I am writing this article as a reminder for my previous and future clients, with the goal of giving, with its help, a tool for self-understanding and primary self-diagnosis to people suffering from this illness. I also have the goal of explaining my complete inability to help a patient in the absence of his personal responsibility/understanding, as well as without the involvement of good doctors working with this problem. Only together, we can show a good result. At the same time, I do not diminish the merits psychotherapy. It is necessary and effective, in its area of ​​​​responsibility. And so. Epilepsy is a chronic disease of the brain, characterized by a persistent predisposition to epileptic seizures. An epileptic seizure is a transient clinical manifestation of pathological excessive or synchronous neural activity of the brain. The disease is chronic, manifested in the body’s predisposition to the sudden onset of convulsive seizures, and also accompanied by equivalents of mental seizures. Equivalents Mental (or epileptic) equivalents of seizures are substitute seizures of manifestations of disturbances in the mental activity of a patient with epilepsy, not accompanied by convulsions or falls, but certainly seasoned with amnesia. The reasons leading to the development of epilepsy are diverse. Hereditary factors, metabolic pathologies, traumatic brain lesions (including birth trauma), intoxication, and circulatory disorders (impaired blood supply to the brain) play a role in its origin. Thus, epilepsy is associated with a complex of endogenous (internal), exogenous (external) and organic factors, with the interaction of which epileptic disease develops. In approximately one third of cases, the cause of the disease remains unrecognized. In addition, epilepsy is also accompanied by many forms of epileptoid disorders, and their classification is very complex. In addition to a neurological disorder, the disease can be accompanied by psycho-emotional disorders, as well as personality changes, and in some the symptoms progress to mental epilepsy (or epileptic psychoses). Episodic mental disorders in epilepsy include twilight states and dysphoria. Twilight disorder of consciousness is a syndrome of stupefaction, arising suddenly and manifested by deep disorientation in the surrounding space with the preservation of habitual automated actions. Twilight states can occur at night during sleep. Dysphoria (from the Greek dys - disturbance, phoros - to bear) - suddenly developing attacks of irritability, dissatisfaction with others and with oneself; people in this state are capable of insults, sometimes cruel, aggressive actions; the basis is hypothymia, simultaneously combined with anger, anxiety and melancholy. Everything experienced during dysphoria is usually stored in memory, but is not perceived as a painful condition with inexplicable and unusual behavior. The duration of dysphoria is from several hours to several days. In addition to paroxysmal (sudden exacerbation of the disease) and episodic disorders in epilepsy, psychoses with a longer and more protracted course are observed. They can occur acutely after one or a series of seizures, but their onset can be gradual, not related in time to paroxysmal (suddenly occurring) disorders. But the first place is occupied by depressive states in epilepsy (at least 25-50%). Clinical manifestations of depression in epilepsy epilepsyThe development of depression in epilepsy is determined primarily by the presence of the disease itself. Epidemiological studies confirm a two-way relationship between epilepsy and depression. Of course, socio-demographic factors also contribute to the development of depression in people with epilepsy. Therefore, “learned helplessness” is identified as one of the psychological mechanisms for the development of depressive disorders , the essence of whichlies in the fear of losing family or work due to illness. It is also necessary to recognize the existence of iatrogenic factors that provoke the development of depression in patients with epilepsy. Iatrogenesis is persistent impairment of health, physical or mental, that occurs in a person due to treatment or careless comments doctor. This should be monitored by specialists whose tasks include creating the right mood for the patient and his relatives regarding the possibility of achieving control over attacks, developing compliance, preventing social maladaptation of the patient and preventing the formation of an atmosphere of hyperprotection around him. Compliance (from the English patient compliance) , adherence to treatment - the degree of compliance between the patient’s behavior and the recommendations received from the doctor. Much, naturally, depends on the effectiveness of treatment of the disease. Depression in epilepsy can simulate any of the emotional disorders included in the ICD10 classification. Depression in people with epilepsy often manifests itself as symptoms , which can be regarded both as side effects of AEDs and as manifestations of epilepsy, which makes diagnosis difficult. Symptoms can be detected before the onset of an attack (preictal period), as an expression of the attack itself (ictal symptoms), after