Pregnant women with epilepsy showed more symptoms of anxiety and depression than healthy pregnant or non-pregnant women, but mental health screening may help.
Women with epilepsy experience more symptoms of depression and anxiety during pregnancy and postpartum than women who are neither epileptic nor pregnant, according to a study published in Neurology.1
“The good news is we did not find that pregnant women with epilepsy were any more likely to have episodes of major depression than the other two groups,” said study author Kimford J. Meador, MD, Stanford University School of Medicine, and a Fellow of the American Academy of Neurology, in a press release.1
Before the mid-20th century, women with epilepsy were cautioned against becoming pregnant. Current research suggests that it is possible to have a safe pregnancy if the right measures and proper doses of medications are administered.2
But researchers also know that the risk of depression is greater among individuals who suffer from epilepsy—and those with depression have more risk of epilepsy due to abnormal brain networks. Pregnancy and postpartum also increase anxiety, which guided the researchers to better understand how pregnancy, epilepsy, and mood disorders interact.2
Stanford researchers recruited 331 pregnant women with epilepsy, following them during and 9 months after birth. They also studied 102 healthy pregnant women and 102 non-pregnant women with epilepsy as controls.2
The participants answered questions about symptoms of depression and anxiety during each trimester, at time of delivery, and 1 time every 3 months for 9 months postpartum.1 The non-pregnant control group simply visited the clinic every 3 months to answer questions.2 Researchers screened participants for depression, anxiety, or any other psychiatric disorder.
Some of the questions related to socioeconomic status, age, marital status, education, previously diagnosed mood or anxiety disorder, and medications like antidepressants or anti-seizure medications.2
The results suggest that pregnant women with epilepsy had worse depression symptoms compared to non-pregnant epileptic women. Compared to this same control group, the pregnant epileptic group fared worse with postpartum depression symptoms; however, neither group of women had worse major depression.2
Pregnant women with epilepsy did have factors associated with major depression. They included having more than 1 seizure in the past 3 months, taking multiple epilepsy drugs, having an unplanned pregnancy, or having a history of mood disorders.1
At every point in the study, the pregnant and epileptic women also had worse symptoms of anxiety.2 Their anxiety was higher after postpartum, but both pregnant women with epilepsy and healthy pregnant women had less anxiety postpartum.2
Meader said that “these results underscore the importance of regularly screening pregnant women with epilepsy for any signs of depression or anxiety and providing effective treatment.”
The study was limited by it’s small size and long follow-up periods, but the researchers concluded that it provided an accurate evaluation of epilepsy, pregnancy, and mood disorders.1
“Depression is often underrecognized in people with epilepsy, yet we know that effective management of depression can improve people’s quality of life and their overall outcomes for epilepsy treatment, so women with epilepsy should be monitored closely during pregnancy and evaluated when they are thinking about planning a pregnancy,” Meador said.1
Because anti-seizure drugs are metabolized faster during pregnancy,they become less effective, requiring different dosing adjustments. Working with a health care provider to adjust for this could prevent breakthrough seizures and possibly protect mental health outcomes by reducing the risk of major depression.2
“With good health care, the large majority [of women with epilepsy] will have a normal pregnancy and a normal child,” Meader concluded in the press release.2