By: Asma Sehrish
Photo Credit: The Defeating Epilepsy Foundation
Introduction
Epilepsy is a neurological condition that is characterized by regularly occurring spontaneous seizures. Abnormal electrical bursts in the brain cause change in movement awareness of behavior and emotions. The World Health Organization (WHO) estimates that 50 million people suffer from epilepsy around the world. Almost 80% live in low-income and middle-income countries, where medication for neurological care and mental health services is limited (World Health Organization 2024). Women who suffer from epilepsy experience a multi-layered challenge. Everyday life is influenced by depression, anxiety, stigma and barriers to work, menstrual fluctuations and side effects of medications during pregnancy. While these struggles vary among women, they can be understood by patient’s families and clinicians to provide more respectful care.
Mental Health Challenges
Depression and anxiety are deep-seated in epilepsy. By dozens of studies and data, Qin and colleagues (2022) found depression in 27 percent of population-based samples and 34 percent in clinical settings. Risk factors include frequent seizures, low income, being unmarried, being a female, and diminished quality of life. Depression will not occur in all women with epilepsy. Emotional health is a part of regular epilepsy care. Symptoms of depression can include sadness, loss of interest, fatigue, changes in sleep or eating patterns, feelings of guilt, feelings of hopelessness, poor concentration or thoughts of death. Excessive worry, fear of another seizure, restlessness, sleep difficulty, or social avoidance are common symptoms of anxiety. Some women who have chosen to stop driving, stop going to school, or attending meetings for fear of having a public seizure. Sometimes the mood symptoms are viewed as a natural consequence of epilepsy or simply a side effect of the medication. They should be asking specifically about emotional health and not leave it up to the patient to raise.
Medication and Mood
Some anti-seizure medications may cause irritability, anxiety, depression, sedation, or emotional blunting. Kanner (2016) reported that many antidepressants are considered safe when used appropriately and that most SSRIs and SNRIs are safe if used at therapeutic dosages in people with epilepsy. Antidepressants come in a variety of sizes and do not fit everyone. Each decision must be made on an individual basis by a qualified professional. Patients should never simply end their dose reduction or change their anti-seizure medication without consulting their physician because a sudden drop in medication levels can lead to seizures.
Stigma Relationships and Employment
Stigma affects the way women think about themselves and how they are treated by others. After being diagnosed they fear rejection or being judged as incapable. They may hide epilepsy from employers or prospective partners of friends.
In Pakistan, the studies showed that psychosocial stress in marriage education and social life is correlated with epilepsy. In Pakistan, Aziz and co-workers (1997) found that experiences of stigma and psychosocial issues vary widely. Context and culture matter mostly. Disclosure and marriage can carry weight or burden. A female should determine when and how to inform a potential husband about epilepsy. It is possible that the disclosure will come to rejection, or there may be mistrust created due to silence. Jawaid (2025) framed this as a conflict between privacy and a partner’s right to informed choice.
Yeni and colleagues (2018) correlated the knowledge of attitudes, stigma, anxiety, depression, and quality of life. Misconceptions can be reduced, and quality of life can be raised through education and supportive communication. No study can provide information about all cultures.
Work also suffers: Safety fears and discrimination are barriers to jobs and promotion. Financial stress begins and self-confidence diminishes.
West Dye and McMahon (2006) examined formal workplace discrimination complaints in the USA. Approximately three-quarters were post-hire problems such as termination, harassment, or being turned down for a promotion. Hiring complaints was the least common. The study followed the outcomes of the Supreme Court’s Sutton decision. It is a formal complaint, not an overall discrimination rate, and cannot be interpreted as guidance to persons seeking employment by the epilepsy organizations.
Reasonable accommodation helps: Flexible schedules, seizure safety plans, rest breaks, modified duties, or appointments make work possible. The right fit is dependent on the health job and the local law.
