By: Clara O’Hara
Depression in Teens with Epilepsy
Depression across the world affects children and teens with epilepsy. In the U.S., depression in teens with epilepsy ranges between eight to thirty-five percent and is higher than the general population of the same age. The risk of depression becomes more difficult when the teen has lower cognitive functioning, language disorders, and lower scores in specific neuropsychological domains. Age seems to be the least involved in the development of depression.
Impact of Depression on a Teen with Epilepsy
In adolescents with epilepsy depression could interfere with the overall management and quality of life, leading to poor scholar and social functioning, as well as to increased health care system requirements, poorer seizure control, and increased antiepileptic drugs (AED) adverse events. Therefore, comorbid depressive disturbances represent a heavier burden of the disease, particularly at this age.
The issue of how children who have epilepsy feel about themselves and how they get along with others, is not completely understood. Some studies suggest that children with epilepsy might have lower self-esteem because of their disorder. Other studies show that children with epilepsy have poorer self concepts than children with other chronic medical conditions and frequently struggle in school and other social settings. These experiences might lead to poor self-esteem and symptoms of depression.
Depression is under-diagnosed and inadequately treated particularly during adolescence. In a study of the increased rate of self-reported symptoms of anxiety and depression, no patient out of forty-two pediatric patients, ranging from 7 to 18 years, were diagnosed with anxiety or depression. However, twenty-six percent of the patients had exceeded the clinically significant cutoff point for increased self-reported depression. This suggests, with lack of other previously published information, that such symptoms may be poorly recognized in pediatric patients with epilepsy. Furthermore, if healthcare providers do not inquire directly about potential depressive or anxiety-related symptoms, such symptoms may not be detected.
To see if a teen with epilepsy has depression, some important symptoms observed are:
Problems falling asleep or staying asleep; Sleeping too much; Changes in appetite; Greater sensitivity to rejection; Poor self-esteem; Hopeless thoughts; Thoughts of suicide; Irritability; Temporal lobectomy (surgery to remove part of the temporal lobe of the brain); Having epilepsy early in life; A tendency to be impulsive and have outbursts of violent behavior.
Some of the risk factors associated with suicide:
Mood disorders (major depressive disorder and bipolar disorder); Psychotic disorders; Personality disorders; Substance abuse (for example, drugs and/or alcohol); Earlier suicide attempts; History of suicide attempts or completed suicides in the family; Critical life events
According to studies, an epilepsy patient who commits suicide is more likely to be someone who:
Has early onset epilepsy; Is an adolescent; Has seizures often; Takes two or more antiepileptic medications (AEDs) at the same time; Has a history of major depressive disorder
Cognitive behavioral therapy (CBT) is appropriate for children who are approaching the teen years and who are able to think about themselves and their relationships with others and with their illness. CBT helps the child interrupt and change the negative thoughts that sometimes pile on when things are not going well. CBT can be very effective; it takes the expertise of a behavioral health specialist who can coach the child to learn and practice strategies that help to improve mood. It also takes the family and the patient to practice these techniques
Depression affects teens, and children of all ages, with epilepsy more than the general population. The risk of depression affects teens with epilepsy more if diagnosed with low cognitive functioning, language disorders, and low scores in neurophysiological domains. It affects their ability at school and socializing in other social settings. It affects the self-esteem in their disability and themselves. Healthcare providers need to do more to address and notice these causes in depression in teens with epilepsy. Appropriate treatment could be cognitive behavioral therapy for teens.
Coppola, G., Operto, F. F., Matricardi, S., & Verrotti, A. (2019). Monitoring And Managing Depression in Adolescents with Epilepsy: Current Perspectives. Neuropsychiatric Disease and Treatment, Volume 15, 2773-2780. https://doi.org/10.2147/ndt.s192714
Ettinger, A. B., Weisbrot, D. M., Nolan, E. E., Gadow, K. D., Vitale, S. A., Andriola, M. R., Lenn, N. J., Novak, G. P., & Hermann, B. P. (1998). Symptoms of Depression and Anxiety in Pediatric Epilepsy Patients. Epilepsia, 39(6), 595–599. https://doi.org/10.1111/j.1528-1157.1998.tb01427.x
Pediatric Epilepsy and Depression. (n.d.). https://my.clevelandclinic.org/-/scassets/files/org/neurological/epilepsy/pediatric-epilepsy-and-depression-fact-sheet.ashx?la=en