When epilepsy affects you for long periods, you may notice changes in your behavior, your feelings, and in how you see the world. Feelings of depression or anxiety are especially common. A few people with epilepsy experience psychosis (losing contact with reality). Some doctors believe in the existence of a distinct temporal lobe epilepsy personality.

Dysphoric disorder and depression

Dysphoria means loss of pleasure or joy. (You may know the more common word euphoria, which means extreme joy. They share the same root.) Many people who have epilepsy experience dysphoric episodes. These episodes, which can last between a few hours and a few days, consist of depressive moods, irritability, lack of energy, pain, anxiety, insomnia, and euphoric moods. Usually they are part of a syndrome known as interictal dysphoric disorder instead of being linked to recent or upcoming seizures.1 (Interictal means "between seizures.")

People with interictal dysphoric disorder (IDD for short) aren't always depressed; there are times when everything is OK, and times when everything is not. These times are connected to seizures, but not the way you might think. Often IDD is discovered or becomes worse when seizures are fully controlled or less frequent. Some scientists believe that the same chemicals and paths that slow or stop seizure activity also lower levels of other brain activity; this change can be linked to depressed mood and many of the symptoms of IDD.

What's the difference between IDD and depression? Some people have long, severe, and consuming dysphoric episodes. These people have a different mood disorder: major depression. Many of the symptoms are the same as in IDD. The difference lies in their severity. With depression, these symptoms are present for 2 weeks or longer without letting up. Thoughts of death appear repeatedly and suicide may be considered or attempted.

In the general population, about 5% to 10% of people are affected by depression or a related mood disorder. The percentage is much higher for people with epilepsy. (The exact numbers vary depending on how the study is designed.) If you have symptoms of depression or IDD, please talk to your doctor. There are many treatments that can help you. You just have to ask.

Anxiety disorders

Probably the next most common psychological disorders involve anxiety. Anxiety and epilepsy are so closely linked that seizures sometimes are mistaken for panic attacks in those who have never had seizures before.

About 4% of the general population has generalized anxiety disorder, a constant state of tension or worry. Again, the number is much higher for people with epilepsy. It's possible that this disorder is caused or made worse by seizures. Anxiety disorders have been associated with the amygdala, a structure in the front part of the temporal lobe. The seizures of temporal lobe epilepsy frequently affect the amygdala and cause it to act in different ways. Anxiety can also be directly related to the possibility of seizures. Not knowing when a seizure may occur can increase worry about having one in an embarrassing or dangerous situation.

Certain kinds of people are more susceptible to anxiety disorders. Genetic influences and a person's response to stress may play a part in their development. Women are more likely than men to have anxiety disorders, and patients with nonepileptic seizures also have higher rates of anxiety. The presence of auras involving fear has been linked to anxiety disorders; in patients who had the front part of their temporal lobe removed, only those who previously had fear auras continued to have anxiety disorders after surgery.

If you have problems with anxiety, talk to your doctor. There are medications that are effective for anxiety, and some seizure medicines are known to have an anti-anxiety effect.

Topic Editor: Andres M. Kanner, M.D.
Last Reviewed:10/21/03