Hormones and Physical Health
Hormones sway seizure patterns in some women. Estrogen stimulates the brain and increases the risk of seizures. Progesterone and its neuroactive metabolite allopregnanolone can often claim neuronal activity, and its effects vary.
Certain women experience an increase in seizures at certain times of their menstrual cycle. If this pattern continues, it is called ‘catamenial epilepsy’. It was reviewed by Herzog (2008), who defined its definition of prevalence mechanisms and treatment.
Only one rough month does not make an appropriate diagnosis. Neurologists can identify true patterns by monitoring seizures by menstrual dates, sleep stress, and medication.
Hormonal changes during pregnancy, childbirth, and perimenopause may affect the response to seizures, sleep, stress, and mood. A woman should consult a neurologist before pregnancy about medication and pregnancy plans.
Pregnancy and the Postpartum Period
Pregnancy poses difficult questions about medication safety, childbirth, breastfeeding, fetal health, and seizure control. Women should take individualized preconception counseling rather than stopping medication out of fear. Uncontrolled seizures also pose a threat to the mother and baby.
Bjørk and colleagues (2014) reported increased levels of peripartum depression and anxiety among women with epilepsy compared with comparison groups. Bjørk and team (2015) summarized the frequency of risks and treatment considerations for depression and anxiety during pregnancy and postpartum.
These papers can assist with mental health monitoring during pregnancy and postpartum. It doesn’t mean that all women must suffer. Screening and support should be personalized to individual symptoms.
Medication requires special concern and attention during pregnancy. Seizures can be balanced by guidance with fetal safety. Valproate carries significant teratogenic and neurodevelopmental risks in pregnancy while other drugs may appropriately suit the certain cases. Depending on the type of syndrome and seizure type, the right choice might depend on response to pregnancy plans and overall health before pregnancy.
Never discontinue medication suddenly. Pregnant women or women who are thinking about becoming pregnant or breastfeeding should consult and coordinate care with neurology and obstetrics.
Diagnosis and Treatment
Diagnosis depends on clinical history about seizure description examination and tests such as EEG brain imaging and labs. Mental health assessment is important for seizure management and quality of life due to depression and anxiety.
Screening Instruments
Screening instruments identify individuals for more in-depth assessment. They do not diagnose individually.
The PHQ 2 screens briefly for depression. It has been validated by Kroenke Spitzer and Williams (2003) as a fast screen for those who require a comprehensive evaluation.
The GAD 7 screens for anxiety. Kroenke and colleagues (2007) examined anxiety disorders and anxiety screening in primary care. In a sample of epilepsy patients in France, Micoulaud Franchi and colleagues (2016) confirmed the validity of the GAD 7 in conjunction with the NDDI E.
For appropriate diagnosis, scores need professional interpretation. If scores are positive, this does not indicate a “diagnosed disorder,” but rather a suggestion to proceed with further evaluation. Biondi and colleagues (2024) tested a digital mental health screening tool for epilepsy. Digital tools cannot replace clinical judgment and human contact to catch missed distress.
Access to Treatment
Shortage of medication, stigma, and limited mental health services slow down care for cost distance transport specialists. This is more pronounced in rural and low resource areas. Le Pichon and team (2022) discussed virtual tools to narrow neurology disparities including epilepsy. Telehealth can provide patients with access to education and follow up from specialists. It doesn’t solve or fix all the problems. Access to the Internet, digital literacy, language, and continuity of care remain necessary. The disparities in epilepsy care and the need for equitable access to diagnosis, treatment, and support were emphasized by Kapur and colleagues (2025). McGinley and colleagues (2024) charted geographic disparities in neurologist and MS care in the United States. That study was not specific about epilepsy, but it also demonstrates how location affects neurological access.
Medication Options and Side Effects
Anti-seizure drugs are selected based on the type of seizure syndrome, age of the person, reproductive plans, and other medications that they are taking, and their response. The aim is to control seizure activityl with minimal side effects.
