The Interplay Between Anxiety and Epilepsy: Understanding the Neurological Link
By Shivani Narasimhan
Background
Over 2,000 years ago, Hippocrates identified a two-way connection between depression and epilepsy, noting that "melancholics often become epileptics, and epileptics, melancholics," depending on how the illness progresses. Despite this early observation and subsequent recognition by physicians of the link between epilepsy, depression, and anxiety, these mental health conditions in people with epilepsy (PWE) were largely overlooked in epilepsy research and treatment for many years. Recent epidemiological studies, however, have shown that depression affects 9-37% of PWE, while 11-25% experience anxiety—both of which are significantly higher rates than in those without epilepsy.
Correlation between Depression/Anxiety and Epilepsy
Depression and anxiety are more prevalent in people with drug-resistant epilepsy, especially in those with temporal lobe epilepsy (TLE), than in the broader population of people with epilepsy (PWE). Recent research has identified depression and anxiety as risk factors for drug-resistant epilepsy in newly diagnosed patients, and these conditions are also associated with poorer outcomes following epilepsy surgery. Additionally, patients with epilepsy and with depression and anxiety tend to experience more adverse effects from antiepileptic drugs (AEDs). As a result, the presence of these psychiatric conditions can significantly impact the quality of life for PWE, highlighting the importance of early detection and management to improve patient outcomes. This article would further deep dive into case scenarios highlighting the comorbidities in Epileptic patients - One being Anxiety and Depression.
Case Scenario 1
The following example illustrates a realistic scenario summarized by the members of the epilepsy unit at the Hospital del Mar Medical Research Institute (IMIM-Hospital del Mar) based on the results obtained from 500 different patients with epilepsy. The study of 493 patients (out of 500) with drug-resistant epilepsy admitted to Hospital del Mar (2013-2021) aimed to identify seizure origins and assess surgical options. Over 71% reported poor quality of life, while half showed signs of depression, and 53% had anxiety.
Case Scenario 2
A cross-sectional study was conducted from October 2021 to March 2022 at Prince Mohammed bin Abdulaziz Hospital, involving 147 respondents (65.6% response rate) with epilepsy. Depression was assessed using the PHQ-9 scale (Patient Health Questionnaire), and anxiety with the GAD-7 scale (Generalized Anxiety Disorder). Demographic variables, including sex, age, marital status, and epilepsy-related factors, were also recorded. The results revealed that 39.5% of participants were diagnosed with major depressive disorder (MDD), while 27.9% were diagnosed with generalized anxiety disorder (GAD). Consequently, the study highlighted that patients with epilepsy were more susceptible and higher prevalence to MDD and GAD.
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