with two trips to a doctor or even a grocery store.

This sounds like a very difficult situation. Unfortunately, there is no quick fix advice that I could provide; the key lies in finding a way to get to very frequent regular appointments with your mental health professionals. You may want to speak to the social workers at your local epilepsy foundation to see if they can find some ways to assist you in getting support for transportation needs.



Will my depression and mood disorders go away after the surgery I am having for the tumor and seizures?

Over the long-term, the prognosis for improvement in mood after such a surgery would be quite good, especially if the tumor can be completely removed and the seizures are brought under control. In the short term however, there may be a transient period in which depression can develop or get worse but this tends not to be long-lasting.



How does depression go hand-in-hand with epilepsy?

This is a very complicated story and books and many papers have been written about this. In a word, depression appears to relate to many factors including the biology of the conditions that give rise to epilepsy, chemical changes among the nerve cells, medication effects, effects of the seizures, psychosocial reactions to have a difficult disorder, and many other potential causes.



I was diagnosed with TLE after I had a 'grand mal' seizure at 42 years old (2005). I had seizures as an infant (non-febrile) and took Phenobarbital until I was two, but never had a seizure again until the age of 42, when that tonic-clonic came out of nowhere. Since then, I've lost my job due to my inability to drive as my complex partials are not under control. (I've been on Dilantin, Lamictal and am now taking Keppra and Topamax.) My husband thinks I am depressed because I am "snippy" and tired a lot. I think I am simply angry because I have lost my independence. And the 3,000 mgs. of Keppra and 400 mgs. of Topamax certainly do not help my mood or energy level. How am I supposed to know if I'm depressed or just suffering from yet another side-effect of these meds? My life has been turned upside down, of course I'm upset!

I am so sorry to hear of the terrible disruptions in your life. There are many potential causes of your depression symptoms and it is important for all to understand that this is not something one can necessarily simply decide to exhibit or choose not to. Keppra and Topamax may not be the most optimal antiepileptic drugs for an individual suffering from depression as either carries the potential to induce or worsen those symptoms. Your depression symptoms deserve as much attention as your seizures. I would encourage you to have a frank discussion with your doctor and consider getting an evaluation by a mental health professional.



My wife suffers from seizures, now excessive anxiety, increased tension, heart rate, loss balance, loss of short term memory, depression, and little body strength. No alcohol or recreational drugs, on Lamictal Prozac, and xanax. I am frustrated as a caregiver. Doctors have been useless and unable to provide information or help. Next step...to see a Pschiatrist. Help!!

I am hopeful that the psychiatric evaluation can be very helpful. Your question suggests that the referral to the psychiatrist is now the last resort which raises an important issue about the concept of a psychiatric referral. I believe that a psychiatrist should be involved early in the evaluation of any individual dealing with the difficulties and mood complications of epilepsy. There should be no shame in getting this kind of assistance and the interventions they can offer can often be extremely helpful.



I have complex partial seizures. In the days immediately following a seizure, I feel a host of negative emotions: frustration, anxiety, depression, despair. Is that normal?

What you are describing sounds like the classic “prodromal period” that some individuals experience with seizures. This is a relatively understudied area but may also help warn you about impending seizures which theoretically could enable your doctor to institute some additional treatment at those times.


I have Left Front Temporal Lobe Epilepsy. I am on Trileptal 600mg twice a day, Keppra 500mg and Lamictal 25mg a day. With taking all this medication my Partial Complex and Motor Seizures are still not totally controlled. I have around 2 seizures a day every 3 days. I am finding that I have no desire to get out and do anything. All I want to do is sleep and/or cry. I always feel sick and have no energy. Please tell me what can I do to become better.

My hope is that you get evaluated at a specialty (aka tertiary) epilepsy center where a comprehensive team of specialists can offer options both for the uncontrolled epilepsy (including the possibility of potentially curative epilepsy surgery) as well as your psychological needs. This is really the first step to getting better.



Is there a link between epilepsy and bipolar disorder?

We have actually studied this issue and found that over 12 percent of epilepsy patients from the community and 15 percent of patients from our specialty epilepsy center have had bipolar symptoms. However, we are very cautious about using the formal term “diagnosis” and believe that this is a more subtle mood instability that may relate more directly to the epilepsy. This is an area that warrants much further study.



I was told depression runs in the family but with my epilepsy it seems worse. I'm on Depakote 500mg 3 times a day they said this should take care of both. IT doesn't! Why won't they put me on something that will help me with the depression? I lock myself in a room I don't go out much. Help me if you can.

Family histories of depression do appear to often predispose a patient with epilepsy to also experience depression. Depakote is considered a “mood stabilizer” but probably doesn’t have potent antidepressant properties. Your distressing situation certainly warrants a thorough assessment by a psychiatrist who is comfortable working with patients who have epilepsy.



I have had seizures for 5 years and suffer from extreme moodiness. I often blow up at my family and seem unable to control my temper. I am on Lamictal, Tegretol, and Phenobarbital. Do you have any alternative drug suggestions which may lower my chances for such moodiness? Of course, I also suffer from memory loss as well.

Mood instability appears to be common in epilepsy. We are currently studying this issue in both adults and a separate study in adolescents. While Lamictal and Tegretol have been touted as mood stabilizers, Phenobarbital has been more associated with depression and thinking impairment. However, any tapering of Phenobarbital has to be done with extreme caution as it could provoke major withdrawal seizures.



What medications should I take for my mood disorder? It is very bad sometimes and I don't want anybody to be around me. Nobody understands and I am also going through pre-menopause.

The selection of medications for your mood disorder should be guided by a psychiatrist who should perform a thorough evaluation. The good news nowadays is that the risks of lowering seizure threshold with the newer generation of antidepressants is very low and the response rate tends to be quite good. Alternative agents may be indicated if there are major mood swings. The first step in my opinion is to get the proper assessment.