Epilepsy and Psychological Disorders

Epilepsy is not a mental illness. In fact, the vast majority of people living with epilepsy have no cognitive or psychological problem. For the most part, psychological issues in epilepsy are limited to people with severe and uncontrolled epilepsy.

Epilepsy and Intellectual Disability

Epilepsy itself does not cause severe intellectual problems, but the two can occur together and be caused by the same thing. For example, low oxygen, injury or infection at birth may cause mental retardation, epilepsy, and cerebral palsy.

The degree of cognitive or intellectual problems is related to

• epilepsy starting at an early age
• having many seizures
• having an underlying brain lesion
• poor seizure control
• how long it takes to get seizures controlled

In young children, development can be delayed due to uncontrolled seizures.

Individuals with severe intellectual problems have higher rates of brain abnormalities (or changes in the brain structure). They may result in different kinds of seizures.  These also usually start in early life.

Epilepsy and Depression

Depression in people living with epilepsy is very common and an important issue for children and adults. Symptoms of depression can be constant or change over time. They can vary from mild to severe and may have a great impact on daily activities and quality of life. Depressed persons may lose interest in hobbies; have changes in appetite; feel sad, angry, or scared; and have trouble sleeping.

Many possible causes of depression in people living with epilepsy have been identified.

• The most common cause is injury to a part of the brain that controls mood.
• Hormone levels, especially low estrogen, can also trigger depression and can affect seizure frequency.
• Anti-seizure medications, like phenobarbital, can affect mood centers and may increase risk of depression.

Depression, with or without epilepsy, is treatable.

• Treating depression and epilepsy involves identifying the best combination and the lowest dose possible of anti-seizure medications and antidepressants to maintain seizure control and improve depression.
• Psychotherapy, education, and family therapy can also be very helpful. 

Epilepsy and Cognitive Disorders

• The most frequent cognitive complaints in adults are feeling slowed down mentally, memory impairment, and attention problems.
• Memory problems are an important feature of seizures arising from one part of the brain called the temporal lobe. Short-term memory problems are seen most often.
• Dementia has also been diagnosed in some people with poorly controlled epilepsy.
• Medications can also affect memory.

Epilepsy and Anxiety

Anxiety is related to epilepsy in different ways.

• Anxiety can occur as a reaction to the diagnosis, a symptom of seizures, or even a side effect of some anti-seizure medications.
• Most frequently, anxiety appears after the diagnosis of epilepsy or after the first seizure and can involve the fear of having another event.
• Feeling social isolated or rejected due to epilepsy may influence anxiety symptoms.
• Causes of epilepsy can also play a role in development of anxiety.

The best way to address these problems include psychotherapy, counseling, behavioral therapy, and, in some cases, anti-anxiety medications. Learn more about anxiety and epilepsy.

Epilepsy and Behavioral Issues

• Epilepsy influences the lives of people with seizures and families as it restricts activities and forces specific behaviors. Taking medicines, not driving, maintaining regular sleep cycles, limiting alcohol use, and making other lifestyle changes can lead to feeling a loss of independence.
• Factors associated with behavioral problems involve fear, stress, frustration, and embarrassment of having seizures.
• Areas in the brain that control emotions and behavior may not work properly due to epilepsy.
• Finally, anti-seizure medications can change the balance of chemicals in the brain that may affect a person’s behavior.

Side Effects of Medications

Many anti-seizure medications can cause psychological changes.

• Older medications like phenytoin, carbamazepine, and phenobarbital have been related to memory difficulties.
• Topiramate has been associated with word-finding difficulties; however, these tend to be related to high doses. Newer medications are less likely to cause this type of side effect.
• Levetiracetam is associated with changes in mood or behavior and can worsen other psychiatric conditions.
• Some seizure medications can be helpful and be used as mood stabilizers too, (for example lamotrigine, carbamazepine, valproic acid). These tend to have a positive effect on memory, behavior, and anxiety.
• Older people living with epilepsy are more vulnerable to the side effects of anti-seizure medicines.
• Learn more about seizure and epilepsy medicine side effects.

Non-drug Treatments

• Epilepsy surgery usually does not cause psychological problems, and, by virtue of improving seizure control, it can even help memory.
• Neurostimulation is another technique that can improve mood and quality of life over time.

Getting Help

• All psychological and cognitive symptoms should be reported to your primary care provider and neurologist. 
• Specialists in neurology, psychiatry, and psychology, as a team, can take better care of these issues.
• In people living with epilepsy who have significant cognitive changes, memory rehabilitation can help.
• Education and support can help people with seizures and families learn about the disease, understand it, and cope with the diagnosis.
• Explore the “Managing Your Epilepsy” section of epilepsy.com to find information and tools that may help.