an attack (postictal symptoms). The postictal period can last up to 120 hours after the attack. Most often, symptoms of depression can occur regardless of the attack (interictal symptoms). Symptoms of depression in the periictal period Preictal symptoms - symptoms usually appear as groups (clusters) of dysphoric symptoms. Their duration is about an hour, less often they appear 1-3 days before the onset of the attack. Hypotymia (ancient Greek ὑπο- “under-” + θυμός “mood, feeling”) is a persistent decrease in mood, which is accompanied by a decrease in the intensity of emotional, mental and, sometimes, motor (motor) activity. Ictal symptoms of depression appear during simple partial attack. It is known that mental symptoms appear in about 25% of auras, some of them (about 15%) contain in their structure symptoms of mood changes, in first place are symptoms of anxiety or fear, which are the most common types of ictal affect, in second place in Symptoms of depression are more common. Ictal symptoms of depression tend to be short in duration, stereotyped, develop out of context or situation, and are associated with other ictal phenomena. Feelings of anhedonia (inability to experience pleasure in anything), guilt, and suicidal ideation are the most common symptoms. As an attack progresses from simple partial to complex (with impaired consciousness), ictal symptoms of depression usually then give way to impaired consciousness. Postictal symptoms of depression The postictal period was defined as 72 hours after the return of consciousness after an attack or series of attacks. The main neurovegetative symptoms most often encountered in the postictal period are fatigue, changes in sleep patterns, appetite and sexuality), symptoms of depression. Postictal depression lasts several hours or days after the attack and is characterized by symptoms such as increased susceptibility to frustrating factors, anhedonia, a feeling of helplessness , irritability, feelings of inadequacy, guilt, crying spells and feelings of hopelessness. In some cases, suicidal thoughts and tendencies occur. In such patients, a history of major depression or bipolar disorder can be found. Anhedonia is a wide range of disturbances in hedonic function, including a decrease in motivation or the ability to experience pleasure. Frustration is a mental state that arises in a situation of real or perceived impossibility of satisfying certain needs, or , simply put, in a situation where desires do not correspond to available possibilities. Bipolar disorder -a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Symptoms of depression have a chronic course, interspersed with symptom-free periods lasting from several hours to several days. This manifestation of depressive episodes is most similar to dysthymia, “dysthymia-like disorder in epilepsy.” Dysthymia, or dysthymic disorder (from ancient Greek δυσθυμία - “despondency, depression, sadness”), is a chronic mood disorder. There are several pathogenetic mechanisms that contribute to the development of depression in epilepsy. These include the reactive process, iatrogenic factors, and seizure-related neurochemical, neurophysiological, and structural abnormalities. Reactive Process A psychophysiological response to the following factors may precipitate the development of depressive symptoms: Discrimination experienced by patients with epilepsy; rejection and poor adaptation to the diagnosis; unpredictability of the course of the disease and insufficient control caused by the unpredictability of the frequency of epileptic seizures; lack of social support; the need to change lifestyle, forced job change, etc. Iatrogenic processes Iatrogenic processes are often associated with symptoms of depression that are induced by antiepileptic drugs (AEDs), including those with psychotropic properties. There are known cases of symptoms of depression when taking phenobarbital, primidone, vigabatrin, felbamate, levetiracetam, topiramate. AEDs with mood-timing properties, such as carbamazepine and valproate, may also occasionally cause depressive episodes, although in fewer cases than other AEDs. Often depressive episodes follow the withdrawal of AEDs with normothimic properties, thus revealing hidden mood disorders that were relieved by these AEDs. Much evidence suggests that disturbances in the metabolism of serotonin, norepinephrine, dopamine, GABA and glutamate play a role in the pathogenesis of both epilepsy and depression. Such disorders are considered to be the main pathogenetic mechanism of emotional disorders, and are the basis for the development of the effect of antidepressants. Some personality disorders in epilepsy should also be considered as associated with cerebral circulatory disorders, which also contribute to the manifestations of convulsive syndrome. Based on the complex nature of the disease, such conditions require qualified assistance not only from a neurologist, but also from a psychiatrist and psychotherapist. Therapy of depression in epilepticsDepression, given the high the frequency of its occurrence in people with epilepsy requires increased attention from epileptologists. However, in most cases, the patient is left without an