By Chadrick Lane, M.D., Psychiatry
More than 2,000 years ago, Hippocrates, the Greek physician and “father of medicine,” wrote about the relationship between depression and epilepsy – and how that relationship goes both ways.
People with epilepsy are at increased risk for mental health disorders, yet only 21% of epilepsy centers include a psychiatric evaluation as part of the workup for epilepsy surgery.
Today, we know that people who have mental health conditions are two to three times more likely to develop a seizure disorder than the general population. And patients with epilepsy are known to have higher rates of mental health conditions, such as depression, anxiety, and psychosis. Compared with their peers, these patients also have a 40% to 50% higher rate of suicide, with those numbers increasing for patients with medication-resistant epilepsy – when at least two medications do not achieve sustained freedom from seizures.
Because of this interconnectivity, it is critical to involve mental health professionals in the care of patients with epilepsy. The International League Against Epilepsy’s guidelines recommend every person being considered for epilepsy surgery undergo a psychiatric evaluation.
Unfortunately, this is a resoundingly unmet need across the country.
UT Southwestern’s Epilepsy Program is one of just 21% of comprehensive epilepsy centers in the U.S. that includes a psychiatric evaluation as part of the surgical workup. In most centers, access to follow-up psychiatric care is even rarer. As a Level 4 epilepsy center, UT Southwestern provides the highest quality evaluation and treatment – and that includes embedding mental health care for our patients with epilepsy.
How epilepsy and mental health are connected
Epilepsy and mental health conditions are a result of changes in brain function. Many of the neural networks involved in seizures are also instrumental to mood regulation and cognition.
Depression or anxiety likely develop as a result of complex neurobiological, psychological, and social factors, or even as a side effect of some epilepsy treatments.
'Neuropsychiatrists focus on treating cognitive, emotional, and behavioral symptoms caused by brain disorders, and at UT Southwestern we collaborate with our epileptologists on patient-care strategies, especially for those with medication-resistant epilepsy.'
- Chadrick Lane, M.D., Psychiatry
That’s why neuropsychiatrists, who focus on treating cognitive, emotional, and behavioral symptoms caused by brain disorders, should collaborate with epileptologists on patient-care strategies especially for those with medication-resistant epilepsy. Some may be eligible for surgery to potentially stop or decrease the frequency and severity of their seizures.
For example, temporal lobectomy is an evidence-based surgery for the most common type of focal epilepsy, in which seizures start in the temporal lobe of the brain. The temporal lobe is also instrumental to emotional regulation and memory.
Ongoing mental health care is of the utmost importance as a percentage of patients may notice recurrent or new psychiatric symptoms in the months following surgery. Knowing this information, we embed neuropsychiatrists such as myself in our epilepsy team to help plan follow-up care and decrease mental health risks.
The good news is that combined epilepsy and mental health treatments are effective. Medical literature shows that by a year after temporal lobectomy, most patients’ mental health is either comparable to or better than before surgery.
What to expect if you’re considering epilepsy surgery
In our program, meeting with a neuropsychiatrist will become a regular part of your pre- and post-surgical care. Before epilepsy surgery, we evaluate and set a baseline of your mental health to compare with after surgery.
This conversation also helps us understand how closely to monitor you based on your personal and family mental health history. We’ll discuss potential symptoms to watch for, such as:
- Anxiety
- Depression
- Difficulty concentrating or remembering
- Fatigue
- Distressing thoughts or perceptions
After surgery, we will continue monitoring how you’re feeling. If you begin to have mental health symptoms, we can start treatment right away. If you have thoughts of harming yourself or others, call 911 and/or go to the nearest emergency room.
How we treat psychiatric conditions in people with epilepsy
Weekly, neurologists, neurosurgeons, a neuropsychiatrist, and radiologists in the UT Southwestern Epilepsy Program meet to discuss patients who are being considered for epilepsy surgery. We combine our expertise to develop a comprehensive treatment plan for each patient.
Psychotherapy
We recommend psychotherapy to a large percentage of patients in our program. Also called “talk therapy,” it involves one-on-one and/or group sessions. Several types of psychotherapy have been demonstrated to help patients handle difficult emotional states such as anger, anxiety, and depression.
Medication
Medications, when carefully chosen for indicated symptoms, can be effective for patients with epilepsy. Some anti-seizure meds have a higher risk of psychiatric complications or may interact with other medications. Your epileptologist and neuropsychiatrist can work together to determine which medications and dosages are safe and beneficial for your needs.
How to advocate for your mental health
If mental health problems are affecting your life, it’s important to know that help is available. Talk with your epileptologist or primary care physician and ask about a referral to a mental health professional. You also can check with your local mental health authority to find providers and resources in your community.
I encourage patients who have epilepsy that has not improved with at least two medicines to talk to their neurologist about potential surgical options. If they are unable to offer such treatments, ask for a referral to a Level 4 epilepsy center such as UT Southwestern.
Prior to surgery, you’ll receive a psychiatric evaluation, followed by ongoing care from our mental health professionals.
Every person with epilepsy deserves highly quality care for both physical and emotional health. It is an enormous privilege for our team of epilepsy experts to help people achieve both of those goals.
To talk with a specialist about mental health and epilepsy care, call 214-645-8300 or request an appointment online. If you’re in crisis, call 911 immediately.