Epilepsy Exacerbates Suicide Risk
> 7/16/2007 10:23:41 AM

Epilepsy, a chronic condition marked by the repeated occurrence of seizures both conditional and unprovoked that affects an estimated 1 percent of the population, can range in nature from an irritating tic to a constant, debilitating handicap that negatively effects physical health and quality of life. Beyond the recurring disconnects and subsequent obstacles presented by the disorder, diagnosed patients face a markedly heightened suicide risk. A recent study of almost 450,000 residents of Denmark revealed that those diagnosed with epilepsy were more than three times as likely to eventually die by their own hands. After researchers disregarded patients with previous psychiatric diseases and controlled for marriage status, socioeconomic and age-related factors, epileptic individuals still registered a suicide rate more than double that of the general population. Among those with pre-existing mental illness, rates were nearly fourteen times that of control cases. The numbers grew particularly stark when considering women and those recently diagnosed with the condition: mentally ill individuals diagnosed with the condition fewer than six months before initially participating in the study were 29 times as likely to commit suicide. Percentages were higher for women than men, and, interestingly, the recorded suicide risk decreased as patients aged.

Beyond its sidelining physical side-effects, why is epilepsy so often an emotionally crippling condition, and how can those suffering from its most severe manifestations receive the appropriate care necessary to achieve some semblance of relief? The mechanisms of seizure, by nature, disrupt the functions of the brain in their areas of locus, leading to chemical and hormonal imbalances that, in clinical research, bear a notable resemblance to those present in patients with depression and anxiety disorders. Specifically, the secretion of neurotransmitters serotonin and dopamine is often disrupted or unbalanced in epileptic patients, with lower levels of each particularly after seizure. Some in fact experience a dip in mood directly after each seizure. This period can last from several minutes to several days, and the frequency of seizures can contribute. The relationship between depression and epilepsy appears to be mutually dependent in many cases as well: previous research suggests that the seizure patterns of individuals with comorbid depression do not respond as well to the standard medical regimen. Physicians and casual observers have long noted that "melancholics" are predisposed to seizure disorder; experts suggest that depression may be a marker for more severe epilepsy and that the condition itself could directly foster depressive states, estimating its prevalence among the epileptic population at 20-50%. Clinical trials have rated the incidence of depression among epileptics at three times that of the unaffected population. Such depressions often go untreated due to the false perception that somewhat downcast moods are a normal reaction to epilepsy, brought about by the idea of oneself as a diseased individual as well as the disruptions that frequent seizures can bring upon one's daily schedule, career and relationships.

Epilepsy is still a largely misunderstood condition, and its effects can create formidable hurdles along the path toward one's ideal social, professional and emotional state. Care providers and psychiatrists need to pay particular attention to epileptic patients when considering treatments for depression and the possibility of suicidal ideation. Asking the patient about his or her mood or providing related questionnaires could be a first step. Epilepsy can be overcome completely, even in its more extreme cases, and those whose seizures continue after treatment can still lead normal and productive lives. But they need to be aware of the amplified risks they face. Their condition need not be a debilitating influence, but increased scrutiny and regular emotional appraisals can only be a good thing.

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