Side effects vary; Sleepiness, dizziness, inability to concentrate, trouble with weight shifts, irritability, mood changes, nausea or coordination problems can happen. Other drugs have more of an impact on mood. Pisani and colleagues (2023) provided an overview of therapy optimization for seizures with psychiatric comorbidities highlighting the importance of considering both seizure control and mental health. Hormonal contraception and/or reproductive hormones interact with some anti-seizure drugs. Medication can also affect weight, energy, sexual health, or mood. Patients should discuss it openly with a neurologist. Not all symptoms are a result of medication. Not all symptoms are due to epilepsy. It’s necessary to review symptoms and side effects carefully. Women who could become pregnant should receive counseling on contraceptive options, pregnancy planning, folic acid, medication, risk, and control of seizures. Decisions must be made on an individual basis, NOT on the basis of internet advice.
Other Care Options
Medication is a real care. Neurological treatment combined with psychological social and lifestyle support is beneficial for many women.
Psychological Care
Cognitive behavioral therapy (CBT) helps patients control anxiety, catastrophic thinking, avoidance, and fear of future seizures associated with depression. Psychoeducation includes education for patients and families about epilepsy treatment, seizure first aid, and responses to stigma. Mental health professionals can also provide assistance for grief, trauma relationship issues, identity workplace stress, and coping with chronic illness. Thoughts of self-harm require urgent professional help or emergency services.
Lifestyle and Stress Management
Healthy habits always support wellbeing and seizure management. One must make sure to get enough sleep. Take medication as prescribed on time. Attend appointments. Keep records of their seizures, menstruation cycles, sleep, and triggers. Follow a balanced diet and consult with a clinician about special diets. Use gentle physical activity if safe. If it feels comfortable, practice relaxation or mindfulness, breathing, yoga, or meditation. Ask for support from trusted family peers or trusted epilepsy organizations. These practices are used to assist but should not be used for treatment. Exercise and complementary approaches must be compatible with seizure type to control physical health and safety needs. Puteikis and colleagues (2026) found an eight-week cognitive and psychosocial rehabilitation program lifted quality of life and lowered anxiety in people with epilepsy with benefits lasting up to 16 weeks. Structured rehabilitation has promise but cannot be applied to all women or all types of epilepsy.
Practical Recommendations
For Women with Epilepsy
Learn first aid techniques to manage one’s seizures. Don’t blame yourself for any misconceptions about epilepsy. Physicians should encourage treatment and not make decisions for the patient. Listen carefully to concerns regarding marriage, pregnancy, work, and medication. Support the woman’s independence and informed choices related to epilepsy.
For Families
Learn seizure first aid and how to follow a seizure action plan. Avoid blaming the person, shaming them, and supporting negative stereotypes about epilepsy. Encourage treatment without making decisions for the patient. Listen respectfully to concerns about marriage, work, pregnancy, and medication. Support the woman’s independence and informed choices.
For Clinicians and Organizations
Regularly assess for depression and anxiety. Keep records about menstrual cycle related seizure changes. Provide culturally sensitive counseling about marriage disclosure, pregnancy, and contraception. Keep a record list of medication effects on mood, weight, sexual health, and reproductive planning. Improve referral systems for neurology, mental health, obstetrics, and primary care. Increase availability of affordable care tele-education and support in less-served areas.
Conclusion
Women with epilepsy experience seizures, mental health, hormone imbalances, pregnancy, side effects of medication, employment challenges, and stigma. Anxiety and depression are typically treatable and are part of the everyday care of people with epilepsy. Some may experience changes in seizure patterns due to hormonal changes. More careful medical and psychological monitoring is required during pregnancy and post-natal period. Medication needs to carefully select both seizure control and mood side effects against contraception and reproductive plans. Screening can identify distress and cannot take the place of diagnosis by a professional. Care is best administered in a personalised and team-based way. Women with epilepsy should be provided with accurate information, respectful communication, and appropriate treatment and support when they are making decisions regarding health relationships, work, and future. Epilepsy can influence a woman’s life, but it can never define her worth.
References
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