established diagnosis of depression, and, accordingly, without the necessary adjustment of treatment. The possibility of depression should be taken into account when prescribing anticonvulsants. In some cases, a correction of therapy will be required - adding antidepressants to the treatment, which can not only increase the effectiveness of therapy, but also improve the quality of life (including the social status of the patient with epilepsy in society). In my practice, in the topic "psychosomatics and clinical psychology" I work with the health disorders described above and have experience in accompanying people along the path of healing. I know that a person who wants healing and puts his efforts into it, walking hand in hand with a competent epileptologist, with the help of suitable psychotherapy, can restore his health and live a full life. Specialists treating epilepsy and depression associated with epilepsyEpilepsy is a kind of “bone of contention” ” between neurology and psychiatry. Treatment of epilepsy involves influencing the primary disease that was the cause, eliminating provoking factors, long-term use of AES (anti-epileptic drugs), correction of mental changes, psycho-emotional rehabilitation of patients. ForFor doctors, the main questions are the cause, diagnosis, treatment and prognosis of epilepsy. For the patients themselves and their relatives, it is important to be able to lead a normal lifestyle. Epileptologist An epileptologist is a neurologist or psychiatrist who, thanks to additional education, is involved in the diagnosis of epileptic seizures and paroxysmal disorders, treatment of epilepsy and rehabilitation of patients. A good practicing doctor has in-depth knowledge in the field of paroxysmal disorders disorders (diseases of the nervous system that are accompanied by seizures), electrophysiology, neuroimaging, pharmacology of antiepileptic drugs and genetics, as well as social rehabilitation of patients. Additional knowledge in these areas is necessary for differential diagnosis, determining the exact diagnosis and form of epilepsy, referral for examination for the purpose of correction therapy and treatment of patients with severe rare forms (a neurologist, as a general specialist, cannot always effectively solve these problems). If signs of a depressive disorder appear, it is important to inform the attending physician, who will optimize the treatment regimen for epilepsy and, possibly, introduce new drugs into it , will make additional referrals to specialists. If you suspect that your epilepsy medication is affecting your mood, talk to your doctor. The doctor may change the dose or prescribe a different drug. Unfortunately, there are many reasons for the underdiagnosis of mood disorders in epilepsy. One of them is the doctor's neglect of the symptoms that patients with depression may have. This is due to the fact that neurologists and epileptologists lack adequate training in psychiatry. Another reason is that depression in epilepsy has atypical clinical manifestations that cannot be classified as standard psychiatric diseases. Here a good psychiatrist can help us. To choose the most effective treatment, it may be necessary to consult with specialists: neurologist, psychiatrist, neurosurgeon, psychotherapistNeurologistNeurologist specializes in the treatment of diseases of the nervous system. Diagnosis and treatment of depression is carried out by specialists - neurologists, psychotherapists, psychiatristsNeurosurgeonNeurosurgeons can perform surgery according to indications and with the consent of the person. Psychiatrist Considering that individual symptoms of depression can be part of the epileptic attack itself, this type of symptoms does not require treatment with antidepressants. Those symptoms that occur in the patient during the interictal period persist for a long time and meet the criteria for depression of mild to moderate severity require the prescription of antidepressants. Patients with severe depressive disorders, with a history of suicidal thoughts and attempts, bipolar affective disorders, epileptic psychoses should be observed by a psychiatrist, not a neurologist. If necessary, a psychiatrist will help you choose an antidepressant. But it is not superfluous for the patient himself to know that: When prescribing an antidepressant to a patient with epilepsy, it is necessary to adhere to the following rules: low doses in the initial period of treatment, slowly increasing the dose to the target level, use of drugs with minimal proconvulsant effect. It is generally accepted that SSRIs are the drugs of choice for the treatment of depression in patients with epilepsy. SSRIs affect all symptoms of dysphoric epileptic disorder once a therapeutic dosage is reached. The advantages of SSRIs in epileptology provide the following characteristics: low proconvulsant effect; absence of fatal consequences of overdose; favorable tolerability profile; minimum pharmacokinetic interaction with anticonvulsants. In general, all SSRIs are reasonably safe for inducing seizures. However, fluoxetine should be used with caution, since its interaction with carbamazepine and diphenine changes its plasma concentration. Selective3