Identifying Mood and Anxiety Disorders in Patients With Epilepsy

Postictal psychiatric symptoms are also an unrecognized cause of poor quality of life. For example, the median duration of postictal psychiatric symptoms is 24 hours, Dr. Kanner pointed out. “What is worse, a seizure that lasts one to two minutes or 24 hours of thinking, ‘How am I going to kill myself?’” Cognitive behavioral therapy is a good option for postictal symptoms that do not respond to pharmacotherapy. “We teach patients that they are dealing with short-duration, time-sensitive symptoms and show them strategies to overcome them, particularly suicidal ideation.”

Panic Attack or Ictal Fear?

Symptoms of fear that patients experience as part of their epileptic seizure are often misdiagnosed as a panic disorder, Dr. Kanner said. “However, by taking a careful history, physicians can identify red flags to help distinguish between the two.”

With panic disorder, for example, consciousness is usually preserved, whereas patients with ictal fear can report confusion, difficulty focusing, or the need to take a nap after the panic episode. Also, the duration of a panic attack is at least five minutes and can last up to 20 minutes with anxiety symptoms persisting for hours, while ictal fear typically lasts less than one minute. Patients with ictal panic may salivate excessively, but people with a panic attack have a dry mouth. Patients with ictal panic rarely experience agoraphobia, but those with panic attacks do. “Furthermore, the intensity of the fear is not as strong [in ictal fear] as that of the patient with a panic attack,” Dr. Kanner noted. “The panic attack patient has a feeling of impending doom. They think they are going to die.” The two conditions are not mutually exclusive, however. Patients with ictal fear have an increased risk of panic disorder, compared with the general population.

—Adriene Marshall

Suggested Reading

Alper K, Schwartz KA, Kolts RL, Khan A. Seizure incidence in psychopharmacological clinical trials: an analysis of Food and Drug Administration (FDA) summary basis of approval reports. Biol Psychiatry. 2007;62(4):345-354.

Kanner AM, Barry JJ, Gilliam F, et al. Depressive and anxiety disorders in epilepsy: do they differ in their potential to worsen common antiepileptic drug-related adverse events? Epilepsia. 2012;53(6):1104-1108.

Perucca P, Jacoby A, Marson AG, et al. Adverse antiepileptic drug effects in new-onset seizures: a case-control study. Neurology. 2011;76(3):273-279.

Tellez-Zenteno JF, Patten SB, Jetté N, et al. Psychiatric comorbidity in epilepsy: a population-based analysis. Epilepsia. 2007;48(12):2336-2344.