Teens, Epilepsy and depression are linked!

Teenagers who have epilepsy often face a double whammy because along with the seizure disorder, they're much more prone to depression and other psychiatric problems.

In fact, up to 60 percent of all teens with epilepsy will experience depression or another psychiatric illness, according to a new study in the March issue of the journal Neurology.

What's worse, only about 33 percent of those teens will receive treatment, according to the study. That lack of treatment may put teens with epilepsy at a higher risk for suicide as well. The study reported that up to 30 percent of people with epilepsy had attempted suicide, compared to about 7 percent of people without the disorder.

"Kids with epilepsy are sort of hit twice," said Dr. Sigita Plioplys, a pediatric neuropsychiatrist in the department of child and adolescent psychiatry at Children's Memorial Hospital in Chicago. "There's an enormous stigma associated with epilepsy, and they may feel ashamed or burdened by having epilepsy. And mental disorders also have a profound stigma attached to them. Many kids will tend to minimize their depressive symptoms until they can't function any more."

Dr. Gary Trock, director of pediatric neurology at Beaumont Hospital in Royal Oak, Mich., said teens with epilepsy aren't the only ones who tend to minimize their symptoms.

"Parents are often hesitant to ask for a referral to a psychiatrist or psychologist because of the stigma associated with it," he said, adding that the problem can be compounded if the family's health insurance doesn't pay or severely limits payments for mental-illness care.

As many as 2.7 million Americans have epilepsy, according to the Epilepsy Foundation. It is a neurological disorder that causes seizures or brief blackouts. The disorder varies in severity, with some people experiencing occasional seizures, while others have frequent seizures. Most seizures can be controlled with medications, though the side effects -- sleepiness, slowed mental function -- can be hard for some people to tolerate.

In a recent study of adults with epilepsy, 85 percent said their medicine was effective at controlling their seizures, but almost two-thirds said their medicine's side effects keep them from "living the life they want to live."

According to the Neurology report, it has been known for some time that teens with chronic illnesses are more likely to suffer from depression. However, the association between teens with epilepsy and depression appears to be even stronger.

That's probably true for a number of reasons, suggest the study authors, from the University of Liverpool in England. One reason may be that epilepsy and depression are affected by the same neurotransmitters -- the brain's chemical messengers that help tell the rest of the body what to do.
But, Plioplys noted that researchers really don't know for sure why there's such an increased risk of depression in teens with epilepsy.

"Depression is a multi-factorial illness. There are biological factors, psychological and social factors that cause depression. We can't state that one factor is most prominent in causing depression," she explained.

One thing is clear, however. The more seizures a person has, the more likely they are to experience depression. About 9 percent of people with epilepsy struggled with depression, according to one study highlighted in the new review. But among those with frequent seizures, the depression rate jumped to 21 percent.

The bottom line, said both Trock and Plioplys, is that parents and medical professionals need to be aware that depression and an increased risk of suicide are common among teens with epilepsy, and they need to be on the lookout for signs of depression.

"These children are vulnerable and at risk," Plioplys said. "Depression can go unnoticed for months and years, and the high risk of suicide is a very dangerous condition."

She said medications for seizure control may mask depression because one of the common side effects of some drugs is sleepiness. Fatigue and excessive sleeping are often hallmarks of depression. But in a teen on seizure medication, it can be hard to know what's a side effect of the medicine and what's a sign of depression, she explained.

Irritability, anger, learning problems, regressive behavior and oppositional and other conduct-behavior problems can all be signs of depression in teens.

"If your child is sullen, angry, withdrawn, spending less time with friends, and school grades are declining, don't just write it off as a moody teenager or something that will pass," Trock said.
Both Trock and Plioplys said it's important to get treatment, either with psychotherapy or medications.

And, Plioplys added that, although it can be difficult to get an appointment with a child psychiatrist because of a shortage of qualified doctors, it's important to get your child help. Psychologists, psychiatrists, social workers, and even your child's neurologist can be a good place to start, she said.