The Relationship Between Epilepsy and Depression

Below is a transcript of a conversation recorded between Jamie and Ally for a piece of coursework Ally needed to do for a science communication class. You can listen to the recording as a LUNA Listen here: https://open.spotify.com/episode/4rYXA9q2Xa3g4GOwbQhJhg?si=4488791460294ef5

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Jamie - I am Jamie

Ally - Hi I am Ally

J - and today we are going to be talking about the relationship between epilepsy and depression. When you said that you wanted to talk about this I was a little surprised at first - after all, isn’t epilepsy a physical health problem and depression a mental health problem? But then I did a quick google and found that, actually, 1 in 3 people with epilepsy have depression! But what I couldn’t find from my quick google search was why this is the case, so I am really looking forward to exploring this for the next 10 minutes!

So, to get us started. I think I know what both epilepsy and depression are, certainly they’re words I’ve heard before, but just to make sure my understanding is correct can you tell me a little bit about them? Maybe you could start by telling me about what it means to be a “person with epilepsy”?

A - Of course. So, epilepsy is a neurological disorder, meaning it is a condition which affects the brain and so to understand epilepsy we need first to just understand a wee bit about the brain. The brain is able to work and do all the amazing things it does as a result of communication between different areas and the brain and the body. This communication is done by messengers called neurotransmitters. As they communicate with each other electricity is created in the brain. This electricity is super normal. However, for people with epilepsy, sometimes they get random bursts of extra electricity, and these are called seizures. The extra burst of electricity happens inside someones head, and normally causes a change in behaviour for a few minutes - such as losing consciousness, or a sudden jerk of a limb, or to lose awareness, and we call this a seizure. If a person has two or more epileptic seizures, and a doctor thinks it is likely they will go on to have more, then they are likely to be diagnosed with epilepsy. For context, around 1 in 100 people in Scotland have an epilepsy diagnosis.

J - Okay, all of those different seizures you mentioned seem very different. So epilepsy is quite a broad diagnosis, then?

A - Exactly - the type and frequency of someones seizures, and the way in which they are treated means that there is incredible diversity in the experience of people with epilepsy. But, within this range of experiences, we have this significantly increased likelihood of developing depression. As you said earlier it is 1 in 3 people with epilepsy who have depression compared to 1 in 6 people in the general population who have depression.

J - And what are we meaning when we say that someone has depression?

A - When we say a person with depression we are talking about someone who, for at least the last two weeks, has experienced feelings of sadness and hopelessness and a loss of interest in things they previously enjoyed. They will have felt these things almost all day, almost every day.

J - So, having epilepsy makes you more likely to develop depression?

A - Yes, significantly more so, but, really interestingly, having depression also makes you slightly more likely to go on to develop epilepsy.

J - Oh, interesting! So we seem to have this weird two way crossover between epilepsy and depression where having one makes it more likely that you have the other. Why is this the case?

A - This is a very good question which in recent years a lot of different researchers have tried to find the answer to. The answers they find generally fall into two categories: social factors and biological factors.

The social factors are consequences of living with epilepsy which in turn have a negative impact on a person's mental health. Some examples are:

• People with epilepsy can experience a loss of independence through not being able to hold a driving licence.

• They may miss out on seeing friends and doing things they enjoy because of having had a seizure or being worried about having a seizure.

• They may experience stigma and negative attitudes towards them and their seizures from the people around them.

These all contribute to low mood, which as we talked about before is a key component of depression. We can see that they would also feed into the other component too - loss of interest in things you previously enjoyed. It may be seizures that stop people doing what they enjoyed before, or even just the fear of having a seizure.

J - Okay. To me, these social factors seem to be a plausible answer to why we have this connection between having epilepsy and having depression. Even just hearing that list makes it very understandable that epilepsy would have a negative impact on your mental health!

A - Yes exactly. However, researchers have also looked at the mental health of people with other chronic illnesses that have a similar social impact, such as type 1 diabetes, and found that whilst rates of depression were higher than among the general population, they were not as high as in people with epilepsy. This suggests that there must be something more going on, and that brings us to our second category of factors: biological.

J - so when we say biological factors do we mean what’s physically going on in the brain?

A - Exactly! For us the key things it encompassess are the structure of the brain and the processes happening inside the brain. Epilepsy and depression are both conditions of the brain so, intuitively, the biological factors make a lot of sense. We can see the logic that there may be some kind of link or interaction in the brain. For some people with epilepsy and depression both illnesses are being caused by something going wrong in the same part of the brain - this could be a structural difference, or a pathway or response which doesn’t work as it should. So we would say they have a common cause. This helps us to explain why people with depression are a bit more likely to develop epilepsy than the general population.

For other people, the link may be a result of medications they take. Depression and low mood are a very common side effect of anti - epileptic drugs. It is likely because they work to treat epilepsy by altering the neurotransmitters (the messengers i mentioned at the beginning), and a consequence of this change may manifest as depression for some people.

J - That is really interesting! Listening to you talk about it I can’t help but think that there must be cases in which the biological factors cause the social factors to get worse and vice versa, which then would lead to either depression or epilepsy getting worse, which then, from what you have said, leads to the other getting worse. Am I right in that?

A - You are totally right - completely dividing these factors into two categories is over simplifying it. The reality is that there are lots of interactions both between factors - social with social, biological with biological, and social with biological.

An example of a seemingly simple biological - biological interaction is the interaction between antidepressant medication and anti epileptic medication. Some antidepressants can increase the likelihood of a person having a seizure, and, as we talked about before, some anti epileptic medications can increase the severity of someone's depression. So you can see how they would feed into each other.

However, we can also see how this will have an affect on social factors too - more seizures may mean more isolation, more missing out, more stigma experienced, and so more depression.. You can imagine how quickly a vicious cycle can form between epilepsy and depression - one gets worse, meaning more social and biological factors are brought into the situation, meaning the other gets worse, and drags in even more social and biological factors, and repeat.

J - Is it kind of like a spiderweb situation, with all those factors connected to each other, simultaneously influencing and being influenced by each other?

A - Kind of! To compare it to a spider's web, however, perhaps paints a picture of this being static, when in reality it is an incredibly dynamic process. Perhaps a better comparison is to a snowball: you start at the top of the hill with your small ball of snow (reasonably well controlled epilepsy), and then as it starts to roll down the hill you accumulate a one or two social or biological risk factors, which makes your ball bigger (more seizures), which makes accumulate more risk factors, until you have a big ball of snow rolling uncontrollably down the hill.

J - That seems a pretty overwhelming situation to be in!

A - It definitely is quite a heavy topic. However, to end on a negative note would paint a false picture of where we are at with it. Whilst there is still a long way to go in fully understanding this complex relationship between epilepsy and depression, huge progress has been made in recent years to try and untangle it.

Having a better understanding of epilepsy and depression will help us to minimise and mitigate risk factors, and hopefully reven create an upward spiral, where by identifying and treating depression in people with epilepsy, we are able to help people have less seizures.

J - If someone listening has epilepsy and is worrying about their mood being low, what should they do?

A - A great question, if you have epilepsy and you have been worried about having low mood then I would say to go and talk to your GP or epilepsy nurse or neurologist. I can promise you that you won't be the first person with epilepsy to go to them about low mood, so they will be equipped to help you with this.

J - Great! That feels a good note to end on. Thank you for talking with me about this - I feel like I have learnt a lot! I hope anyone listening found it as interesting as I did!!

A - Thank you for chatting with me about it!