While both depression and anxiety are common mood disorders in the general population, there is a growing body of evidence that the prevalence rate of these disorders is also substantial in people with epilepsy. Based on this premise Joyce Cramer, Associate Research Scientist, Department of Psychiatry, Yale University and colleagues recently conducted a study examining symptoms of anxiety and depression as well as health-related quality of life (HRQOL) among epilepsy patients whose seizures were not fully controlled. Their findings were published in the journal Epilepsy & Behavior (Cramer JA, Brandenburg N, Xu X. Differentiating anxiety and depression symptoms in patients with partial epilepsy. Epilepsy Behav 2005;6:563-9).Adult epilepsy patients taking two or more antiepileptic drugs completed the Hospital Anxiety and Depression (HADS) questionnaire and the Quality of Life in Epilepsy (QOLIE-10) questionnaire.

Hospital Anxiety and Depression Scale (HADS)

HADS is a research tool designed to measure both anxiety and depression. The anxiety subscale of the HADS contains seven questions designed to measure generalized anxiety including: anxious mood, restlessness, anxious thoughts, and panic attacks. The depression subscale also includes seven questions and is geared towards lost interest and diminished pleasure ("lowering of hedonic tone"). Each subscale score ranges from 0 to 21, with higher scores representing poorer emotional well-being. Scores of 0–7 on either subscale are considered to represent “normal”, 8–10 represents “mild”, 11–14 represents “moderate”, and 15–21 represents “severe” levels of anxiety and depression.

Quality of Life in Epilepsy (QOLIE-10)

Dimensions of health-related quality of life in epilepsy were assessed by the QOLIE10. This instrument includes 10 questions assessing energy, overall quality of life (QOL), cognitive and social functioning, emotional well-being, the effects of epilepsy medications, and worry about seizures. Previous work has demonstrated that this abbreviated instrument is as reliable as the longer QOLIE-31 instrument, using the same format of seven subscales and a total score. Higher scores represent more favorable health states.

Findings and Implications of the Study

Anxiety and depression are separate psychiatric conditions that are often inter-related. This study examined whether they exist independently, and whether they affect all quality-of-life domains. “What our study revealed is that approximately half of the patients had symptoms of anxiety and depression. Patients reporting more severe anxiety or severe depression had worse HRQOL than patients with no or mild symptoms. Depression symptoms had a greater influence on HRQOL than anxiety symptoms, but both were related to overall HRQOL”, said Cramer. She suggested that patients may benefit from increased attention to the role of anxiety separately from depression. She further contended that screening, diagnosis and treatment of anxiety and depression could be an important contribution to the wellness of people with epilepsy whether or not seizures are controlled. “Future studies are needed to determine the individual correlations with epilepsy, and specific medications. Studies should be performed with patients having purely anxiety or depression, and taking a single antiepileptic drug,” added Cramer.

What is an Anxiety Disorder?

As defined by the National Institute of Mental Health , “anxiety is a normal reaction to stress. However, when anxiety becomes an excessive, irrational dread of everyday situations, it is a disabling disorder.”

Anxiety disorders affect approx 10% of adults. 25% of epilepsy patients have symptoms of anxiety. There are five major types of anxiety disorders:

• generalized anxiety disorder (GAD)

post-traumatic stress disorder (PTSD)

• panic disorder
• obsessive-compulsive disorder (OCD)
• social phobia (or social anxiety disorder)
• specific phobias

What is a Depressive Disorder?

A depressive disorder is an illness that involves the body, mood, and thoughts.

Depressive disorders affect approximately 10% of adults in general and up to 40% of epilepsy patients.

According to the National Institute of Mental Health

Major depression is manifested by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives. Dysthymia is a low grade depression encompassing the same features as major depression (depressed mood, weight or appetite change, sleep dysfunction, agitation or psychomotor retardation, guilt, lack of feeling pleasure/enjoyment).

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Symptoms Of Depression and Mania

Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

Depression

• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being "slowed down"
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Mania

• Abnormal or excessive elation
• Unusual irritability
• Decreased need for sleep
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased sexual desire
• Markedly increased energy
• Poor judgment
• Inappropriate social behavior

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