Stress, Anxiety and Epilepsy
It is widely accepted that we live in a stressful society. The pressures of financial survival, work, travel in crowded cities and meeting our responsibilities are just some of the stresses that everyone experiences in their daily life.
For people with epilepsy there may be additional stresses associated with their condition. These included the need to take medication regularly, uncertainty about when a seizure will occur, difficulties gaining a driver’s licence and dependency on others, to name just a few.
The effect of this stress, and the anxiety and emotion that accompany it, can trigger seizures. An Australian study found that 63 per cent of respondents believed there was a relationship between stress and seizure control.
Stress management cannot replace the use of anticonvulsant medication. However, together with regular medication, it can be one of the most effective approaches to reducing seizures and living well with epilepsy.
How stress develops and how it affects the body
Stress is a natural physical response by the body. It is believed to be associated with the primitive ‘flight or fight’ instinct. When confronted by a challenge, the body responds by releasing a hormone called adrenalin which gives extra strength to the muscles and sharpens our responses. This physical reaction is designed to provide a quick response to a challenging situation. The stress reaction can become a problem, however, if there are too many challenges to the body at any one time.
Just how much stress is too much varies for each individual. You can recognise when you have too much stress in your life by watching for certain changes in your behaviour. These changes might include missing meals, drinking too much alcohol or being unable to rest and relax.
Techniques that help to reduce stress
There is a wide range of techniques you can use to help manage and reduce stress. Some techniques are outlined below.
Relaxation and breathing:
These techniques involve focusing on your body and your breathing, consciously relaxing your muscles, deepening your breathing and allowing your thoughts to flow without attempting to control them.
Meditation:
Meditation emphasises relaxing the mind, techniques such as observing thoughts and emotions, and focusing on your breathing.
Exercise:
Regular exercise helps keep you fit and can induce better sleep and a healthy appetite. It often contributes to a sense of well-being, by providing a break from day-to-day worries, and gives a sense of control and achievement.
Gentle movement – such as simple stretching, rocking, and moving hands and arms – can relax and calm the body.
Time management:
This approach addresses excessive demands within work and personal time. It involves techniques such as establishing priorities, using lists, notes and a diary, taking time for yourself and rewarding yourself for a job well done.
Assertiveness training:
Assertiveness is an approach that helps you better communicate your feelings and needs, without aggression, in both personal and professional areas of your life. This technique also emphasises the importance of listening to and respecting the other person or people in the discussion.
Improving self-esteem:
By becoming aware of the power of your own thoughts in creating your self-image, this technique builds up positive thought and reduces negative ones. It involves actively learning about yourself and taking more control of your life.
Anxiety management:
Anticipating problems also causes stress. A range of approaches can help to diminish anxiety. These include identifying your fears and learning to take control of your life, to name just two.
An anxiety disorder is characterized by constant feelings of worry, nervousness or intermittent panic attacks. People with anxiety disorders may feel “on edge”. There are different types of anxiety disorders including:
- Generalized Anxiety Disorder
- Panic Disorder
- Post Traumatic Stress Disorder
- Obsessive Compulsive Disorder
Anxiety disorders are common in the general population and are more common among people with epilepsy. We all experience feelings of anxiety and nervousness. Anxiety becomes a disorder when the feelings are frequent or intense, are produced by trivial things or nothing at all, and interfere with our functioning.
What causes anxiety?
As with depression, several factors can be part of the cause of anxiety disorders including psychological stress related to the epilepsy, medication effects, associated neurological or psychiatric disorders, and the epilepsy itself.
How is an anxiety disorder treated?
Anxiety disorders can be effectively treated with counseling, therapy, and medications. A newer medication to treat anxiety, buspirone (Buspar), is safe for almost all patients with epilepsy and anxiety. The SSRIs also can be helpful in treating anxiety. The benzodiazepines are very effective in the short-term treatment of anxiety and insomnia, but they should be avoided if possible because they are among the most habit-forming (addictive) drugs legally available. They include:
- clobazam (Frisium; not available in the US)
- clonazepam (Klonopin)
- diazepam (Valium)
- alprazolam (Xanax)
- chlordiazepoxide (Librium)
- clorazepate (Tranxene)
- estazolam (Prosom)
- lorazepam (Ativan)
- triazolam (Halcion)
These drugs also may temporarily reduce seizure frequency and intensity but after someone takes the same dose for a period of weeks, the effect on anxiety, insomnia, and seizure control diminishes. As the original anxiety or seizures return, there is a strong tendency for the patient and doctor to increase the dose, which again briefly reduces troublesome symptoms. This cycle leads to a buildup of the dose to levels that can cause memory impairment, depression, tiredness, and other problems. If the dose is then reduced, the real trouble begins: anxiety, insomnia, and seizures become more severe.
When anxiety is severe, other more powerful drugs such as the antipsychotic drugs may be used.